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Pathology of Verruciform


Dr Sampurna Roy MD


Pathology Quiz Case 14: Case history and images:

Diagnosis: Verruciform Xanthoma 




Verruciform xanthoma (VX) is a rare, benign, mucocutaneous,  nondestructive lesion characterized by proliferation of non-Langerhans lipid-rich histiocytes. 

Clinically the lesion may mimic cutaneous squamous cell carcinoma and a correct diagnosis is crucial to avoid inappropriate aggressive treatment.

Related post: Pathology of Xanthelasma  

Human papillomavirus has been indicated in several cases of VX as a causative agent. Cases have been reported in immunocompromised patients with HIV-1 infection and  graft versus host disease.

Verruciform xanthoma may be associated with epidermal nevi, fibroepithelial polyp of the vulva, squamous cell carcinoma, arteriovenous hemangioma, discoid lupus erythematosus and lymphedema of the leg. 

Site:  Predominantly noted in the oral cavity, but it has been reported to occur on the genital skin and mucosa (vulva, perianal skin, scrotum, penis).

Gross:  Usually solitary, flat plaques or warty lesions (about 2 cm in diameter).

Microscopic features:  

Hyperkeratosis, focal parakeratosis and verrucous acanthosis.

Exocytosis of neutrophils into the upper layer of epithelium and the parakeratotic scales.

Characteristic feature:  

Presence of numerous xanthoma cells in the papillary dermis. Cells contain lipid and small amounts of PAS-positive diastase resistant material.

Immunohistochemistry :

The characteristic foam cells of verruciform xanthoma showed strong positive staining for CD68 [KP1] and vimentin and weak positivty for cytokeratin. S100 protein is negative.

Differential diagnosis:  

Differential diagnosis also included squamous cell carcinoma, verrucous carcinoma, seborrheic keratosis, verruca vulgaris, condyloma acuminatum, granular cell tumor with pseudoepitheliomatous hyperplasia.

Images related to Verruciform xanthoma


Further reading:

Verruciform xanthoma: A view on the concepts of its etiopathogenesis.

Verruciform xanthoma of the palatal gingiva: a report of two cases.

Verruciform xanthoma.

Verruciform xanthoma of the oral cavity - a case report.

Verruciform xanthoma of the earlobe in an immunosuppressed patient.

Verruciform xanthoma of the upper-extremity in the absence of chronic skin disease or syndrome: a case report and review of the literature.

Verruciform xanthoma: report of five cases.

Verruciform xanthoma with porokeratosis-like features but no clinically apparent lymphedema.

Verruciform xanthoma: report of two cases.

Verruciform xanthoma: a special epidermal nevus.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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