A 42-year-old man made a complaint of restriction of motion particularly in the 4th and 5th fingers of his left hand. He had never been examined before because the restriction of motion had only arisen in the past month. The painless masses were growing slowly and were causing dysfunction of the affected joints. Although all of the MCP joints were covered with these solid and painless masses (), only the 4th and 5th MCP joints exhibited extension loss (20 and 30 degrees, resp., in the left hand). The neurovascular examination was intact. The patient has bilateral arcus cornea, which may be an indication of hypercholesterolemia (). The patient's serum cholesterol level was above normal, and he has a positive family history of early death due to myocardial infarction. There were no abnormal findings observed in the plain X-rays; however, multiple solid masses that were engaged to the extensor tendons were detected in the superficial ultrasound (USG). The severity of engagement was remarkable at the level of the MCP joints of the 4th and 5th fingers. Regarding our findings and the clinical progression, the patient underwent an open excisional biopsy and tenolysis of the extensor tendon at the 4th and 5th MCP joints.\nUnder local anesthesia and tourniquet control, a “V-shaped” excision was used to explore the masses over the extensor side of the 4th and 5th MCP joints. After the retraction of the subcutaneous tissue, 2 × 2 cm and 3 × 2 cm, solid, yellowish masses were detected over the extensor side of the 4th and 5th MCP joints, respectively (). Peritendinous fibrosis were observed as these masses infiltrated the extensor tendons thus restricting the gliding of the tendons. All masses were meticulously dissected from the tendon with devoted attention to maintain the continuity of the tendon by preserving the paratenon. The full range of motion was achieved after excision of the masses and the wound was sutured. Immediate active and passive ranges of motion exercises were started to avoid stiffness. Although the literature mentions wound complications, no issue with wound healing was encountered [].\nA biopsy specimen showed xanthoma cells dispersed between the collagen fibers of the tendon (). After thirty months followup, no recurrence or complications were detected in regard to maintaining a full range of motion of the affected joints.
A 62-year-old man was admitted to our department due to a gradually evolving disseminated papulonodular eruption on face, flexors, and trunk for 30 years ago. On examination, multiple, well-defined, yellowish brown papules and nodules and tumor-like lesions were seen symmetrically on upper and lower eyelids (). Such papules also were observed on the cheeks and perioral region. On the anterior of the neck the lesions were confluent and formed a diffused plaque ().\nHundreds of red to brown papules were distributed symmetrically on axilla, genitalia, poplitea, and trunk, some of which are confluent together and formed plaque or tumor-like lesions (Figures and ). There were also some papule and nodules on nasal mucosa ().\nHe had no history of polyuria or any previous medical history.\nAnalysis at that point did not reveal any abnormalities in urine osmolality. Laboratory findings revealed a white blood cell count of 10,300 cells/mL containing 74% neutrophils. C-reactive protein was 7 mg/dL (normal values of 0.5 mg/dL).\nFasting cholesterol was 148 (normal values up to 200) and triglyceride was 141 (normal values up to 150).\nChest X-ray was normal.\nMagnetic resonance imaging of the brain and pituitary revealed no abnormalities.\nHistopathologic examination of skin biopsies showed a dense dermal diffuse histiocytic infiltration interspersed with mixed inflammatory cells and giant cells (Figures and ). Abundant foam cells were also seen (). A neural infiltration was not present. Immunohistochemistry was positive for CD68 (KP1) () and negative for S-100 protein.