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Aihie OP, Azzam MJ, Haroon A, Braudis K. Verruciform Xanthomas in the Setting of COVID-19: A Case Series and Review of Other Conditions Associated With This Benign Cutaneous Neoplasm. Cureus 2022; 14:e31849. [PMID: 36440299 PMCID: PMC9685364 DOI: 10.7759/cureus.31849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
Verruciform xanthoma is a rare benign neoplasm that predominantly affects the oral mucosa but can also affect cutaneous sites on the face, trunk, extremities, and genitalia. It is usually identified in isolation; however, there are several known associations with other conditions. Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus that emerged in December 2019 and caused a worldwide pandemic. It primarily manifests as a respiratory illness although various associations and sequelae of COVID-19 are still being elucidated. The clinical and pathologic presentations of two cases of Verruciform xanthoma associated with documented COVID-19 infection at our institution after the start of lockdowns during the COVID-19 pandemic in 2020-2021 are described. In addition, we reviewed the literature for other infectious and non-infectious diseases associated with Verruciform xanthomas to see if there is any basis for a potential link between this rare benign neoplasm and novel viral infection.
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Shigeoka M, Koma YI, Kodama T, Nishio M, Akashi M, Yokozaki H. CD163 + Foamy Macrophages Are Associated with the Morphogenesis of Oral Verruciform Xanthoma through Angiogenesis by VEGF Expression: An Immunohistochemical Study. Dent J (Basel) 2020; 8:dj8010018. [PMID: 32075061 PMCID: PMC7175176 DOI: 10.3390/dj8010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/25/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Oral verruciform xanthoma (OVX) is an uncommon benign lesion that is characterized histologically by the accumulation of several foamy macrophages in the lamina propria papillae. The pathogenesis of OVX has not been completely elucidated, although the significance of macrophage polarization (M1, tumor suppression; and M2, tumor promotion) and the contribution of M2 macrophages to angiogenesis are well established. This study investigated the role of foamy macrophages in OVX, with a focus on angiogenesis. Four patients who underwent surgical excision or total excisional biopsy for OVXs were enrolled in this study. We evaluated the expression of the macrophage markers CD68 (broad) and CD163 (M2) and the CD34-positive microvessel density (MVD) of OVXs. The foamy macrophages of all patients exhibited positivity to CD68 and CD163. We evaluated the MVD and the expression of the vascular endothelial growth factor (VEGF) based on histological architecture. The MVD of all OVX cases was significantly higher than that of the corresponding normal epithelia. Interestingly, the MVD of verrucous-type OVX cases was higher than that of the other type. VEGF was expressed on foamy macrophages in all cases. Overall, the foamy macrophages expressing CD163 were associated with the morphogenesis of OVX through the process of angiogenesis by VEGF expression.
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Affiliation(s)
- Manabu Shigeoka
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
- Correspondence: ; Tel.: +81-78-382-5465; Fax: +81-78-382-5479
| | - Yu-ichiro Koma
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takayuki Kodama
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Mari Nishio
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masaya Akashi
- Division of Oral and Maxillofacial Surgery, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Hiroshi Yokozaki
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Belknap AN, Islam MN, Bhattacharyya I, Cohen DM, Fitzpatrick SG. Oral Verruciform Xanthoma: A Series of 212 Cases and Review of the Literature. Head Neck Pathol 2020; 14:742-748. [PMID: 31898056 PMCID: PMC7413928 DOI: 10.1007/s12105-019-01123-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
Verruciform xanthoma (VX) of the oral cavity is an uncommon, reactive lesion of unknown etiology. In this study, we present a large series of VX with analysis of demographics, clinical appearance, histologic presentation and extensive review of literature. To the best of our knowledge, this is the largest series of oral VX reported to date. Following IRB approval, all cases diagnosed as VX found in the archives of the University of Florida Oral Pathology Biopsy Service (1994-2018) were included. Patient age, gender, location, clinical appearance, clinical impression, and duration of each lesion was collected. A total of 212 cases were included in our database with a mean age of 61 years (range of 9-94), and a female: male ratio of 1.06:1. The most common location in descending order was the gingiva (n = 110, 51.2%), followed by palate (n = 41, 19.3%), buccal mucosa (n = 18, 8.5%), tongue (n = 20, 9.4%), vestibule (n = 13, 6.1%), lip (n = 4, 1.9%), floor of mouth (n = 3, 1.4%), and unspecified (n = 1, 0.5%). The lesions were most frequently pink in color, and most often described as bumpy, rough, verrucoid and/or papillary. Clinical impression in descending order was papillary (n = 67, 31.6%), not specified or unknown (n = 41, 19.3%), hyperkeratosis (n = 24, 11.3%), fibroma (n = 20, 9.4%), leukoplakia (n = 17, 8.0%), dysplastic lesion (n = 13, 6.1%), pyogenic granuloma (n = 7, 3.3%), granulomatous reaction (n = 5, 2.4%), lichen planus, VX (n = 4 each, 2.0%), pigmented, other lesions (n = 3 each, 1.4%), and salivary and periapical lesions (n = 2 each, 0.9%). Three of the lesions were recurrences. The demographics and clinical parameters of this case series were in concordance with that of previously published reports. In our series, only 4 cases were suspected as VX, demonstrating the lack of familiarity clinicians have with this lesion.
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Affiliation(s)
- Austin N. Belknap
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Mohammed N. Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Donald M. Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
| | - Sarah G. Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610 USA
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Barrett AW, Boyapati RP, Bisase BS, Norris PM, Shelley MJ, Collyer J, Sneddon KJ, Gulati A. Verruciform Xanthoma of the Oral Mucosa: A Series of Eight Typical and Three Anomalous Cases. Int J Surg Pathol 2019; 27:492-498. [PMID: 30727785 DOI: 10.1177/1066896919827374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this series, there are 8 typical verruciform xanthomas of the oral mucosa and 3 anomalies, 1 polypoid, 1 florid, and 1 carcinomatous. All were characterized by infiltrates of CD68-positive xanthomatous histiocytes in the lamina propria. The 11 patients comprised 6 men and 5 women (mean age = 54.5 years, range = 40-69). Both keratinized and nonkeratinized sites were affected. A history of lichenoid inflammation was recorded in 5 patients. The polypoid xanthoma presented in a woman aged 54 years as a polyp of the labial commissure. The florid lesion affected the dorsum of the tongue of a man aged 54 years and at 20 mm was the largest of the 11 lesions, but the only one with candidal infection. The squamous cell carcinoma manifested as a papilloverrucous hyperkeratosis of the palatal gingiva in a man aged 69 years. The latter 2 (and 1 "typical" verruciform xanthoma) required re-excision, but none has since recurred.
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Affiliation(s)
- A W Barrett
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - R P Boyapati
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - B S Bisase
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - P M Norris
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - M J Shelley
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - J Collyer
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - K J Sneddon
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - A Gulati
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
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5
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Baig FAH, Luqman M, Vij H, Ibrahim M. Oral Verruciform Xanthoma of lateral border of tongue - a sheep in wolf's clothing. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:480-482. [PMID: 30557744 DOI: 10.1016/j.jormas.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/07/2022]
Abstract
Oral Verruciform Xanthoma (OVX) is an uncommon benign lesion of the oral cavity. Most authors consider it to develop as a response to chronic local irritation. It usually presents as a pink, yellow or greyish flat mass occurring on the gingiva, alveolar ridge or hard palate. This paper reports to you the management of a case of Oral Verruciform Xanthoma occurring on the latero-ventral border of the tongue in a young male patient, which is a rare location for this lesion. It goes on to discuss the etiopathogenesis and clinical features of this rare lesion and emphasizes the importance of having a broad knowledge of oral pathologic lesions especially for lesions that resemble malignant or pre-malignant pathologies in the oral cavity.
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Affiliation(s)
- F A H Baig
- OMS department, College of dentistry, King Khalid University, Abha, Saudi Arabia.
| | - M Luqman
- DDS Department, College of dentistry, King Khalid University, Abha, Saudi Arabia
| | - H Vij
- Boston School of Dentistry, USA
| | - M Ibrahim
- OMS department, College of dentistry, King Khalid University, Abha, Saudi Arabia
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Tamiolakis P, Theofilou VI, Tosios KI, Sklavounou-Andrikopoulou A. Oral verruciform xanthoma: Report of 13 new cases and review of the literature. Med Oral Patol Oral Cir Bucal 2018; 23:e429-e435. [PMID: 29924759 PMCID: PMC6051686 DOI: 10.4317/medoral.22342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/05/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Oral verruciform xanthoma (OVX) is a rare lesion. The purpose of the present study is to describe the clinical features of 13 OVXs and review all cases reported in the English literature. MATERIAL AND METHODS Thirteen cases of OVX diagnosed during a 47-year period were retrospectively collected. The patients gender and age, as well as the main clinical features of the lesions were retrieved from the biopsy request forms. Pubmed, Scopus and Google ScholarTM electronic databases were searched with the key word verruciform xanthoma. Only cases of histologically confirmed OVX were included in the study. RESULTS The 13 OVXs represented approximately 0.04% of 35,617 biopsies accessioned during the study period. They affected 13 patients, 8 males and 5 females with a mean age of 48.8±14 years. They mainly appeared as asymptomatic granular nodules or plaques, with elastic or normal consistency and white color, in the gingiva or hard palate. Literature review yielded 416 cases of OVX. With the addition of cases of the present study, 429 cases of OVX have been presented in the English literature. OVX has a slight male predominance with a male to female ratio of 1.4:1 and the majority of patients are in the 5th to 7th decade of life. Clinically, OVX mainly presents as an asymptomatic, single, papillary or granular plaque or nodule, with elastic or soft consistency and white, red or pink color. It measures approximately 1cm and is most commonly located on the gingiva, tongue, hard palate or buccal mucosa. The treatment of choice is surgical excision with little rates of recurrence. CONCLUSIONS Verruciform xanthoma is a rare lesion most often encountered on the ginigival mucosa. As its clinical presentation is not pathognomonic, it should be included in the differential diagnosis of verrucous or papillary lesions.
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Affiliation(s)
- P Tamiolakis
- Department of Oral Medicine and Oral Pathology, School of Dentistry, National and Kapodistrian University of Athens, Greece, 2 Thivon Str, 11527, Goudi, Athens, Greece,
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Oral Verruciform Xanthoma within Lichen Planus: A Case Report and Literature Review. Case Rep Dent 2018; 2018:1615086. [PMID: 29850274 PMCID: PMC5937561 DOI: 10.1155/2018/1615086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background Verruciform xanthoma is an uncommon benign tumor, which exhibits a wide range of clinical patterns. The occurrence of the lesion in patients with immune-mediated mucocutaneous diseases may suggest a role of localized epithelial cell damage and chronic inflammation in its pathogenesis. Case Report A case of verruciform xanthoma on the tongue of a 56-year-old female with oral lichen planus is reported. An asymptomatic pink-white lesion with a granular surface was observed in the left lateral lingual border, which was closely associated with a white plaque and striae. An incisional biopsy was performed, and histologically, epithelial projections in a verrucous pattern were observed. In the subepithelial connective tissue, aggregates of foamy cells that exhibited immunoreactivity for CD68 were noted. The final diagnosis was verruciform xanthoma. The mucosa adjacent to the lesion demonstrated histopathological features consistent with lichen planus. Conclusions A total of twelve cases of oral verruciform xanthomas in patients with oral lichen planus including the present case have been reported in the literature. The clinician should be aware that verruciform xanthoma may mimic malignancy, and therefore, biopsy is required for definitive diagnosis to be established, especially when this tumor develops within conditions that show potential for malignant transformation.
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Garcia AS, Pagin O, da Silva Santos PS, Oliveira DT. Verruciform xanthoma in the hard palate: a case report and literature review. J Korean Assoc Oral Maxillofac Surg 2016; 42:383-387. [PMID: 28053911 PMCID: PMC5206246 DOI: 10.5125/jkaoms.2016.42.6.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 11/20/2022] Open
Abstract
Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.
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Affiliation(s)
- Alexandre Simões Garcia
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Otávio Pagin
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Denise Tostes Oliveira
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Stiff KM, Cohen PR. Vegas (Verruciform Genital-Associated) Xanthoma: A Comprehensive Literature Review. Dermatol Ther (Heidelb) 2016; 7:65-79. [PMID: 27848170 PMCID: PMC5336425 DOI: 10.1007/s13555-016-0155-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Verruciform xanthoma is a wart-like benign lesion. The classic histologic appearance consists of foamy histiocytes within elongated dermal papillae and epithelial acanthosis. The lesion most commonly occurs in the oral cavity, but has been reported in extra-oral sites such as the penis, scrotum, and vulva. The clinical and histologic characteristics of verruciform genital-associated (Vegas) xanthomas of the penis, scrotum, and vulva are reviewed. Methods PubMed was used to search the following term: verruciform xanthoma. The relevant papers were obtained and reviewed. Results There have been 193 cases of genital-associated verruciform xanthomas. There were 164 in men and 29 in women. Similar to verruciform xanthomas of the oral mucosa, they presented as asymptomatic lesions, demonstrated foam cells in the dermal papillae, and were typically managed successfully with surgical excision. Conclusion Verruciform xanthoma is a benign lesion characterized by a wart-like growth that is most commonly seen in the oral mucosa. Verruciform xanthomas of the genital region have been coined Vegas xanthomas. Vegas xanthomas have been reported in association with a variety of diseases, as well as in healthy individuals. Biopsy is required for diagnosis, and complete surgical excision is typically curative.
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Affiliation(s)
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA.
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Abstract
Verruciform xanthoma (VX) is an uncommon, benign, asymptomatic mucocutaneous lesion of an unknown etiopathology. It usually presents as a papule or single plaque with a verrucous or a papillomatous surface and pale yellowish to red in color. It occurs primarily on the masticatory mucosa of middle-aged individuals. We report a case of VX on the lip of a 59-year-old man. Histopathologically, VX is diagnosed by the presence of foam cells in the papillary region of the connective tissue. Differentiating a verrucous carcinoma from VX is important, especially in small superficial lesions, which may lead to inappropriate and excessive surgical intervention. Treatment of VX consists of simple surgical excision and recurrence is rare.
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Affiliation(s)
- Treville Pereira
- Department of Oral and Maxillofacial Pathology and Microbiology, DY Patil School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Subraj Shetty
- Department of Oral and Maxillofacial Pathology and Microbiology, DY Patil School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Shashibhushan Dodal
- Department of Oral and Maxillofacial Pathology and Microbiology, DY Patil School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Avinash Tamgadge
- Department of Oral and Maxillofacial Pathology and Microbiology, DY Patil School of Dentistry, Navi Mumbai, Maharashtra, India
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de Andrade BAB, Agostini M, Pires FR, Rumayor A, Carlos R, de Almeida OP, Romañach MJ. Oral verruciform xanthoma: a clinicopathologic and immunohistochemical study of 20 cases. J Cutan Pathol 2015; 42:489-95. [PMID: 25930961 DOI: 10.1111/cup.12500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/05/2015] [Accepted: 04/18/2015] [Indexed: 01/02/2023]
Abstract
Verruciform xanthoma of the oral cavity is an uncommon benign lesion that usually affects the palate and gingiva mainly as a well-circumscribed solitary yellowish to whitish plaque or nodule, which is promptly recognized microscopically by identification of sub-epithelial foamy macrophages. The aim of this study was to evaluate the clinicopathologic and immunohistochemical features of 20 cases of oral verruciform xanthoma. All cases were evaluated by conventional hematoxylin/eosin staining and six of those were submitted to immunohistochemical reactions for CD68, CD63, CD163, syndecan-1 (CD138), S-100 protein and cytokeratins (CK) 8, 14 and 19. Oral verruciform xanthoma presented as yellowish papillary nodules affecting mainly the palate (30%), buccal mucosa (30%) and gingiva (25%) of middle-aged male patients. Most cases presented papillary epithelial hyperplasia and sub-epithelial foamy cells, which were immunopositive for CD68, CD63 and CD163 in all cases. The orange parakeratin superficial layer was negative for CK14 and presented a distinct granular membrane pattern of positivity for CD138. S-100 protein, CK8, and CK19 were negative.
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Affiliation(s)
- Bruno A B de Andrade
- Oral Pathology, Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Michelle Agostini
- Oral Pathology, Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Fábio R Pires
- Oral Pathology, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Alicia Rumayor
- Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (FOP-UNICAMP), Piracicaba, Brazil
| | - Román Carlos
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Oslei P de Almeida
- Oral Pathology, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Mário J Romañach
- Oral Pathology, Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Aggarwal S, Aggarwal A, Gill S, Bakshi Y, Singh HP. Verruciform xanthoma of oral cavity- a case report. J Clin Diagn Res 2014; 8:FD11-2. [PMID: 25177573 DOI: 10.7860/jcdr/2014/8822.4590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 06/06/2014] [Indexed: 11/24/2022]
Abstract
Verruciform xanthoma is an uncommon benign lesion of undetermined aetiology. It is a superficial normo-lipemic xanthoma, probably reflecting a multifactorial reactive and dystrophic process. Its clinical and pathological recognition and correct diagnosis is critical because it can occur in conjunction with other systemic and cutaneous inflammatory diseases; therefore, it necessitates further clinical assessment. We, hereby report a rare case of verruciform xanthoma in 46-year-old male patient with history of leukemia with emphasis on need of vigilant comprehensive analysis of clinicopathological and immunohistohemical finding to arrive at definitive diagnosis and for better understanding of pathogenesis.
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Affiliation(s)
- Shivani Aggarwal
- Professor & Head, Department of Oral and Maxillofacial Pathology, Manav Rachna Dental College , Faridabad, Haryana, India
| | - Ashim Aggarwal
- Professor & Head, Department of Oral Surgery, Manav Rachna Dental College , Faridabad, Haryana, India
| | - Sharanjeet Gill
- Senior Lecturer, Department of Oral Pathology & Microbiology, Manav Rachna Dental College , Faridabad, Haryana, India
| | - Yujika Bakshi
- Senior Lecturer, Department of Prosthodontics, DJ Dental College , Uttar Pradesh, India
| | - Harkanwal Preet Singh
- Senior Lecturer, Department of Oral Pathology & Microbiology, Dasmesh Institute of Research and Dental Sciences , Faridkot,India
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13
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Hegde U, Doddawad VG, Sreeshyla H, Patil R. Verruciform xanthoma: A view on the concepts of its etiopathogenesis. J Oral Maxillofac Pathol 2014; 17:392-6. [PMID: 24574658 PMCID: PMC3927341 DOI: 10.4103/0973-029x.125205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Verruciform xanthoma is a very uncommon papillary growth seen chiefly in the oral mucosa. The presence of foam cells in the connective tissue papillae between the epithelial rete ridges forms the hallmark in its diagnosis. There has been wide speculation and various hypotheses put forth in explaining the etiopathogenesis of verruciform xanthoma and the origin of foam cells. This article aims to update the different hypotheses in understanding the pathogenesis of the lesion.
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Affiliation(s)
- Usha Hegde
- Department of Oral Pathology and Microbiology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital (A Constituent College of Jagadguru Sri Shivarathreeshwara University), Mysore, Karnataka, India
| | - Vidya G Doddawad
- Department of Oral Pathology and Microbiology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital (A Constituent College of Jagadguru Sri Shivarathreeshwara University), Mysore, Karnataka, India
| | - Hs Sreeshyla
- Department of Oral Pathology and Microbiology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital (A Constituent College of Jagadguru Sri Shivarathreeshwara University), Mysore, Karnataka, India
| | - Rekha Patil
- Department of Oral Pathology and Microbiology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital (A Constituent College of Jagadguru Sri Shivarathreeshwara University), Mysore, Karnataka, India
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14
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El-Kaissi AMN. Verruciform Xanthoma in Severe Phenytoin-Induced Gingival Overgrowth: A Case Report. Clin Adv Periodontics 2014. [DOI: 10.1902/cap.2012.120107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ryu DJ, Lee SH, Yuk JI, Kim HJ, Huh JK, Park KH. Verruciform xanthoma of the palatal gingiva: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2013; 39:292-6. [PMID: 24516820 PMCID: PMC3912787 DOI: 10.5125/jkaoms.2013.39.6.292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 11/23/2022] Open
Abstract
Verruciform xanthoma (VX) is a rare, benign lesion that presents in the oral cavity, skin, or genital organs as a verrucous, papillomatous, or flat papule with varying colors. VX has indistinct clinical features, making histopathological examination necessary for a definitive diagnosis. Histologically, VX is characterized by parakeratosis, rete ridges with uniform depth, and an accumulation of the foam cells, which are also known as the "xanthoma cells". These foam cells test positive for antibodies, such as CD-68 and vimentin; it is thought that VX foam cells are derived from the monocyte-macrophage lineage, and that VX's pathogenic mechanism is partly related to an immune mechanism. Nevertheless, the pathogenesis of VX remains unclear. VX can be treated by surgical excision; other medical, chemical, and radiological treatments are not required postoperatively. Recurrence and malignant transformation of VX are rare. Two patients, each with a mass of unknown origin on the palatal gingiva, were presented at our clinic. Excisional biopsies of the masses were performed for a histological diagnosis after clinical and radiological examinations. Histological examination confirmed a diagnosis of VX in both cases.
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Affiliation(s)
- Da Jung Ryu
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang Hoon Lee
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jong In Yuk
- Department of Oral Pathology, Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Joing-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kwang-Ho Park
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
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16
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Oral verruciform xanthoma: a case report and literature review. Case Rep Dent 2013; 2013:528967. [PMID: 24396610 PMCID: PMC3876769 DOI: 10.1155/2013/528967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/19/2013] [Indexed: 11/17/2022] Open
Abstract
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 × 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.
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17
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Dorankula SPR, Ramani P, Premkumar P, Anuja, Sherlyn HJ. Verruciform xanthoma of the oral cavity - a case report. J Clin Diagn Res 2013; 7:1799-801. [PMID: 24086918 DOI: 10.7860/jcdr/2013/6559.3309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/07/2013] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Shyam Prasad Reddy Dorankula
- Senior lecturer, Department of Oral & Maxillofacial Pathology, Kamineni Institute of Dental Sciences , Narketpally, Nalgonda (dt), Andhra Pradesh, India
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18
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El-Kaissi AMN. Verruciform Xanthoma in a Severe Context of Phenytoin-Induced Gingival Overgrowth: a Case Report. Clin Adv Periodontics 2013. [DOI: 10.1902/cap.2013.120107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Woo SB. Diseases of the oral mucosa. MCKEE'S PATHOLOGY OF THE SKIN 2012:362-436. [DOI: 10.1016/b978-1-4160-5649-2.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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20
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Shahrabi Farahani S, Treister NS, Khan Z, Woo SB. Oral verruciform xanthoma associated with chronic graft-versus-host disease: a report of five cases and a review of the literature. Head Neck Pathol 2011; 5:193-8. [PMID: 21305367 PMCID: PMC3098333 DOI: 10.1007/s12105-011-0246-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/27/2011] [Indexed: 12/18/2022]
Abstract
Verruciform xanthoma (VX) is an uncommon benign inflammatory mucocutaneous condition that chiefly occurs in the oral cavity. It is often associated with pre-existing epithelial and/or inflammatory disorder and is characterized histopathologically by papillary epithelial hyperplasia and the presence of foamy macrophages in connective tissue papillae. We report of a series of five cases with VX who concurrently had chronic oral graft-versus-host disease following hematopoietic stem cell transplantation.
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21
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KISHIMOTO S, TAKENAKA H, SHIBAGAKI R, NAGATA M, YASUNO H. Verruciform xanthoma in association with a vulval fibroepithelial polyp. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.19602036.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Ide F, Obara K, Yamada H, Mishima K, Saito I, Kusama K. Cellular basis of verruciform xanthoma: immunohistochemical and ultrastructural characterization. Oral Dis 2008; 14:150-7. [PMID: 18302675 DOI: 10.1111/j.1601-0825.2007.01362.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Verruciform xanthoma (VX) holds two basic pathogenic interests: (1) Why and how do macrophage foam cells accumulate exclusively in the sub-basal papillae? and (2) What underlies the disease chronicity? Moreover, an unsolved question is which came first - epithelial hyperplasia or foam cell collection? MATERIALS AND METHODS We analyzed 36 oral mucosal lesions to dissect a series of linked cellular changes in VX using immunohistochemical and ultrastructural techniques. RESULTS Macrophage scavenger receptor-1 (MSR-1), monocyte chemoattractant protein-1 (MCP-1), CCR2, and oxidized low-density lipoprotein (ox-LDL) were all expressed by foam cells. VX epithelium showed reactivity for MCP-1, HLA-DR and IL8 in varying degrees, and showed a nearly 40% reduction in Langerhans cell density. In sub-epithelial inflammatory infiltrates, CD8+ T cells preponderated (>70%), but only a minority were positive for granzyme B (<1%). Keratinocyte/basal lamina complex exhibited disruption of basal lamina, squamatization and cytolysis of basal cells, fragmentation of desmosomes, and intraepithelial migration of macrophages. In severely inflamed papillae, necrotic foam cells were scavenged by adjacent macrophages. CONCLUSIONS Under synergistic regulation of T cells, MCP-1/CCR2-mediated macrophage recruitment in the sub-basal papillae and the lysosomal engulfment of epithelial lipids by MSR-1-bearing macrophages may be central in VX formation. Once developed, ox-LDL-induced foam cell necrosis and macrophage-dependent debris disposal may cyclically perpetuate VX.
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Affiliation(s)
- F Ide
- Department of Pathology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
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García-Melgares M, Martínez A, Alegre V. Pápulas verrucosas en el glande. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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24
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García-Melgares M, Martínez A, Alegre V. Verrucous Papules on the Glans Penis. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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25
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Yu CH, Tsai TC, Wang JT, Liu BY, Wang YP, Sun A, Chiang CP. Oral verruciform xanthoma: a clinicopathologic study of 15 cases. J Formos Med Assoc 2007; 106:141-7. [PMID: 17339158 DOI: 10.1016/s0929-6646(09)60230-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Oral verruciform xanthoma (VX) is an uncommon oral mucosal lesion. This retrospective study evaluated the clinical and histopathologic features of 15 oral VXs occurring in Taiwanese patients. METHODS Fifteen consecutive cases of oral VX were collected from January 1988 to December 2005. Clinical data and microscopic features of these cases were reviewed and analyzed. RESULTS The mean age of patients was 45 years (range, 18-79 years). There were eight male and seven female patients. Seven (46.6%) cases occurred on the gingiva, four (26.7%) on the tongue, and four (26.7%) on the buccal or vestibular mucosa. The greatest mean dimension of the lesions was 0.8 cm (range, 0.3-2.0 cm). Three patients had concomitant other oral mucosal lesions such as oral submucous fibrosis, squamous cell carcinoma, and erosive oral lichen planus. Microscopically, all specimens showed varying degrees of surface parakeratosis and the accumulation of numerous foam cells in the connective tissue papillae among uniformly elongated epithelial ridges. Individuals or aggregates of foam cells were also found underneath the epithelial ridges in nine (60%) cases. When the oral VX lesions were further classified into three types according to the microscopic surface architecture, seven (47%) lesions were of the verrucous type, three (20%) the papillary type, and five (33%) the flat type. All patients received surgical excision of the lesions and no recurrence was noted during follow-up of up to 18 years. CONCLUSION Oral VXs occur more frequently in the fifth decade of life. The more commonly affected site is the gingiva. The treatment of choice for oral VXs is surgical excision. The prognosis is excellent and recurrence was not seen in this study.
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Affiliation(s)
- Chuan-Hang Yu
- Graduate Institute of Clinical Dentistry and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
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26
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Rawal SY, Kalmar JR, Tatakis DN. Verruciform xanthoma: immunohistochemical characterization of xanthoma cell phenotypes. J Periodontol 2007; 78:504-9. [PMID: 17335374 DOI: 10.1902/jop.2007.060196] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Verruciform xanthoma (VX) is a benign lesion that primarily affects the oral cavity, most frequently the gingiva. VX lesions are characterized by xanthoma cells (lipid-laden macrophages or foam cells) found in the superficial connective tissue. To characterize these foam cells further, immunohistochemical techniques were used to investigate the presence of macrophage subpopulations in oral lesions of VX. METHODS Sixteen biopsy samples of VX lesions from the oral cavity (six from gingiva, three from palate, and seven from other mucosa) were studied. Immunohistochemical analysis was performed using antibody probes to macrophage subpopulations, including RM3/1 (reparative), 25F9 (resident), and 27E10 (inflammatory). The percentage of antibody-labeled foam cells was determined by visual counts of selected fields within lesional connective tissue. RESULTS The proportion of VX lesions that demonstrated positive xanthoma cell reactivity with antibodies RM3/1, 25F9, and 27E10 was 100%, 88%, and 50%, respectively. Foam cells that stained positively with RM3/1, 25F9, and 27E10 represented 61.5% +/- 19.6%, 51.8% +/- 29.4%, and 10.9% +/- 14.7% of the counted cells, respectively. When results were analyzed based on anatomic location (gingiva, palate, and other mucosa), there was no difference in the percentage of positively stained cells by anatomic site for any of the three antibodies (P >0.05). Similarly, there were no differences between masticatory (gingiva and palate) and other mucosa (P >0.05). CONCLUSIONS VX lesions contain primarily reparative and resident foam cells, with limited numbers of inflammatory macrophages, consistent with a chronic reactive process. These findings were independent of the anatomic site.
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Affiliation(s)
- Swati Y Rawal
- Department of Periodontology, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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27
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Sibaud V, Marit G, Deminière C, Campana F, Taieb A, Fricain JC. [Multiple verruciform xanthomas of the oral mucosa associated with graft versus host disease]. Ann Dermatol Venereol 2007; 133:995-9. [PMID: 17185932 DOI: 10.1016/s0151-9638(06)71086-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Verruciform xanthoma is an uncommon lesion that occurs primarily on the mucous membranes and more rarely on the skin. A few authors have reported the extremely rare occurrence of multiple lesions. Triggering or enhancing factors have been occasionally described such as an underlying immunosuppression or associated inflammatory mucous or skin diseases. We report, to the best of our knowledge, the first case report of multiple verruciform xanthomas of the oral mucosa in a patient with graft-versus-host disease with specific oral lesions. CASE REPORT A 57 year-old man presented with an 8-year history of chronic myeloid leukemia. He was considered in complete remission for leukemia after allogenic bone marrow transplantation. Nevertheless, he was still treated with immunosuppressive drugs for oral and cutaneous lesions of chronic graft-versus-host disease. In this context, the patient presented two symmetric lesions of the gingiva. These lesions had progressed over several months. The clinical presentation was similar, with a yellowish and verrucous aspect and a sessile base. Histologic and immunohistochemical analysis led to the diagnosis of multiple verruciform xanthomas. DISCUSSION The occurrence of multiple lesions of this rare tumour in our patient was probably not fortuitous. Immunosuppression associated with oral chronic inflammatory lesions are certainly involved in the pathogenesis of these two verruciform xanthomas, for example following degeneration of epithelial cells after local chronic irritation and/or reduction of Langerhans cells. Systematic research of enhancing or triggering factors seems essential in verruciform xanthoma.
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Affiliation(s)
- V Sibaud
- Service de Dermatologie, Hôpital Saint André, Bordeaux
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28
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Abstract
The mucosal lining of the respiratory and digestive systems contains the largest and most complex immune system in the body, but surprisingly little is known of the immune system that serves the oral mucosa. This review focuses on dendritic cells, particularly powerful arbiters of immunity, in response to antigens of microbial or tumor origin, but also of tolerance to self-antigens and commensal microbes. Although first discovered in 1868, the epidermal dendritic Langerhans cells remained enigmatic for over a century, until they were identified as the most peripheral outpost of the immune system. Investigators' ability to isolate, enrich, and culture dendritic cells has led to an explosion in the field. Presented herein is a review of dendritic cell history, ontogeny, function, and phenotype, and the role of different dendritic cell subsets in the oral mucosa and its diseases. Particular emphasis is placed on the mechanisms of recognition and capture of microbes by dendritic cells. Also emphasized is how dendritic cells may regulate immunity/tolerance in response to oral microbes.
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Affiliation(s)
- C W Cutler
- Department of Periodontics, 110 Rockland Hall, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794-8703, USA.
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29
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Erşahin C, Szpaderska AM, Foreman K, Yong S. Verucciform xanthoma of the penis not associated with human papillomavirus infection. Arch Pathol Lab Med 2005; 129:e62-4. [PMID: 15737058 DOI: 10.5858/2005-129-e62-vxotpn] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Verruciform xanthoma (VX) is a rare lesion with a predilection for oral mucosa. Only 16 cases of VX of the penis have been reported. Histologically, VX lesions in different locations are identical; however, the etiology is controversial. Previous studies have reported the presence of human papillomavirus (HPV) in VX of the skin. The purpose of this study was to determine whether HPV is a causative agent in this rare case of VX of the penis. Microscopically, the lesion demonstrated prominent verrucoid squamous hyperplasia with hyperkeratosis, parakeratosis, and acanthosis. Histiocytes, a hallmark of VX, were identified in the elongated dermal papillae. Nested polymerase chain reaction was performed on the DNA with the commonly used primer sets MY9/MY11 and GP5+/GP6+, which identify more than 40 HPV types. The results failed to identify HPV DNA in the sample, although HPV could be readily detected in genomic DNA extracted from paraffin-embedded condyloma acuminatum, a known HPV-associated lesion. Additionally, we tested a VX lesion of the palate for HPV DNA and obtained negative results. Our results indicate that VX can arise without HPV infection and suggest other possible origins may be involved.
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Affiliation(s)
- Cağatay Erşahin
- Department of Pathology, Loyola University Medical Center, Maywood, Ill 60153, USA.
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30
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Affiliation(s)
- Christopher W Cutler
- Department of Periodontics, School of Dental Medicine, Stony Brook University, New York, USA
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31
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Kanitakis J, Euvrard S, Butnaru AC, Claudy A. Verruciform xanthoma of the scrotum in a renal transplant patient. Br J Dermatol 2004; 150:161-3. [PMID: 14746641 DOI: 10.1111/j.1365-2133.2004.05752.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Abstract
Verruciform xanthoma is a rare, benign, mucocutaneous, nondestructive lesion characterized by proliferation of non-Langerhans lipid-rich histiocytes. We describe the clinical and pathologic findings in a 30-year-old female with recurrent verruciform xanthoma of the vulva 8 years after initial therapy. The differential diagnosis includes seborrheic keratosis, verruca simplex, condyloma acuminatum, granular cell myoblastoma, vulvar intraepithelial neoplasia, bowenoid papulosis, erythroplasia of Queyrat, and verrucous carcinoma.
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Affiliation(s)
- Olaf Reich
- Department of Obstetrics and Gynecology, University of Graz, Austria.
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Philipsen HP, Reichart PA, Takata T, Ogawa I. Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan. Oral Oncol 2003; 39:325-36. [PMID: 12676251 DOI: 10.1016/s1368-8375(02)00088-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The biological profile of oral verruciform xanthoma (VX) is presented based on a world-wide literature survey of 282 cases. From 1979 onwards, extraoral cases have also been reported. This rare, harmless lesion with a sessile or pedunculated base is a red/pink, papillary/granular/verrucous mucosal growth, occurring in females (mean age, 54.9 yrs) and males (mean age, 44.2 yrs) in a female:male ratio of 1:1.1. The most common location is by far the gingival margin and other areas of the masticatory oral mucosa. Comparison between 173 non-Japanese and 109 Japanese patients with oral VX showed few discrepancies in epidemiological data, indicating only few significant ethnic differences between the two cohorts. Histomorphologically, the epithelium covering the lesion can be divided into three groups: (A) a verrucous, (B) a papillary and (C) a flat pattern. The hallmark of all VX, irrespective of the lesion being intra- or extraoral is, however, the presence of vacuolated, foam or xanthoma cells which ultimately replace the connective tissue between the epithelial ridges. The xanthoma cells have been shown to be cells of the monocyte/macrophage lineage. The present concept of the etiology and pathogenesis of VX, including the possible viral (HPV) association is revised, based on both intra- and some extraoral cases, and it is concluded that it is still far from being clarified.
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Affiliation(s)
- H P Philipsen
- Edificio El Cóndor 30, Guadalmina Alta, San Pedro de Alcántara, Spain
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34
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Connolly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD. Management of cutaneous verruciform xanthoma. J Am Acad Dermatol 2000; 42:343-7. [PMID: 10640929 DOI: 10.1016/s0190-9622(00)90108-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Verruciform xanthoma is an uncommon mucocutaneous condition of uncertain cause that only occasionally affects the skin. The histopathology is distinctive for the presence of foamy histiocytes present within elongated dermal papillae. Although simple excision of intraoral lesions is reportedly curative, treatment of cutaneous lesions has not been previously reported. We describe a 62-year-old man with a large lesion of verruciform xanthoma affecting both inguinal folds. Immunohistochemical staining, reverse transcriptase polymerase chain reaction for human papilloma virus, and ultrastructural analysis were performed to investigate the pathogenesis of this lesion. The results of these studies support the theory that the source of lipid in dermal histiocytes is degenerating keratinocytes. Initial treatment with wire loop electrosection, pulsed dye (585 nm) laser, and x-ray therapy of this patient proved unsuccessful. Preliminary success has been achieved using wide surgical excision with primary closure.
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Affiliation(s)
- S B Connolly
- Department of Dermatology, University of Minnesota, Minneapolis, USA
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35
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Matsumoto T, Nobukawa B, Kobayashi K, Watanabe M, Hosokawa A, Tomaru K, Ichikawa G. Solitary polypoid xanthoma in the larynx. Histopathology 1999; 34:475-7. [PMID: 10231427 DOI: 10.1046/j.1365-2559.1999.0676d.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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36
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Polonowita AD, Firth NA, Rich AM. Verruciform xanthoma and concomitant lichen planus of the oral mucosa. Int J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0901-5027(99)80682-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
We report a case of verruciform xanthoma of the nasal skin. The case is unique because the lesion both bled and has shown evidence of multicentricity.
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Affiliation(s)
- T Than
- Department of Histopathology and ENT Surgery, Sunderland Royal Hospital, UK
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40
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KISHIMOTO S, TAKENAKA H, SHIBAGAKI R, NAGATA M, YASUNO H. Verruciform xanthoma in association with a vulval fibroepithelial polyp. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb01126.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Takiwaki H, Yokota M, Ahsan K, Yokota K, Kurokawa Y, Ogawa I. Squamous cell carcinoma associated with verruciform xanthoma of the penis. Am J Dermatopathol 1996; 18:551-4. [PMID: 8902105 DOI: 10.1097/00000372-199610000-00017] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a case of squamous cell carcinoma of the penis that seemed to arise within a verruciform xanthoma of this organ. A lesion in the prepuce was initially diagnosed as a verruciform xanthoma histopathologically and was removed in part. Six years later, the patient exhibited a well-differentiated squamous cell carcinoma of the penis that contained many clusters of xanthoma cells in the stroma. Although the retrospective examination of biopsy specimens of the initial lesion in this patient showed the features mainly of verruciform xanthoma, significant architectural and cytological atypia was also present in the overlying epidermis. Thus, we must be careful not to overlook the presence of a squamous cell carcinoma arising within a benign reactive lesion such as a verruciform xanthoma.
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Affiliation(s)
- H Takiwaki
- Department of Dermatology, School of Medicine, University of Tokushima, Japan
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42
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Huang JS, Tseng CC, Jin YT, Huang CC, Wong TY, Chen HA, Chen HR, Kuo MY, Kuo YS. Verruciform xanthoma. Case report and literature review. J Periodontol 1996; 67:162-5. [PMID: 8667137 DOI: 10.1902/jop.1996.67.2.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Verruciform xanthoma is a relatively uncommon lesion. Half of the reported cases occurred in the gingiva or alveolar ridge. In most cases, the clinical impressions are papilloma or verrucous carcinoma, which demonstrates the importance of the clinical and pathological recognition of this lesion. The cause of pathogenesis is still unknown since the first report in 1971. There are some cases reported in conjunction with leukoplakia, carcinoma in situ, pemphigus, and discoid lupus erythematosus (DLE), which merits close evaluation of this disease. This article reports two cases of verruciform xanthoma and reviews the evidence of its pathogenesis from the available literature.
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Affiliation(s)
- J S Huang
- National Cheng-Kung University Hospital, Taiwan, ROC
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Requena L, Sarasa JL, Martin L, Pique E, Farina MC, Olivares M, Escalonilla P. Verruciform xanthoma of the penis with acantholytic cells. Clin Exp Dermatol 1995; 20:504-8. [PMID: 8857349 DOI: 10.1111/j.1365-2230.1995.tb01390.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Verucciform xanthoma is an unusual lesion characterized by verrucous epithelial proliferation accompanied by a prominent replacement of the dermal papillae with foamy histiocytes. We describe a case of verruciform xanthoma on the glans penis. The most striking histopathological finding was the presence of numerous acantholytic cells in the upper layers of the epithelium. We discuss the differential diagnosis with other acantholytic disorders of the genital area and conclude that our findings can be interpreted as an additional example of incidental acantholysis.
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Affiliation(s)
- L Requena
- Department of Dermatology, Universidad Autonoma, Madrid, Spain
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