Verruciform xanthoma
{{Infobox medical condition (new)
| name = Verruciform xanthoma
| synonyms =
| image =
| alt =
| caption =
| pronounce =
| field = Dermatology
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
Verruciform xanthoma is an uncommon benign{{cite journal |vauthors =Leong FJ, Meredith DJ |title=Verruciform xanthoma of the vulva. A case report |journal=Pathol. Res. Pract. |volume=194 |issue=9 |pages=661–5; discussion 666–7 |year=1998 |pmid=9793968 |doi= 10.1016/S0344-0338(98)80106-4}} lesion that has a verruciform (wart-like) appearance, but it may appear polypoid, papillomatous, or sessile.{{cite book |author1=James, William D. |author2=Berger, Timothy G.|title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|535}} The verruciform was first described by Shafer in 1971 on the oral mucosa.Shafer WG. Verruciform xanthoma. Oral Surg Oral Med Oral Pathol. 1971;31(6):784-789 Usually found on the oral mucosa{{cite journal |vauthors=Mohsin SK, Lee MW, Amin MB, etal |title=Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells |journal=Am. J. Surg. Pathol. |volume=22 |issue=4 |pages=479–87 |date=April 1998 |pmid=9537477 |doi= 10.1097/00000478-199804000-00014}} of middle-aged persons, verruciform xanthomas have also been reported on the scrotum and penis{{cite journal |vauthors =Canillot S, Stamm C, Balme B, Perrot H |title=[Verruciform xanthoma of the penis] |language=fr |journal=Ann Dermatol Venereol |volume=121 |issue=5 |pages=404–7 |year=1994 |pmid=7702268 }} of middle-aged to elderly Japanese males.{{cite journal |vauthors =Nakamura S, Kanamori S, Nakayama K, Aoki M |title=Verruciform xanthoma on the scrotum |journal=J. Dermatol. |volume=16 |issue=5 |pages=397–401 |date=October 1989 |pmid=2600278 |doi= 10.1111/j.1346-8138.1989.tb01288.x|s2cid=6362649 }} 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.{{cite journal |author=Haustein UF |title=[Xanthomatous cells in inflammatory linear verrucous epidermal nevus or nevoid verruciform xanthoma?] |language=de |journal=Dermatologische Monatsschrift |volume=170 |issue=7 |pages=475–8 |year=1984 |pmid=6468717 }}
Signs and symptoms
The most common location by far is the gingival margin and other areas of the masticatory oral mucosa, 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.{{cite journal |vauthors=Yu CH, Tsai TC, Wang JT |display-authors=etal|title=Oral verruciform xanthoma: a clinicopathologic study of 15 cases |journal=J. Formos. Med. Assoc. |volume=106 |issue=2 |pages=141–7 |date=February 2007 |pmid=17339158 |doi= 10.1016/S0929-6646(09)60230-8|doi-access=}}
The condition can affect other organs of body, such as the penis,{{cite journal |vauthors =Torrecilla Ortíz C, Marco Pérez LM, Dinares Prat J, Autonell J |title=[Verruciform xanthoma of the penis] |language=es|journal=Actas Urol Esp |volume=21 |issue=8 |pages=797–9 |date=September 1997 |pmid=9412234 }} vulva,{{cite journal |vauthors =de Rosa G, Barra E, Gentile R, Boscaino A, Di Prisco B, Ayala F |title=Verruciform xanthoma of the vulva: case report |journal=Genitourin Med |volume=65 |issue=4 |pages=252–4 |date=August 1989 |pmid=2807284 |pmc=1194362 |doi= 10.1136/sti.65.4.252}} and can occur in anal region,{{cite journal |vauthors =Griffel B, Cordoba M |title=Verruciform xanthoma in the anal region |journal=Am J Proctol Gastroenterol Colon Rectal Surg |volume=31 |issue=4 |pages=24–5 |date=April 1980 |pmid=7386619 }} nose,{{cite journal |vauthors =Than T, Birch PJ, Dawes PJ |title=Verruciform xanthoma of the nose |journal=J Laryngol Otol |volume=113 |issue=1 |pages=79–81 |date=January 1999 |pmid=10341929 |doi= 10.1017/s0022215100143221}}{{cite journal |vauthors =Landthaler M, Manzini BM, Spornraft P, Braun-Falco O |title=[The disease picture of verruciform xanthoma] |language=de |journal=Hautarzt |volume=39 |issue=11 |pages=727–30 |date=November 1988 |pmid=3072323 }} the ear,{{cite journal |vauthors =Jensen JL, Liao SY, Jeffes EW |title=Verruciform xanthoma of the ear with coexisting epidermal dysplasia |journal=Am J Dermatopathol |volume=14 |issue=5 |pages=426–30 |date=October 1992 |pmid=1329573 |doi= 10.1097/00000372-199210000-00009}} lower extremity,{{cite journal |vauthors =Chyu J, Medenica M, Whitney DH |title=Verruciform xanthoma of the lower extremity--report of a case and review of literature |journal=J. Am. Acad. Dermatol. |volume=17 |issue=4 |pages=695–8 |date=October 1987 |pmid=3312319 |doi= 10.1016/S0190-9622(87)80466-8|doi-access=free }} scrotum.{{cite journal |vauthors =Shindo Y, Mikoshiba H, Okamoto K, Morohashi M |title=Verruciform xanthoma of the scrotum |journal=J. Dermatol. |volume=12 |issue=5 |pages=443–8 |date=October 1985 |pmid=3914496 |doi= 10.1111/j.1346-8138.1985.tb02870.x|s2cid=5575656 }}
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.{{cite journal |vauthors =Hu JA, Li YN, Li SY, Ying H |title=[Study of the clinicopathology on verruciform xanthoma of the oral cavity] |language=zh |journal=Shanghai Kou Qiang Yi Xue |volume=14 |issue=4 |pages=370–3 |date=August 2005 |pmid=16155700 |url=http://www.omschina.org.cn/sjs/info.asp?id=1737 |archive-url=https://web.archive.org/web/20160919020458/http://www.omschina.org.cn/sjs/info.asp?id=1737 |url-status=dead |archive-date=2016-09-19 }} 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{{cite journal |vauthors =Reich O, Regauer S |title=Recurrent verruciform xanthoma of the vulva |journal=Int. J. Gynecol. Pathol. |volume=23 |issue=1 |pages=75–7 |date=January 2004 |pmid=14668556 |doi=10.1097/01.pgp.0000101143.79462.f7 }} 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. 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)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. and cathepsin B.Rawal SY, Kalmar JR, Tatakis DN. Verruciform xanthoma: Immunohistochemical characterization of xanthoma cell phenotype. J Periodontol. 2001;78:504–9.
=Differential diagnosis=
Treatment
Surgical excision is the treatment of choice.{{cite journal |vauthors =Connolly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD |title=Management of cutaneous verruciform xanthoma |journal=J. Am. Acad. Dermatol. |volume=42 |issue=2 Pt 2 |pages=343–7 |date=February 2000 |pmid=10640929 |doi= 10.1016/S0190-9622(00)90108-7}}
Epidemiology
Verruciform xanthoma is uncommon, with a female:male ratio of 1:1.1{{cite journal |vauthors =Philipsen HP, Reichart PA, Takata T, Ogawa I |title=Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan |journal=Oral Oncol. |volume=39 |issue=4 |pages=325–36 |date=June 2003 |pmid=12676251 |doi= 10.1016/S1368-8375(02)00088-X}}