Xanthoma of the Breast

In a series of nine hundred (circa) tumors of the breast in which the preoperative diagnosis was carcinoma, histologic examination showed that in three instances the lesion was a xanthoma. Although the diagnostic error in reference to xanthoma was, therefore, small, the rarity of these tumors and their relation to abnormal lipoid metabolism prompts a discussion of them, as well as of the xanthomatous degenerative processes occurring secondarily in inflammations and in true neoplasms in the breast. Xanthomas are apparently not true neoplasms. A neoplasm has been defined as a more or less circumscribed collection of cells arising wholly independently of the rest of the body, in general growing progressively, and serving no useful purpose in the organism. Xanthomas violate the second premise in the definition, for they have been shown by blood chemistry determinations to be related to an abnormal lipoid metabolism. Before the development of the modern quantitative methods of blood chemistry which enabled this factor to be proved, there were well known clinical findings which suggested it. Xanthomas were known to be most frequent in elderly individuals with diseases of the liver, particularly those complicated by icterus, with nephritis, and with diabetes. Hutchinson, Sangster and Crocker, for instance, found that four-fifths of the 28 cases of xanthoma multiplex which they collected in 1882 were associated with chronic jaundice. Torok made a similar report. Chauffard and Laroche in 1911 first made blood cholesterin determinations in cases of xanthoma and found the cholesterin content to be distinctly elevated. This finding has since been verified by many workers. It has even been shown that when the blood cholesterin falls as the result of the administration of a cholesterin-free diet or because of treatment of coexisting diabetes, the xanthomas may disappear. Xanthomas are thus the local manifestation of a syndrome which may be called xanthomatosis.