Genital verruciform xanthoma: lessons from a contemporary multi‐institutional series

Abstract

Aims: Verruciform xanthoma (VX) is an uncommon lesion, seen in the oral mucosa and rarely occurring at cutaneous genital sites. Reports of exceptional VX presentations dominate the literature; herein, we assess the clinical and histological features of a cohort of routine, consecutive cases. Methods and results: Clinicopathological features of genital VXs from four academic centres were reviewed. A cohort of 25 lesions from 24 patients (22 male, two female; median age = 62 years), occurred on the scrotum (84%), penis (8%) and perineum/ vulva (8%). VX was never suspected clinically; considerations ranged from fibroepithelial polyps to squamous cell carcinoma. Classic diagnostic criteria were present at least focally in each lesion, including verrucous architecture, prominent wedge-shaped parakeratosis extending between exophytic epidermal projections and neutrophils in the stratum corneum. Xanthomatous cells were present in all cases, but scattered to rare in 24%. Conclusions: Consecutive genital VXs reliably exhibited classic histopathological features, although the essential finding of xanthomatous cells may be scarce. Our comparison to meta-analyses of published cases found relatively fewer penile and vulvar examples. Additionally, the median age was older than in published series, which have emphasised syndromic associations.

Histological differential diagnosis of verruca vulgaris: A systematic review

“…Clinically, VX is presented as Papillary or cauliflower-like growth commonly seen in the oral mucosa and is sometimes pedunculated. Microscopically, the lesion has a hallmark of accumulation of foamy macrophages with lipid-containing vacuoles; however, VX shares hyperkeratosis, parakeratosis, and papillomatosis with VV [31][32][33][34][35][36] . In addition to the differential diagnosis, VV has several variants [Figure 2].…”

Vulvar Verruciform Xanthoma: A Comprehensive Literature Review

“… 1 The second main feature is the papillomatous appearance, including plaque-like configurations, more polypoid papular proliferations to lesions, discrete frondular papillae overlying ectatic basal vessels and variable chronic inflammation. 27 …”