Primary Xanthoma of the Mandible: Report of a Rare Case

Abstract

Xanthoma is a lesion most commonly seen in soft tissues such as the skin, subcutis, or tendon sheaths. Xanthoma formation is often associated with primary or secondary hyperlipidemia. Primary bone xanthomas are extremely rare benign bone lesions not associated with hyperlipidemia, histopathologically characterized by histiocytes, abundant lipid containing macrophages (foam cells), and multinucleated giant cells. Cholesterol clefts can be found in the medullary bone. Less than ten cases of xanthoma in the mandible have been reported. We present a rare primary intrabony xanthoma in a normolipidemic patient.

Keywords: Foamy histiocytes; Intraosseous xanthoma; Mandible; Non-Langerhans histiocytic process; Xanthoma.

Fig. 1

Panoramic radiograph on presentation. Note the positioning error, depicted by larger teeth on the left side

Fig. 2

CBCT on presentation. Axial (a), coronal (b), and 3D reconstruction (c) views

Fig. 3

Photomicrographs. Low power (×10) H + E stain showing histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of significant inflammatory infiltrate

Fig. 4

High magnification (×40) H + E stain demonstrating the abundance of foamy histiocytes

Fig. 5

Xanthoma cells exhibiting strong positive CD68 staining

Fig. 6

Panoramic radiograph at 6 month follow-up