We report the case of a 51-year-old male smoker with diabetes mellitus and hyperlipidaemia and a long history of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) infection treated with various antiretroviral regimes, who was referred to the otolaryngology department with progressive dysphonia. Fibre-optic laryngoscopy showed a solitary, yellowish-white pedunculated polyp on the anterior third of the left cord, with no other abnormality. Pathological analysis revealed a polypoid laryngeal xanthoma that was immunoreactive against CD68, perilipin, and adipophilin. This unusual laryngeal lesion in the clinical context of our patient suggests a possible role of antiretroviral treatment in the pathogenesis of these xanthomas.
An xanthoma is a localised collection of fat-laden histiocytes that is not considered a true tumour but rather a reactive histiocytic proliferation [
Mucosal xanthomas are uncommon [
A 51-year-old male smoker (1 pack/day for 35 years) was referred to the otolaryngology department with progressive dysphonia of 3-week duration. The dysphonia was intermittent initially and later became almost constant.
The medical history included an HIV-1 infection, diagnosed 25 years earlier and controlled with various antiretroviral drugs in the infectious diseases unit, with an acceptable current immunovirological status (CD4 529 cells/
Fibre-optic laryngoscopy showed a solitary, yellowish-white, pedunculated polyp on the anterior third of the left cord, with no abnormalities elsewhere in the larynx. The lesion was easily resected from adjacent tissue via endolaryngeal microsurgery.
Histological examination of the resected specimen showed a laryngeal polyp that was composed internally of medium-to-large islets of foamy macrophages under a squamous epithelium, with small nuclei and without atypia, showing a degree of only superficial orthokeratinisation. There was no inflammatory component within the polyp but abundant vascularisation interspersed with islets of foam cells. The foam cells were negative for periodic acid-Schiff (PAS) and showed no granular character (Figures
Panoramic histological view of the laryngeal polypoid lesion (1a) (H-E, 15x). Frequent islets of clear foam cells with congestive vessels are seen below a laryngeal squamous epithelium without atypia (1b) (H-E, 100x). At higher magnifications, the foam cells have a xanthomatous appearance (1c) (H-E, 250x) and are negative for PAS (1d) (PAS, 400x). Immunohistochemical staining shows intense cytoplasmic reactivity in the foam cells against CD68 (ie) (CD68, 250x) and adipophilin (1f) (adipophilin, 250x).
Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded sections using the antibodies listed in Table
Antibodies used in the immunohistochemical study.
Antibody specificity | Clone | Dilution | Source |
---|---|---|---|
AE-1-3 | AE1/AE3 | 1/50 | Dakopatts, Glostrup, DK |
P-S-100 | Polyclonal | RtU | Dakopatts, Glostrup, DK |
CD68 | KP1 | RtU | Dakopatts, Glostrup, DK |
CD1a | 010 | 1/50 | Dakopatts, Glostrup, DK |
Perilipin | PERI 112.17 | RtU | PROGEN Biotechnik, Heidelberg, DE |
Adipophilin | AP 125 | RtU | PROGEN Biotechnik, Heidelberg, DE |
RtU: ready to use with Envision Flex+.
An xanthoma is defined as an aggregate of lipid-laden histiocytes. They are generally present in the skin and subcutis but can occasionally involve deep soft tissues (tendons or synovium) [
Cutaneous xanthomas are classified, according to their gross appearance and clinical presentation, as eruptive, planar, tuberous, or tendinous [
Noncutaneous xanthomas are infrequent and exceptional in the larynx, with only eight cases reported [
Cutaneous xanthomas usually present few problems in diagnosis and management. Given their nonneoplastic nature, conservative, medical therapy is generally recommended [
The clinical context of our patient, with a long history of treatment with various antiretroviral regimes, provides a hypothesis of the pathogenesis of the polypoid laryngeal xanthoma. At the time of diagnosis, the patient was a diabetic on insulin and had marked hyperlipidaemia, which were attributed to long-term antiretroviral combination therapy [
Francisco Vera-Sempre hereby declares that neither he nor any coauthor of this paper has a financial relationship or interest (currently or within the past 5 years) with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients or any medical product mentioned in the paper.