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      Tratamiento del xantogranuloma palpebral en el adulto mediante colgajos en isla del área zigomática Translated title: Treatment of adult eyebrow xanthogranuloma with a zygomatic island flap

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          Abstract

          El término Xantoma, introducido por Frank Smith en 1869, significa tumor amarillo. El Xantogranuloma en el adulto es una afección cutánea inusual, de localización única, sin afectación visceral y que no remite espontáneamente. La afectación palpebral representa el 25% de los casos y en la mayoría de los casos suele ser un nódulo solitario. Presentamos el caso de un paciente varón de 58 años que acude a nuestro Servicio de Cirugía Plástica por presentar extensas lesiones palpebrales nodulares y bilaterales, de crecimiento lento y coloración amarillenta. Las lesiones fueron diagnosticadas histopatológicamente como xantogranulomas. El defecto palpebral fue reparado mediante un colgajo en isla del área zigomática, descrito por Heywood en 1991, modificado en su diseño original. Nuestro objetivo es describir el Xantogranuloma en el adulto por tratarse de una patología poco frecuente, sus características histológicas y sus posibles diagnósticos diferenciales. Destacamos la utilidad y versatilidad del colgajo zigomático ampliado como una excelente alternativa para la reparación de amplios defectos cutáneos palpebrales inferiores.

          Translated abstract

          The term anthoma, meaning yellow tumor, was introduced by Frank Smith in 1869. Xanthogranuloma in adults is an unusual single-site, cutaneous tumor, with no visceral involvement and without spontaneous regress. Palpebral xanthomas account for 25% of all cases, most of which usually involve a solitary nodule. We present a 58-year-old man who was referred to our Plastic Surgery Service with large, yellowish, slow-growing, bilateral palpebral lesions. The histological diagnosis was xanthogranuloma. The palpebral defect was repaired using an island flap from the zygomatic area, described by Heywood in 1991 and modified from the original design. We describe adult xanthogranulomas, which are unusual lesions, and discuss the histological study and differential diagnosis. We also draw atention to the usefulness and versatility of the extended zygomatic flap as an excellent alternative for the repair of large lower palpebral cutaneous defects.

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          Most cited references13

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          Juvenile xanthogranuloma.

          Juvenile xanthogranuloma (JXG) is a benign, self-healing disorder characterized by solitary or multiple yellow-red nodules on the skin and, occasionally, in other organs. It is predominantly a disease of infancy or early childhood, although adults may also be affected. Histologically, JXG represents an accumulation of histiocytes lacking Birbeck granules (non-Langerhans cells), which can be differentiated from Langerhans cells by specific staining techniques. Affected persons have normal lipid metabolism. JXG is therefore classified as a normolipemic non-Langerhans cell histiocytosis. The patient's general health is not impaired and, in the absence of associated conditions, the prognosis is excellent. Diagnosis is readily made in typical cases, but may be more difficult in unusual variants.
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            Juvenile xanthogranuloma: a clinical, histopathologic and immunohistochemical study.

            Juvenile xanthogranuloma (JXG) is a benign histiocytic proliferation of uncertain histogenesis which usually resolves spontaneously. Histopathologically, classic lesions are characterized by diffuse proliferations of foamy histiocytes, many of which may be multinucleated (Touton cells), admixed with lymphocytes and eosinophils. Histologic variants of JXG, perhaps representing evolving lesions, may lack these typical histopathological features, showing diffuse infiltrates of non-foamy mononuclear histiocytes without Touton cells, posing problems in differentiation from other histiocytic or melanocytic proliferations. Immunohistochemically, JXG is characterized by variable expressions of several histiocytic markers as well as the absence of staining for S100 protein. To assess better the spectrum of histopathological and immunohistochemical features of JXG, we studied nine cases of classic or histologic variant of JXG. The cases were evaluated by light microscopy and with an extensive battery of antibodies. All 9 cases, regardless of their light microscopic appearance, showed markedly positive staining with histiocytic markers including CD68, HAM56, cathepsin B and vimentin, but did not stain for S100 protein. Antibodies to factor XIIIa stained positively in 8 cases while staining for other markers was variable. Our results suggest that the histiocytes in JXG lesions have macrophagic differentiation, probably representing a reactive process to an unknown stimulus.
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              Juvenile xanthogranuloma of the eyelid in an adult.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                June 2009
                : 35
                : 2
                : 149-154
                Affiliations
                [02] Málaga orgnameHospital Universitario Carlos Haya orgdiv1Servicio de Cirugía Plástica y Quemados España
                [04] Málaga orgnameHospital Universitario Carlos Haya orgdiv1Servicio de Anatomía Patológica España
                [01] Cádiz orgnameHospital Universitario Puerta del mar orgdiv1Servicio de Cirugía Plástica y Reparadora España
                [03] Santander orgnameHospital Ramón Negrete orgdiv1Servicio de Cirugía Plástica y Reparadora España
                Article
                S0376-78922009000200010
                10.4321/s0376-78922009000200010
                494694ef-2f44-418c-a510-cc87a7c18716

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 6
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                SciELO Spain


                Xantogranuloma juvenil,Colgajo zigomático,Juvenile Xanthogranuloma,Zigomatic,Flaps

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