%0 Journal Article
%T Oral Verruciform Xanthoma: A Case Report and Literature Review
%A Akshay Shetty
%A Kourosh Nakhaei
%A Yogesh Lakkashetty
%A Maryam Mohseni
%A Iman Mohebatzadeh
%J Case Reports in Dentistry
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/528967
%X Verruciform xanthoma is a benign mucocutaneous, uncommon, nonsymptomatic lesion of uncertain etiopathology, which occurs mostly on the oral mucosa of middle-aged individuals. Histopathologically, VX is diagnosed by presence of lipid-laden foam cells in papillary region of connective tissue. A 60-year-old male patient presented with a painless growth on the left buccal mucosa. On clinical examination a yellowish white exophytic lesion, measuring 11 ¡Á 7£¿mm in size, was found, which was cauliflower-shaped on inspection and painless on palpation. Histopathological examination revealed varying degrees of surface parakeratosis and the accumulation of numerous foam cells in the connective tissue papillae among the uniformly elongated epithelial ridges. On immunohistochemical staining, there was a neutrophilic infiltrate of the epidermis with CD68 positive xanthoma cells restricted to the papillary dermis, mixed with other chronic inflammatory cells. 1. Introduction Verruciform xanthoma (VX) is an uncommon benign mucocutaneous lesion that resembles virus-induced papilloma but has an unknown etiology and uncertain nature. It was first reported by Shafer in 1971. VX usually occurs in the oral mucosa of the middle-aged individuals. It most commonly presents with a verrucous appearance. However in some instances it may appear polypoid, papillomatous, or sessile. It occurs as a small (0.2¨C2£¿cm), solitary, asymptomatic, slow growing, white or yellowish red lesion with no sex predilection [1, 2]. Histologically VX is distinguished from other lesions by the presence of large numbers of foam cells in, and essentially limited to, the connective tissue papillae. The foam cells on ultrastructural studies have been concluded to be fat-laden macrophages [3, 4]. Other cell types, including Langerhans cells, intraepithelial neutrophilic infiltrate, and even fibroblasts, have been reported [1¨C3]. A variable degree of parakeratosis is observed which is present in the crypts between papillae which are of variable length and thickness, often extending close to the surface. The rete pegs are extremely elongated and uniform [2]. Almost every VX case is diagnosed on histological examination as the clinical appearance is not diagnostic. Differentiation from other lesions with foamy or granular cells is not difficult as the VX is the only lesion to have these cells confined to the papillae [4, 5]. Differential diagnosis includes erythroplasia of Queyrat (Bowen disease of the glans penis), seborrheic keratosis, verrucous carcinoma, verruca simplex, and condyloma acuminatum [6, 7]. The
%U http://www.hindawi.com/journals/crid/2013/528967/