Abstract

Xanthomas are lesion present in lipoprotein metabolism disorder which are a reactive histiocytic proliferation in response to altered lipid level. These develop usually in  skin,  subcutis  but  may  also   develop  in deep soft tissue as tendon, ligaments, synovium, periosteum. Tendinous and Tuberous Xanthomas co-existence of both form of atypical large sized Xanthomas in same patient are rare. Herein, we present a case Tendinous and Tuberous Xanthomas diagnosed on FNAC. This case is being reported to emphasize the challenge faced while on FNAC, also of the previous reports have not mentioned the role of cytology in diagnosing these lesions. A 48 years old male presented with large masses in his right feet and right chest which were circumscribed on the extension tendon sheet of the first toe of right feet. The swellings measured 10 x 7cm and 5 x 3cm  in dimensions, painless, firm, non-tendon slowly growing. The patient’s lipid profile showed hypercholesterolemia. FNA had appearance with foamy histocytes, giant cells,Touton giant cells, few inflammatory cells. Histological analysis of the surgical specimens confirmed diagnosis of Tendinous and  Tuberous  Xanthomas.Xanthomas  cells or foamy histocytes usually have only one nucleus, although they have several. In Touton giant cells (multinucleated Xanthomas cells) – specific cytological  features  of  the Xanthomas – either the nucleuses are irregularly distributed as in foreign body giant cells or lie near the center of the cell grouped around a small island of non- foamy cytoplasm and are surrounded by foamy cytoplasm. In older lesions, fibroblasts appear, ultimately collagen bundles replace many of the foamy cells. Tendinous and Tuberous Xanthomas may present as a diagnostic challenge on FNAC due to several reasons such as low  yield, lack of experience. Clinical and laboratory data are important in differential diagnosis of Xanthoma. FNA can be a useful took for the diagnosis of Xanthoma.