Normolipemic plane xanthoma (NPX) is a well-characterized clinicopathologic entity distinct from necrobiotic xanthogranuloma (NXG). We present the case of a patient with the classic clinical course of NPX but with many histologic features in common with NXG, namely, multinucleated lipophages, cholesterol clefts, and degeneration of collagen with associated cellular necrosis (necrobiosis). We suggest that NPX and NXG represent part of a spectrum of xanthomatous dermal reactions associated with paraproteinemias and may be more closely related than previously recognized.
