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June 1999

Red Eroded Nodule on the Foot

Arch Dermatol. 1999;135(6):707-a-712. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-6-dof0699

The biopsy specimen showed a well-defined intradermal nodule with overlying hyperkeratosis and irregular acanthosis. The cellular infiltrate consisted of closely packed histiocytes with sparse lipidization but numerous Touton-type giant cells. Also present were many small vessels and areas of hemorrhage. Polariscopic examination revealed no abnormalities, and special stains were negative for organisms.

Juvenile XGs (JXGs), or "congenital xanthoma multiplex" as first described by Adamson1 in 1905, are single or multiple cutaneous lesions that occur in infants and show spontaneous resolution.2 Since Helwig and Hackney's3 work showing the fibrohistiocytic nature of the tumor, the term JXG has been used. In 1963, Gartmann and Tritsch4 described XG in adults, which was histologically indistinguishable from JXG. Such lesions usually occur during the late teens to late 30s.5 Several cases of yellow to tan, papulonodular tumors have been reported in adults on the scalp, face, oral cavity, trunk, axilla, antecubital fossa, anogenital region, and lower extremities.2,5,6 Previous clinical descriptions of acral XG include extensive palmar nodular swelling7 and a dystrophic toenail with an underlying yellow tumor8 in infants and tumors of the fingers in adults.2,5,6 An XG was not considered in our patient because of its unusual location and red, moist appearance.

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