Verruciform xanthoma is an uncommon
benign[1]lesion that has a verruciform (
wart-like) appearance, but it may appear
polypoid,
papillomatous, or
sessile.[2]: 535 The verruciform was first described by Shafer in 1971 on the oral mucosa.[3] Usually found on the
oral mucosa[4] of middle-aged persons, verruciform xanthomas have also been reported on the
scrotum and
penis[4][5] of middle-aged to elderly
Japanesemales.[6] While the most common site is the oral mucosa, lesions that occur elsewhere usually arise on the
perineum or on the skin with some predisposing factor, such as lymphedema or an
epidermalnevus.[7]
Signs and symptoms
The most common location by far is the
gingival margin and other areas of the
masticatory oral mucosa,[8] these occur more frequently in the fifth decade of life, and have good prognosis, the treatment of choice for oral VXs is
surgical excision, and recurrence is rare.[9]
Verruciform xanthoma is most likely not a
human papillomavirus associated lesion and the foam cells in the lesions are most likely derived from the
monocyte—
macrophage lineage.[19] More research is needed to determine the cause.
Diagnosis
Histology
A distinguishing feature of verruciform xanthoma is the presence of large numbers of
lipid-laden foamy
histiocytes[1][4][11] in the lesion, and essentially limited to, the
connective tissuepapillae in the lesion. The lesions are solitary, raised, or polypoid with cup-shaped craters filled with
parakeratotic cells that blend into
keratinocytes of an
acanthotic and papillomatous
epidermis. There is a
neutrophilic infiltrate of varying intensity between plump parakeratotic cells and keratinocytes, near the surface of the epidermis.[4] The xanthoma cells contain periodic acid Schiff positive, diastase resistant granules. The foam cells are monocyte-macrophage lineage with positive immunohistochemical markers for CD68 (KP1)[20] and cathepsin B.[21]
^Haustein UF (1984). "[Xanthomatous cells in inflammatory linear verrucous epidermal nevus or nevoid verruciform xanthoma?]". Dermatologische Monatsschrift (in German). 170 (7): 475–8.
PMID6468717.
^
abPhilipsen HP, Reichart PA, Takata T, Ogawa I (June 2003). "Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan". Oral Oncol.39 (4): 325–36.
doi:
10.1016/S1368-8375(02)00088-X.
PMID12676251.
^Yu CH, Tsai TC, Wang JT, et al. (February 2007). "Oral verruciform xanthoma: a clinicopathologic study of 15 cases". J. Formos. Med. Assoc. 106 (2): 141–7.
doi:
10.1016/S0929-6646(09)60230-8.
PMID17339158.
^Torrecilla Ortíz C, Marco Pérez LM, Dinares Prat J, Autonell J (September 1997). "[Verruciform xanthoma of the penis]". Actas Urol Esp (in Spanish). 21 (8): 797–9.
PMID9412234.
^Mostafa KA, Takata T, Ogawa I, Ijuhin N, Nikai H. Verruciform xanthoma of oral mucosa: A clinicopathological study with immunohistochemical findings relating to pathogenesis. Virchows Arch A Pathol Anat Histopathol. 1993;423:243–8.