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      A case of intramuscular xanthelasma palpebrarum found during blepharoplasty

      case-report

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          Abstract

          Xanthelasma palpebrarum is the most common cutaneous xanthoma found on the medial side of the eyelid. The typical lesion is usually a flat and yellowish plaque on the skin. However, we report on a unique case of intramuscular xanthoma found during blepharoplasty for the correction of ptosis. A 53-year-old male patient visited our department with a complaint of a ptotic eyelid. He was concerned about the cosmetic appearance and the uncomfortable feeling while opening his eyes, and wanted these problems to be solved. A yellowish plaque of about 0.3 × 0.3 cm in size was found in the orbicularis oculi muscle during the surgery. The lesion was excised and xanthelasma was confirmed with biopsy. We have found this specific case of xanthelasma palpebrarum in the only muscle. Therefore, a careful approach to clinical and histologic examination and imaging is required for patients with these lesions.

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          Pathogenesis and treatment of xanthomatosis associated with monoclonal gammopathy.

          Kristen L Karlin, Florence Cordoliani, S Harel … (2011)
          Xanthomas are a common manifestation of lipid metabolism disorders. They include hyperlipemic xanthoma, normolipemic xanthoma, and a related condition, necrobiotic xanthogranuloma (NXG). All 3 forms can be associated with monoclonal immunoglobulin (MIg). In an attempt to improve diagnosis, understanding, and treatment of this association, we retrospectively analyzed a personal series of 24 patients (2 hyperlipemic xanthoma, 11 normolipemic xanthoma, and 11 NXG) and 230 well-documented reports from the literature. With the exception of the nodules and plaques featured in NXG, the clinical presentation of xanthomatous lesions usually resembled that seen in common hyperlipidemic forms and could not be used to suspect MIg-associated xanthomas. Extracutaneous sites were not rare. The MIg was an IgG in 80% of cases. Myeloma was diagnosed in 35%. Hypocomplementemia with low C4 fraction was present in 80% of studied patients. Low C1 inhibitor serum levels were found in 53%. Cryoglobulinemia was detected in 27%. These abnormalities suggest immune complex formation because of interactions between the MIg and lipoproteins and argue in favor of a causal link between MIg and xanthomas. Monoclonal gammopathy therapy could thus be an option. Indeed, among the patients who received chemotherapy, hematologic remission was accompanied by improvement in xanthoma lesions in several cases.
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            The pathogenesis and clinical significance of xanthelasma palpebrarum.

            Reuven Bergman (1994)
            Xanthelasma palpebrarum is the most common type of xanthoma. On average, only half the patients with xanthelasma palpebrarum are hyperlipidemic. This review is an attempt to elucidate the pathogenesis and clinical significance of xanthelasma palpebrarum, especially its suggested role as a marker for increased risk for atherosclerosis. In hyperlipidemic patients with xanthelasma, the risk for atherosclerosis may be inferred from the associated lipoprotein and apolipoprotein abnormalities. The possible risk for atherosclerosis in normolipidemic patients with xanthelasma is more obscure because of the relative paucity of epidemiologic data and the conflicting results in some of the lipid studies. Several studies, however, showed decreased high-density lipoprotein cholesterol levels and other lipoprotein and apolipoprotein abnormalities that are associated with atherosclerosis. Therefore, on the basis of the present data, determining the plasma lipoprotein and apolipoprotein levels (especially those associated with increased risk for atherosclerosis) in each normolipidemic patient with xanthelasma appears to be justified.
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              Xanthelasma palpebrarum: a review and current management principles.

              Jeffrey E. Janis, Rod J Rohrich, Patrick H Pownell (2002)
              After studying this article, the participant should be able to: 1. Describe the differential diagnosis of xanthelasma palpebrarum. 2. Discuss the various nonsurgical and surgical treatment options and their advantages and disadvantages. 3. Describe the circumstances in which recurrence is most likely after treatment. Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis can often be made on clinical grounds alone. For the plastic surgeon, it is important to apply an algorithmic approach to the treatment of these lesions. Depending on the size and location, several different methods can be used to address this problem, ranging from simple excision, to laser treatment, to chemical peeling. This article addresses the underlying pathophysiology of xanthelasma and the currently accepted modes of treatment.
              Article 0 comments Cited 14 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Craniofac Surg
                Journal ID (iso-abbrev): Arch Craniofac Surg
                Journal ID (publisher-id): ACFS
                Title: Archives of Craniofacial Surgery
                Publisher: Korean Cleft Palate-Craniofacial Association
                ISSN (Print): 2287-1152
                ISSN (Electronic): 2287-5603
                Publication date (Print): December 2018
                Publication date (Electronic): 27 December 2018
                Volume: 19
                Issue: 4
                Pages: 296-299
                Affiliations
                [1 ]Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Korea
                [2 ]Department of Plastic Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
                [3 ]Department of Radiology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
                Author notes
                Correspondence: Sang Yoon Kang Department of Plastic Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea E-mail: nuelk@ 123456nate.com
                [*]

                This article was presented at the Aesthetic Plastic Surgery International Meeting 2016, in Seoul, Korea on March 12–13, 2016.

                Author information
                http://orcid.org/0000-0001-8032-036X
                http://orcid.org/0000-0002-6299-6371
                http://orcid.org/0000-0001-6450-2278
                Article
                Publisher ID: acfs-2018-02068
                DOI: 10.7181/acfs.2018.02068
                PMC ID: 6325326
                PubMed ID: 30613094
                SO-VID: 6c918aaf-0797-437d-9056-3802ed490f9b
                Copyright © Copyright © 2018 The Korean Cleft Palate-Craniofacial Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 9 August 2018
                Date revision received : 23 October 2018
                Date accepted : 24 October 2018
                Categories
                Subject: Case Report

                Keywords: muscles,xanthomatosis,eyelids
                Data availability:
                Keywords: muscles, xanthomatosis, eyelids

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