Pleomorphic cutaneous xanthomas disclosing homozygous familial hypercholesterolemia

Figure 1 Histopathological examination. A: Foam cells infiltrate the superficial and deep dermis in cluster, separated by collagen fibers. Absence of any other significant inflammatory infiltrate (10 ×, EE); B: Xanthoma cells are filled with optically empty vacuoles, showing thin, well defined cytoplasmic membranes, and tend to be attached to each other. They can be multinucleate (20 ×, EE); C: Presence in the dermis of cholesterol crystalline aggregates surrounded by fibrosis and foamy cells (10 ×, EE).