60 year old man presents to his physician after a routine screening test indicates hyperlipidemia. Physical examination reveals raised, irregular, yellow papules in the skin of the soft tissues below the eyes. Biopsy of these lesions would most likely show which of the following?

The lesions are xanthomas, which are tumor-like dermal collections of foamy histiocytes containing cholesterol and lipids. The lesions may also contain multinucleated giant cells (Touton giant cells) with clustered nuclei and foamy cytoplasm. Xanthomas may be idiopathic or may be related to hyperlipidemia or lymphoproliferative malignancies (e.g., leukemias and lymphomas). Nevus cells are a type of melanocyte. Benign nevus cells are a feature of the common nevus, or mole. Malignant nevus cells are a feature of malignant melanoma. Microscopic blisters at the dermal/epidermal junction are a feature of dermatitis herpetiformis. Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 6. Genetic Disorders. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture.