q#15 - drtaher

[ArchivalUser]

A 60-year-old man presents to his physician after a routine screening test indicates hyperlipidemia.
Physical examination reveals raised, irregular, yellow papules in the skin of the soft tissues
below the eyes. Biopsy of these lesions would most likely show which of the following?
A. Benign nevus cells
B. Malignant nevus cells
C. Microscopic blisters
D. Munro microabscesses
E. Multinucleated giant cells

[ArchivalUser]

e..

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

e....

[ArchivalUser]

hi taher

[ArchivalUser]

The correct answer is E. The lesions are xanthomas, which are tumor-like dermal collections of
foamy histiocytes containing cholesterol and lipids. The lesions may also contain
multinucleated giant cells (Touton giant cells) with clustered nuclei and foamy cytoplasm.
Xanthomas may be idiopathic or may be related to hyperlipidemia or lymphoproliferative
malignancies (e.g., leukemias and lymphomas).
Nevus cells are a type of melanocyte. Benign nevus cells (choice A) are a feature of the common
nevus, or mole. Malignant nevus cells (choice B) are a feature of malignant melanoma.
Microscopic blisters (choice C) at the dermal/epidermal junction are a feature of dermatitis
herpetiformis.
Munro microabscesses (choice D), small collections of neutrophils in the cornified epidermis,
occur in psoriasis.