Verruciform xanthoma: A case report and a review of recurrent cases

Abstract

Oral verruciform xanthoma (VX) is an infrequently encountered benign lesion in the oral cavity. We report an unusual case of VX on the left buccal mucosa presented as a red and white exophytic mass with a greyish white diffuse patch associated with it. A differential diagnosis of papilloma, verrucous carcinoma, and squamous cell carcinoma associated with leukoplakia was listed. Histopathological findings were suggestive of VX due to the presence of characteristic foam cells in the connective tissue papillae. Immunohistochemical analysis with CD68 showed strong positive immunoreactivity revealing expression of foam cells. After the excisional biopsy, the patient was followed up for the next 6 months with no recurrence. Follow-up is very essential in such a case as the exophytic lesion was associated with a potentially malignant disorder. A short review of reported recurrent cases of verruciform xanthoma is also discussed.

Keywords: Foam cells; IHC; verruciform xanthoma; verrucous lesions.

Figure 1

Clinical appearance of VX showing whitish red raised diffuse lesion with exophytic growth noticed on the left buccal mucosa

Figure 2

(a) Photomicrograph of VX (H&E; 10x) of the lesion exhibiting the uniform rete pegs with parakeratotic invaginating crypts and connective tissue filled with xanthoma cells (b) Photomicrograph of VX (H&E; 40x) showing the connective tissue exhibiting the accumulation of foam cells between the epithelial rete pegs

Figure 3

(a) Strong positive immunoreactivity to antibody CD-68 (10x) (b) Xanthoma cells showing strong positive immunoreactivity to antibody CD-68 (40x)