This 25-year-old mentally retarded man developed multiple asymptomatic swellings of the feet, ankles, and elbows. Panel A shows lesions on the Achilles tendons, knees and elbows. There was a family history of hypercholesterolemia but no one with similar skin lesions. His cholesterol level was 350mg/dl, and there were no underlying medical disorders that would predispose him to the development of elevated cholesterol. Biopsy from a nodule on the arm showed the features of xanthoma with large clear foamy cells arranged in sheets and clusters (Panels-C&D). There were no signs of nuclear atypia.There were a few giant cells and many cholesterol clefts (Panel-B). In some areas thick bundles of fibrocollagenous tissue was seen traversing the lesion. Oil red-O on frozen sections demonstrated lipid droplets in the cytoplasm of foam cells.
multiple, symmetric, acral discrete and confluent 3-5 cm brownish-yellow subcutaneous and dermal nodules and plaques