title: Necrobiotic xanthogranuloma with paraproteinemia; an atypical case.
abstract: Necrobiotic xanthogranuloma (NXG) is a rare marker for paraproteinemia. An 86-year-old woman had a one year history of large red-yellow to brown annular plaques involving all limbs. Biopsies showed a non-palisading granuloma with numerous multinucleated giant cells showing prominent elastophagocytosis and extensive areas of necrobiosis throughout the entire dermis. Complete loss of elastic fibers was observed in the central atrophic area of an annular plaque. Small vascular thromboses were also present. Laboratory findings revealed paraproteinemia of IgG-lambda type. Immunohistochemical staining detected the presence of roughly equal numbers of IgG-lambda-and IgG-kappa-staining plasma cells in the dermis. We diagnosed NXG with paraproteinemia with monoclonal gammopathy (IgG-lambda type) of unknown significance.
authors.affiliation: Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ito
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nishimura
authors.forename: Kei-Ichi
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Arata
authors.initials: A
authors.lastname: Hakamada
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Isoda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kurokawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Mizutani
mesh_terms: D000369:Aged, 80 and over; D005121:Extremities / Q000473:pathology*; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000473:pathology*; D006801:Humans; D017441:Necrobiotic Disorders / Q000150:complications* / Q000473:pathology*; D010265:Paraproteinemias / Q000150:complications* / Q000473:pathology*