Xanthogranuloma of the Eyelid: A Case Report

Abstract

We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and debulking surgical intervention and surveillance for hematologic malignancy. This 56-year-old patient presented with a six-year history of enlarging masses and swelling around her eyes, with intermittent inflammation, associated pain, and occasional redness. Her past medical history was remarkable for asthma and nasal polyps. Upon external examination, she had severe fullness of the upper lids with yellow plaques and palpable masses along them, nontender palpation, the absence of visible erythema, and blepharoptosis in both eyes. The patient presented with bilateral visual field constriction due to mechanical obstruction. An orbital computed tomography scan revealed a dense diffuse lesion involving the pre- and postseptal tissues and invading the orbit of the right eye. A facial magnetic resonance imaging scan revealed infiltration of the postseptal spaces within both orbits. A skin and soft tissue biopsy from the bilateral periorbital regions of both eyes confirmed the diagnosis of NBX. A workup for underlying hematologic malignancies, including plasma cell dyscrasias and lymphoproliferative disorders, was unremarkable. The patient underwent diagnostic and debulking surgery in an attempt to improve her visual function. Subsequently, she was scheduled for ongoing monitoring of her disease progression.

Keywords: nasal polyps; necrobiotic xanthogranuloma; orbital mass; surgical intervention; yellow plaques.

Figure 1. (A) The anterior view and (B) lateral view show fullness in both eyes and upper eyelids, accompanied by yellow pigmentation.

Figure 2. Bilateral visual field upon presentation (Humphrey, Central 30-2 threshold test, stimulus III, white, Swedish Interactive Threshold Algorithm-Fast).

(A) Right and (B) left visual fields reveal superior field defect (arrows) due to bilateral mechanical ptosis.

Figure 3. Orbital computed tomography and magnetic resonance imaging of the patient.

(A) Orbital computed tomography reveals that the preseptal space was completely infiltrated by the lesion. (B) Magnetic resonance imaging confirms the infiltration of the postseptal spaces within both orbits.

Figure 4. Histopathology of the periorbital mass.

(A) Normal epidermis and underlying broad zones of altered collagen (necrobiosis) (H&E stain, 1×). (B) Altered collagen (necrobiosis) surrounded by a mixed inflammatory cellular infiltrate (H&E stain, 20×). (C and D) Numerous foamy macrophages and giant cells are at the border of a zone of altered collagen (H&E stain, 40×). H&E, hematoxylin and eosin