Dermpath-India: Verruciform Xanthoma

Path Quiz Case- 14

Dr Sampurna Roy MD

Case 14: history and images:

click on the image

April 2008

Normal Histology of Skin

Gross examination of the skin specimen

Reporting of biopsies taken for Inflammatory Skin Diseases

Lichenoid (Interface)Tissue Reaction Pattern

Psoriasiform Reaction Pattern

Vesiculobullous Reaction Pattern

Spongiform Reaction Pattern

Vasculopathic Reaction Pattern

Lichen planus-like lesions

Bullous Pemphigoid

Dermatitis Herpetiformis

Hailey-Hailey Disease

Erythema Nodosum

Toxic Shock Syndrome

Drug related cutaneous lesions

Cutaneous lesion in graft-
versus host disease

Granulomatous Reaction Pattern of the Skin

Granuloma Annulare

Necrobiosis Lipoidica

Necrobiotic Xanthogranuloma

Rheumatoid Nodule

Cutaneous Sarcoidosis

Melkersson Rosenthal Syndrome

Annular Elastolytic Giant Cell Granuloma

Skin lesion in Crohn's Disease

Blastomycosis-like pyoderma

Foreign body granuloma

Interstitial Granulomatous Dermatitis

Interstitial Granulomatous Drug Reaction

Granulomatous T-cell lymphoma

Cutaneous infection and infestations

Histopathological patterns in cutaneous infections

1: Bacterial, Rickettsial and Chlamydial infection

2 : Spirochetal Infection

3 : Mycoses and algal infections

4 : Protozoal Infections

5 : Helminth Infections

6 : Viral Infections

Cutaneous lesion associated
with AIDS

Melanocytic tumours

Acquired Melanocytic Naevus

Balloon cell naevus

Mongolian Spots /Ota's naevus /Ito's naevus

Blue naevus-variants

Deep penetrating naevus

Combined Naevus

Recurrent naevus

Dysplastic naevus

Congenital naevus

Spindle cell naevus

Pigmented melanocytic lesions causing diagnostic problems

Prognostic parameters of melanoma

Lentigo maligna melanoma

Superficial spreading melanoma

Nodular melanoma

Acral lentiginous melanoma

Desmoplastic /Spindle cell /Neurotropic melanoma

Naevoid melanoma

Balloon cell melanoma

Epidermal tumours

Epidermal Naevus

Prurigo Nodularis

Clear cell acanthoma

Large cell acanthoma

Warty Dyskeratoma

Seborrheic Keratosis

Verruca vulgaris;

Keratoacanthoma

Actinic Keratosis

Bowen's disease

Basal Cell Carcinoma

Squamous Cell Carcinoma

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

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.

VX 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: Image Link1 ; Image Link2 ; Image Link3; Image Link4.

Hyperkeratosis, focal parakeratosis & 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 CD 68[KP1] and vimentin & weak positivty for cytokeratin. S100 protein is negative.

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Abstracts:
A novel somatic mutation of the 3beta-hydroxysteroid dehydrogenase gene in sporadic cutaneous verruciform xanthoma.Arch Dermatol. 2005 Oct;141(10):1263-7.

Verucciform xanthoma of the penis not associated with human papillomavirus infection. Arch Pathol Lab Med. 2005 Mar;129(3):e62-4.

Verruciform xanthoma of the oral cavity: clinicopathological study relating to pathogenesis. Report of three cases.APMIS. 2005 Sep;113(9):629-34.

Verruciform xanthoma in close association with isolated epidermolytic acanthoma: a case report and review of the Japanese dermatological literature.J Dermatol. 2005 Jun;32(6):464-8.

Study of the clinicopathology on verruciform xanthoma of the oral cavity. Shanghai Kou Qiang Yi Xue. 2005 Aug;14(4):370-3.

Recurrent verruciform xanthoma of the vulva. Int J Gynecol Pathol. 2004 Jan;23(1):75-7.

Verruciform xanthoma. Mund Kiefer Gesichtschir. 2003 Jan;7(1):52-5.

Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan.Oral Oncol. 2003 Jun;39(4):325-36.

Verruciform xanthoma of the esophagus. Hum Pathol. 2003 Aug;34(8):814-5.

A giant verruciform xanthoma. J Cutan Pathol. 2002 Feb;29(2):119-24.

Verruciform xanthoma of the oral mucosa. Report of four cases and a review of the literature.Oral Oncol. 2001 Apr;37(3):326-31.

Association of human papillomavirus type 6 with a verruciform xanthoma. Am J Dermatopathol. 2000 Oct;22(5):447-52.

Verruciform xanthoma and concomitant lichen planus of the oral mucosa. A report of three cases.Int J Oral Maxillofac Surg. 1999 Feb;28(1):62-6.

Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells.Am J Surg Pathol. 1998 Apr;22(4):479-87.

Verruciform xanthoma of the oral mucosa: an immunohistochemical and ultrastructural study of two cases.Oral Oncol 1997 Jul; 33(4): 279-83

Verruciform xanthoma of the penis.Actas Urol Esp. 1997 Sep;21(8):797-9.

Squamous cell carcinoma associated with verruciform xanthoma of the penis. Am J Dermatopathol. 1996 Oct;18(5):551-4.

Verruciform xanthoma of the penis with acantholytic cells.Clin Exp Dermatol. 1995 Nov;20(6):504-8.

Verruciform xanthoma: a benign penile growth.J Urol. 1995 May;153(5):1625-7.

Verruciform xanthoma in a bone marrow transplant recipient.Oral Surg Oral Med Oral Pathol. 1993;75(5):591-4.

Multifocal verruciform xanthoma of the upper aerodigestive tract in a child with a systemic lipid storage disease. Am J Surg Pathol.1989 Apr;13(4):309-16.

Verruciform xanthoma of the vulva: case report.Genitourin Med. 1989 Aug;65(4):252-4.

Verruciform xanthoma within carcinoma in situ.J Oral Maxillofac Surg. 1989 Apr;47(4):398-400.

Langerhans cells in verruciform xanthomas: an immunoperoxidase study of 10 oral cases. J Oral Pathol. 1986 Jan;15(1):48-53.

Verruciform xanthoma of the vulva. Report of two cases.Am J Clin Pathol. 1979 Feb;71(2):224-8.

Verruciform xanthoma. Further light and electron microscopic studies, with the addition of a third case.Oral Surg Oral Med Oral Pathol. 1975 Aug;40(2):246-56.

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Pathology of the Eyelid

Inflammatory diseases of the Eyelid

Tumour and tumour-like lesions of the Eyelid

Adnexal Tumours of the eyelid

Epidermal tumours of the Eyelid

Mesenchymal Tumours of the Eyelid

Melanocytic tumours of the Eyelid

Skin Tumours

Skin Adnexal Tumours

Benign Sweat Gland Tumours

Chondroid syringoma

Syringocystadenoma Papilliferum

Hidradenoma Papilliferum

Papillary Eccrine Adenoma

Apocrine Adenoma

Classification of Malignant Sweat Gland Tumours

Mucinous carcinoma

Extramammary Paget's disease

Digital papillary adenocarcinoma

Microcystic adnexal carcinoma

Apocrine carcinoma

Cutaneous adenoid cystic carcinoma

Hidradenocarcinoma

Spiradenocarcinoma

Syringomatous ca

Eccrine ductal carcinoma

Clear cell carcinoma

Tumours of the Hair Follicle

Trichoepithelioma

Trichofolliculoma

Cutaneous lymphadenoma

Pilar Sheath Acanthoma

Tumour of the Follicular Infundibulum

Trichilemmal Carcinoma

Proliferating Trichilemmal Tumour

Sebaceous tumours