Pathology of Verruciform
"Appearances are often deceiving -Aesop"
"Clinicians may worry and think it is a malignant tumour. But the histopathologist knows it is a harmless mucocutaneous growth composed of xanthoma cells in the papillary dermis."
Diagnosis: Verruciform Xanthoma
(VX) is a rare, benign, mucocutaneous, nondestructive lesion characterized by proliferation of non-Langerhans
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).
Hyperkeratosis, focal parakeratosis & verrucous acanthosis.
Exocytosis of neutrophils into the upper layer of epithelium and the parakeratotic scales.
Presence of numerous xanthoma cells in the papillary dermis. Cells contain lipid and small amounts of PAS-positive diastase resistant material.
The characteristic foam cells of verruciform xanthoma showed strong positive staining for CD68 [KP1] and vimentin & weak positivty for cytokeratin. S100 protein is negative.
Differential diagnosis also included squamous cell carcinoma, verrucous carcinoma, seborrheic keratosis, verruca vulgaris, condyloma acuminatum, granular cell tumor with pseudoepitheliomatous hyperplasia.
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