Verruciform Xanthoma of the Oral Cavity – A Case Report

Abstract

Verruciform Xanthoma (VX) is a relatively rare benign mucocutaneous lesion of unknown aetiology. VX occurs predominantly in oral cavity which also occasionally affects skin and genital mucosa. It was first reported in the oral cavity in 1971. This rare harmless lesion usually presents as sessile or pedunculated, appear as a papule or single plaque showing verrucous or papillomatous mucosal growth with variable color from reddish pink to gray. In majority of oral cases, it affects gingiva and alveolar mucosa that may be mistaken for benign, premalignant and malignant conditions. VX is diagnosed with certainly only on histopathologic examination. Histologically VX is characterized by the presence of parakeratinized epithelium showing papillary or verrucous growth with thin rete ridges and connective tissue papillae extending up to the surface. The papillae characteristically consist of foam cells also called xanthoma cells. Here we describe a case report of verruciform xanthoma occurring on the buccal mucosa in a 42-years old male patient along with its clinical, pathogenesis, histological features and treatment modalities discussed.

Oral verruciform xanthoma

“…It is a rare finding in the floor of the mouth 1 2. It often presents as a pink, yellow or grey raised plaque or papule with granular, papillary or verrucous surface morphology 3 4. It is usually asymptomatic and slow growing, and more often occurs as a solitary lesion, although multiple lesions have occasionally been reported 1 5.…”

“…Differentials include verrucous carcinoma, squamous cell carcinoma, squamous papilloma, verruca vulgaris, condyloma and leukoplakia 4 5. The verrucous architecture and exophytic nature of this lesion could easily mimic malignancy clinically and therefore biopsy is mandatory.…”

Dermatopathology quiz: Cerebriform papules of the scrotum

“…[ 1 ] Several agents have been implicated as possible etiologic factors for oral lesions of verruciform xanthoma, including tobacco, alcohol, drugs, sensitizing or allergic substances of foodstuffs and dental materials. [ 2 ] Due to the similar clinical appearance and distribution of verruciform xanthoma and condylomata, human papilloma virus (HPV) has been suggested as an etiologic factor, but in situ hybridization has generally failed to find evidence of a genuine association with HPV. [ 1 3 ]…”

“…[ 1 ] Other affected sites include the hard palate, tongue, buccal mucosa, soft palate, alveolar mucosa, floor of the mouth, and the junction between the hard and soft palate. [ 2 ] Extraoral cases commonly involve the vulva, anogenital skin and mucosa. [ 1 2 ] On examination, the lesions are typically solitary, sessile or pedunculated with a coarse surface.…”

“…[ 2 ] Extraoral cases commonly involve the vulva, anogenital skin and mucosa. [ 1 2 ] On examination, the lesions are typically solitary, sessile or pedunculated with a coarse surface. These growths are variable in color ranging from flesh-colored, pale, white, or red and approximately 2 mm-1.5 cm in size.…”