Xanthoma verruziformes

Shafer 1971

Probably traumatically induced, solitary, painless, xanthomatous neoplasm, which is preferentially observed on the oral mucosa (especially hard palate or gingiva) but also in the genital area.

Probably multifactorial etiopathogenesis; often reactive after trauma; a traumatic relocation of surface epithelium into the lamina propria with uptake into then xanthomatous transformed macrophages is discussed. This thesis is unlikely for extraorally localized verrucous xanthomas.

Especially oral mucosa, especially hard palate, gingiva, scrotum, penis, vulva

Sharply defined, 0.2-2.0 cm large, exophytic (plaque, papule, nodule), firm, new formation with a rough, usually wart-like surface. The color may be grayish-whitish, reddish or yellowish. Ulceration of the surface is possible.

Extraorally, there are single or multiple, asymptomatic, filiform or papular wart-like elevations of the skin, which are usually clinically diagnosed as viral acanthomas.

Plump acanthosis of the surface epithelium, hyperparakeratosis, masses of foam cells with immunoreactivity for adipophilin and CD68 in the lamina propria (see case report).

Excision or curettage

Case report (He M et al. (2024)

A 12-year-old female patient presented with vulvar lesions that had been present for over a decade. Ten years ago, a red vegetation the size of a grain of rice appeared on her left labia majora without any recognizable trigger. Over time, the skin lesions gradually increased without any accompanying symptoms. The patient had not been treated since the onset of the disease. She had no family history of similar cases and denied any history of sexual violence.

On physical examination, the patient showed overall good health with no systemic abnormalities. A red, lobulated plaque measuring approximately 6 × 4 cm was evident on the left labia majora, accompanied by minimal scaling on the surface.

Laboratory tests, including blood count, liver function, renal function and blood lipids, revealed no abnormalities. HPV DNA was negative for high-risk (27 species) and low-risk (10 species) types.

Histopathologic examination revealed hyperkeratosis with dyskeratosis, papillomatous epidermal hyperplasia, neutrophilic infiltration in the epidermis, and numerous foamy histiocytes on the head of the dermal papilla. Inflammatory cells, consisting predominantly of lymphocytes, were scattered around the superficial dermal blood vessels.

Immunohistochemistry showed a positive CD68 in the foamy cells of the dermal papillae. Diagnosis: verruciform xanthoma. Treatment: surgical resection, no recurrence during more than one year of follow-up.

1. Beutler BD et al. (2015) Verruciform Genital-Associated (Vegas) Xanthoma: report of a patient with verruciform xanthoma of the scrotum and literature review. Dermatol Online J 21 pii: 13030/qt7kb930rf.
2. de Andrade BA et al. (2015) Oral verruciform xanthoma: a clinicopathologic and immunohistochemical study of 20 cases. J Cutan Pathol 42: 489-495.
3. Harris L et al (2015) Oral verruciform xanthoma. BMJ Case Rep pii: bcr2014209216.
4. He M et al. (2024) A Case of Verruciform Xanthoma of Labia in a Child. Clin Cosmet Investig Dermatol 17:785-789.
5. Qi Y et al. (2013) A case of multiple verruciform xanthoma in gingiva. Br J Oral Maxillofac Surg 52:e 1-3.
6. Shaver WG (1971) Verruciform xanthoma. Oral Surg Med Oral Pathol 31: 784-789
7. Sinnya S et al. (2014) Verruciform xanthoma of the penis: a rare Australian case. Australas J Dermatol 56: e99-e101.