Verruciform xanthoma of the oral mucosa: A clinicopathological study with immunohistochemical findings relating to pathogenesis

Abstract

Verruciform xanthoma is an uncommon benign lesion with unknown aetiology and pathogenesis. In this study, we report ten cases of verruciform xanthoma and document their clinical and histopathological findings. An immunohistochemical investigation was performed using antibodies to macrophage, leukocyte common antigen, T lymphocytes, B lymphocytes, S-100 protein, lysozyme and alpha-1-antichymotrypsin. Our results were similar to the other reported cases. Eighty percent of our cases were found on the gingiva. Candidal hyphae were found in the superficial parakeratotic layers in five cases. The clinical diagnosis of the lesion ranged between papilloma and squamous cell carcinoma. It is important for clinicians to take into consideration the possibility of verruciform xanthoma in the differential diagnosis of papillary and granular lesions of oral mucosa. Immunohistochemically, all foam cells were strongly stained with antimacrophage antibodies. T lymphocytes were the predominant infiltrating lymphocytes in the lesion. Langerhans cells in the epithelia were fewer than those in corresponding normal tissue. Our immunohistochemical findings suggest that verruciform xanthoma is may be a local immunological disorder, with a cell mediated mechanism.

Oral Verruciform Xanthoma Associated with Chronic Graft-Versus- Host Disease: A Report of Five Cases and a Review of the Literature

“…The hallmark feature of VX is the presence of large, lipid-laden foam cells within the connective tissue papillae [1]. These foam cells were found to be histiocytes or macrophages based on immunohistochemical findings demonstrating positivity for CD68, macrophage scavenger receptor-I (MSR-I), monocyte chemo-attractant protein-I (MCP-I), CCR2, and oxidized low-density lipoprotein (OX-LDL) [35,36]. A cystic variant of VX has also been reported [37].…”

Oral verruciform xanthoma: a case report and literature review

“…There is a controversy over the exact origin of these cells. They are said to be a lineage of monocytes/macrophages [19,20]. The lipid found in the xanthoma cells is said to be the same as seen in other inflammatory reactions [12].…”

“…However, a recurrent VX of the vulva has been reported in a 30-year-old woman, 8 years after the initial treatment [20]. Histopathological examination of the biopsies should be performed to distinguish VX from other verrucous lesions [2,21].…”

Verruciformes Xanthom

“…Das besondere Interesse galt in mehreren Studien den Xanthomzellen. Immunhistochemische Untersuchungen konnten hier das Oberflä-chenantigen CD68 als Marker für Makrophagen in den charakteristischen Schaumzellen nachweisen [6,7,14]. In der vorliegenden TEM-Untersuchung konnten die Schaumzellen morphologisch der Makrophagenreihe zugeordnet werden.Auffallend waren zahlreiche, membrangebundene Lipideinschlüsse, die in ihrer Elektronendichte variierten.…”