Verruciform xanthoma

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 Japanese males.[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 epidermal nevus.[7]

Verruciform xanthoma
SpecialtyDermatology

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]

The condition can affect other organs of body, such as the penis,[10] vulva,[1][11][12] and can occur in anal region,[13] nose,[14][15] the ear,[16] lower extremity,[17] scrotum.[6][18]

Cause

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 tissue papillae 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]

Differential diagnosis

Differential diagnosis includes seborrheic keratosis, verruca simplex, condyloma acuminatum, granular cell myoblastoma, vulvar intraepithelial neoplasia, bowenoid papulosis, erythroplasia of Queyrat, and verrucous carcinoma[11]

Treatment

Surgical excision is the treatment of choice.[22]

Epidemiology

Verruciform xanthoma is uncommon, with a female:male ratio of 1:1.1[8]

See also

References
  1. Leong FJ, Meredith DJ (1998). "Verruciform xanthoma of the vulva. A case report". Pathol. Res. Pract. 194 (9): 661–5, discussion 666–7. doi:10.1016/S0344-0338(98)80106-4. PMID 9793968.
  2. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
  3. Shafer WG. Verruciform xanthoma. Oral Surg Oral Med Oral Pathol. 1971;31(6):784-789
  4. Mohsin SK, Lee MW, Amin MB, et al. (April 1998). "Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells". Am. J. Surg. Pathol. 22 (4): 479–87. doi:10.1097/00000478-199804000-00014. PMID 9537477.
  5. Canillot S, Stamm C, Balme B, Perrot H (1994). "[Verruciform xanthoma of the penis]". Ann Dermatol Venereol (in French). 121 (5): 404–7. PMID 7702268.
  6. Nakamura S, Kanamori S, Nakayama K, Aoki M (October 1989). "Verruciform xanthoma on the scrotum". J. Dermatol. 16 (5): 397–401. doi:10.1111/j.1346-8138.1989.tb01288.x. PMID 2600278.
  7. Haustein UF (1984). "[Xanthomatous cells in inflammatory linear verrucous epidermal nevus or nevoid verruciform xanthoma?]". Dermatologische Monatsschrift (in German). 170 (7): 475–8. PMID 6468717.
  8. Philipsen 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. PMID 12676251.
  9. 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. PMID 17339158.
  10. 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. PMID 9412234.
  11. Reich O, Regauer S (January 2004). "Recurrent verruciform xanthoma of the vulva". Int. J. Gynecol. Pathol. 23 (1): 75–7. doi:10.1097/01.pgp.0000101143.79462.f7. PMID 14668556.
  12. de Rosa G, Barra E, Gentile R, Boscaino A, Di Prisco B, Ayala F (August 1989). "Verruciform xanthoma of the vulva: case report". Genitourin Med. 65 (4): 252–4. doi:10.1136/sti.65.4.252. PMC 1194362. PMID 2807284.
  13. Griffel B, Cordoba M (April 1980). "Verruciform xanthoma in the anal region". Am J Proctol Gastroenterol Colon Rectal Surg. 31 (4): 24–5. PMID 7386619.
  14. Than T, Birch PJ, Dawes PJ (January 1999). "Verruciform xanthoma of the nose". J Laryngol Otol. 113 (1): 79–81. doi:10.1017/s0022215100143221. PMID 10341929.
  15. Landthaler M, Manzini BM, Spornraft P, Braun-Falco O (November 1988). "[The disease picture of verruciform xanthoma]". Hautarzt (in German). 39 (11): 727–30. PMID 3072323.
  16. Jensen JL, Liao SY, Jeffes EW (October 1992). "Verruciform xanthoma of the ear with coexisting epidermal dysplasia". Am J Dermatopathol. 14 (5): 426–30. doi:10.1097/00000372-199210000-00009. PMID 1329573.
  17. Chyu J, Medenica M, Whitney DH (October 1987). "Verruciform xanthoma of the lower extremity--report of a case and review of literature". J. Am. Acad. Dermatol. 17 (4): 695–8. doi:10.1016/S0190-9622(87)80466-8. PMID 3312319.
  18. Shindo Y, Mikoshiba H, Okamoto K, Morohashi M (October 1985). "Verruciform xanthoma of the scrotum". J. Dermatol. 12 (5): 443–8. doi:10.1111/j.1346-8138.1985.tb02870.x. PMID 3914496.
  19. Hu JA, Li YN, Li SY, Ying H (August 2005). "[Study of the clinicopathology on verruciform xanthoma of the oral cavity]". Shanghai Kou Qiang Yi Xue (in Chinese). 14 (4): 370–3. PMID 16155700. Archived from the original on 2016-09-19.
  20. 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.
  21. Rawal SY, Kalmar JR, Tatakis DN. Verruciform xanthoma: Immunohistochemical characterization of xanthoma cell phenotype. J Periodontol. 2001;78:504–9.
  22. Connolly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD (February 2000). "Management of cutaneous verruciform xanthoma". J. Am. Acad. Dermatol. 42 (2 Pt 2): 343–7. doi:10.1016/S0190-9622(00)90108-7. PMID 10640929.
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