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Bar O, Elad S, Avni B, Abu-Tair J, Zaharia B, Hanut A, Zadik Y. Oral verruciform xanthoma in chronic graft-versus-host disease patients. Support Care Cancer 2020; 29:79-84. [PMID: 32803727 DOI: 10.1007/s00520-020-05681-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Verruciform xanthoma (VX) is an uncommon benign epithelial lesion which mainly appears in inflamed oral epithelium. In this study, our aim was to present new cases of oral VX (OVX) in chronic graft-versus-host disease (cGVHD) and review the literature. METHODS We conducted a retrospective chart review of cGVHD patients (2012-2019) to reveal cases of OVX. The demographics, medical background, clinical presentation, treatment provided, and follow-up were obtained. Additionally, Medline was searched using the terms "graft-versus-host disease," "verruciform xanthoma," and "oral." Of the articles, the above-mentioned demographic and clinical features were retrieved. RESULTS The patient pool included 133 oral cGVHD patients. Three cGVHD patients (males, aged 15-49 years, post-hematologic malignancy) were diagnosed with OVX. All patients had oral mucosal lichenoid lesions, but not in close proximity to the VX lesion. Medline searches revealed 9 cases of OVX in cGVHD patients reported in the literature. Eleven of the 12 patients had oral mucosal lichenoid lesions. Four patients had multiple OVX lesions. All lesions were asymptomatic. Six patients had lesions in the masticatory mucosa (hard palate and gingiva) and 4 patients had lesions in the buccal mucosa. CONCLUSIONS To the best of our knowledge, this is the largest published OVX in cGVHD series, including 12 patients. It appears that despite the higher prevalence in cGVHD patients relative to the general population, OVXs do not necessarily develop in sites with lichenoid lesions. It is advised that clinicians be familiar with the clinical and histological features in order to consider OVX in the differential diagnosis of oral lesions in cGVHD patients.
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Affiliation(s)
- Ori Bar
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Batia Avni
- Department of Bone Marrow Transplantation and Immunotherapy, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jawad Abu-Tair
- Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine and Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Bianca Zaharia
- Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine and Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Aiham Hanut
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yehuda Zadik
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. .,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Military Medicine, Hebrew University-Hadassah School of Medicine, P.O. Box 12000, 91120, Jerusalem, Israel.
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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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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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Sette CS, Wachholz PA, Brandão LSG, Marques GF, Casafus FS, Soares CT. Verruciform xanthoma on the penis: an unusual location. Clin Exp Dermatol 2015; 40:807-8. [PMID: 25787016 DOI: 10.1111/ced.12579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- C S Sette
- Lauro de Souza Lima Institute, Bauru (SP), Brazil
| | - P A Wachholz
- Lauro de Souza Lima Institute, Bauru (SP), Brazil
| | | | - G F Marques
- Lauro de Souza Lima Institute, Bauru (SP), Brazil
| | - F S Casafus
- Lauro de Souza Lima Institute, Bauru (SP), Brazil
| | - C T Soares
- Lauro de Souza Lima Institute, Bauru (SP), Brazil.
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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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Murat-Susić S, Pastar Z, Dobrić I, Camino Varela A, Hutinec Z, Husar K, Kljenak A. Verruciform xanthoma in recessive dystrophic epidermolysis bullosa Hallopeau-Siemens. Int J Dermatol 2007; 46:955-9. [PMID: 17822501 DOI: 10.1111/j.1365-4632.2007.03071.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Murat-Susić
- University Department of Dermatology and Venereology, Zagreb University Hospital Center, Zagreb, Croatia.
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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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Abstract
Verruciform xanthoma is xanthomatous dermal infiltrate in a proliferating epidermal lesion and is an uncommon phenomenon. It has been reported in various neoplastic or inflammatory conditions. We report a 72-year-old man who had an asymptomatic 1-cm black nodule on his abdomen. Histopathology showed a typical acanthotic type of seborrheic keratosis characterized by basaloid keratinocyte proliferation and pseudohorn cysts. Many aggregated xanthomatized cells were seen in dermal papillae within the acanthotic epithelium. Papillomatosis, parakeratosis, and neutrophil infiltrates, the histologic features of typical verruciform xanthoma, were not seen. The foamy cells were positive for CD-68 and vimentin and negative for cytokeratin and S-100. No human papillomavirus DNA was found by nested polymerase chain reaction. The blood lipid profile was normal. The presence of verruciform xanthomatous change in seborrheic keratosis provides further evidence that verruciform xanthoma may be a reactive phenomenon occurring in common skin disorders.
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Affiliation(s)
- Yu-Hung Wu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
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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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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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