Verruciform xanthoma: report of five cases

Abstract

We describe five cases of verruciform xanthoma (VX). The patients, all males, presented with single warty verrucous lesions of 0.5-2 cm size that had been diagnosed clinically as viral warts (four cases) and leukoplakia (one case). Two patients had the lesion in the oral cavity, two on the genital mucosa, and one on the scrotal skin. Histopathology was diagnostic, with verrucous and papillomatous epidermal hyperplasia with the silhouette of a viral wart but with numerous foamy histiocytes packed in the elongated dermal papillae. Columns of deep parakeratosis and neutrophils in the upper spinous layers, with a dermal plasma cell infiltrate were the other histopathologic findings. Excision of the lesions was curative, without recurrences, in the two patients who had lesions in the oral cavity; follow-up was not available in the cases with genital lesions. VX is an uncommon but distinctive clinicopathologic entity affecting the oral and genital mucosa that may be mistaken for benign, premalignant, and malignant conditions. VX can be diagnosed with certainty only on histopathologic examination.

Keywords: Foam cells; verruciform xanthoma; viral wart.

Figure 1

Verrucous plaque on the left buccal mucosa (case 1)

Figure 2

Exophytic papillomatous epidermal hyperplasia with silhouette of wart (H and E; 20×) (case 3)

Figure 3

Neutrophils in the upper spinous layers, with foamy histiocytes in the dermal papillae (H and E; 100×) (case 3)

Figure 4

Elongated dermal papillae stuffed with foam cells (H and E; 400×) (case 3)

Figure 5

Deep invaginated columns of parakeratosis (H and E; 40×) (case 2)