Verruciform xanthoma is an unusual lesion that was initially reported in 1971. Clinically, it is a verrucous, vascular, epithelial plaque or papillomatous growth commonly found on oral or mucosal tissues. Histologically, it is characterized by a verruciform epithelium with abundant parakeratosis and by foam cells occupying the vascularized dermal papillae. This is the second extramucosal verruciform xanthoma reported. Our patient had several unique features. She is the youngest patient described to date, her lesion is the largest reported, and the lesion occurred in an epithelial nevus-type eruption of a phocomelic extremity. Light and electron microscopic studies disclosed abnormal keratinization, mast cell proliferation, and the previously described foam cells. We believe that the verruciform xanthoma in our patient represents part of a reaction to the epithelial nevus occurring in association with a developmental anomaly.
Late-onset chronic mucocutaneous candidiasis (CMCC) is part of a spectrum of candidal infections. It usually develops during or after the fourth decade of life and is often associated with an underlying neoplasm, especially thymoma. A 56-year-old man with late-onset CMCC and thymoma had several unusual features. His malignant thymoma seemed to be more widespread than the thymomas of previously described patients. Ocular infection was present in addition to extensive involvement of the skin, nails, and oral mucosa. To our knowledge, this is the first report of ocular involvement in this syndrome. We also believe that this is the first patient with thymoma-associated late-onset CMCC to be treated effectively with ketoconazole.
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