Oral Verruciform Xanthoma: A Series of 212 Cases and Review of the Literature

Abstract

Verruciform xanthoma (VX) of the oral cavity is an uncommon, reactive lesion of unknown etiology. In this study, we present a large series of VX with analysis of demographics, clinical appearance, histologic presentation and extensive review of literature. To the best of our knowledge, this is the largest series of oral VX reported to date. Following IRB approval, all cases diagnosed as VX found in the archives of the University of Florida Oral Pathology Biopsy Service were included. Patient age, gender, location, clinical appearance, clinical impression, and duration of each lesion was collected. A total of 212 cases were included in our database with a mean age of 61 years (range of 9-94), and a female: male ratio of 1.06:1. The most common location in descending order was the gingiva (n = 110, 51.2%), followed by palate (n = 41, 19.3%), buccal mucosa (n = 18, 8.5%), tongue (n = 20, 9.4%), vestibule (n = 13, 6.1%), lip (n = 4, 1.9%), floor of mouth (n = 3, 1.4%), and unspecified (n = 1, 0.5%). The lesions were most frequently pink in color, and most often described as bumpy, rough, verrucoid and/or papillary. Clinical impression in descending order was papillary (n = 67, 31.6%), not specified or unknown (n = 41, 19.3%), hyperkeratosis (n = 24, 11.3%), fibroma (n = 20, 9.4%), leukoplakia (n = 17, 8.0%), dysplastic lesion (n = 13, 6.1%), pyogenic granuloma (n = 7, 3.3%), granulomatous reaction (n = 5, 2.4%), lichen planus, VX (n = 4 each, 2.0%), pigmented, other lesions (n = 3 each, 1.4%), and salivary and periapical lesions (n = 2 each, 0.9%). Three of the lesions were recurrences. The demographics and clinical parameters of this case series were in concordance with that of previously published reports. In our series, only 4 cases were suspected as VX, demonstrating the lack of familiarity clinicians have with this lesion.

CD163+ Foamy Macrophages Are Associated with the Morphogenesis of Oral Verruciform Xanthoma through Angiogenesis by VEGF Expression: An Immunohistochemical Study

“…Ide et al (2008) suggested periodontal pathogens, mechanical stimuli, smoking, alcohol, drugs, and sensitizing or allergic agents of foodstuffs and dental materials are involved in OVX [23]. Belknap et al (2020) noted subepithelial inflammation, which supports the hypothesis that inflammation is the main etiology of OVX [24]. Moreover, de Andrade et al (2015) concluded that inflammation plays a role in the development of OVX [15].…”

Unusual plaque in a patient with recessive dystrophic epidermolysis bullosa

“…First described in 1971 by Shafer, 1 verruciform xanthoma (VX) is a papillary lesion primarily found in the oral mucosa. 2,3 With a proposed incidence rate of oral VX of 0.025%-0.05%, extraoral cases of VX are exceedingly rare, primarily occurring on the skin and anogenital regions, and often found in association with other conditions such as lymphedema and congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome. 2,3 The etiology of VX remains unclear, and the lesions have been hypothesized to result from a variety of different mechanisms, including trauma, inflammation, candida infection, carcinoma in situ, and immunologic dysfunction.…”

“…2,3 With a proposed incidence rate of oral VX of 0.025%-0.05%, extraoral cases of VX are exceedingly rare, primarily occurring on the skin and anogenital regions, and often found in association with other conditions such as lymphedema and congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome. 2,3 The etiology of VX remains unclear, and the lesions have been hypothesized to result from a variety of different mechanisms, including trauma, inflammation, candida infection, carcinoma in situ, and immunologic dysfunction. 2 Oral verruciform xanthoma typically presents as an asymptomatic 2-mm papule to 1.5-cm nodule with a papillary surface, ranging in color from white, red, or yellow.…”

“…2 Oral verruciform xanthoma typically presents as an asymptomatic 2-mm papule to 1.5-cm nodule with a papillary surface, ranging in color from white, red, or yellow. 2,3 These slow-growing lesions have been reported in individuals ranging from 2 to 89 years old, most frequently appearing in adults between 50 and 60 years old, with the nodules lasting between <1 month and over 5 years. 3 VX typically manifests as a single lesion, and the less-frequent cases of multiple VX lesions have been identified in association with other diseases such as discoid lupus erythematous, oral pemphigus vulgaris, CHILD syndrome, and recessive dystrophic epidermolysis bullosa.…”

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

“…Verruciform xanthoma (VX) is a benign squamous proliferation that presents clinically as a well-circumscribed white, yellow or erythematous papule or plaque with a verrucous surface and a flat or pedunculated base. 3,4 Lesions arising in the oral cavity are most common, and have been described in significant numbers in some series. 4,5 However, an infrequent subset arises at cutaneous sites, 6 often involving the genitals, 7 where they can pose diagnostic challenges clinically as well as histopathologically.…”