Verruciform xanthoma in the hard palate: a case report and literature review

Abstract

Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.

Keywords: Hard palate; Immunohistochemistry; Xanthomatosis.

Fig. 1. Clinical appearance of the lesion on the hard palate showing verrucous surface and erythematous spots, measuring approximately 5 mm in diameter.

Fig. 2. Histopathological features of the verruciform xanthoma showing hyperkeratosis, acanthosis, elongated rete pegs and numerous foam cells with clear cytoplasm and pyknotic nucleus in the connective tissue (H&E staining, ×200; A), foam cells showing negative for periodic acid-Schiff (PAS staining, ×400; B), foam cells positive for anti-CD68 antibody (anti-CD68 staining, ×400; C), basal layer of the oral epithelium positive to KI-67 and negative for foam cells (anti-KI-67 staining, ×200; D).

Fig. 3. Seven months of follow-up, no recurrences.