Verruciform xanthoma of the penis with acantholytic cells

Abstract

Verucciform xanthoma is an unusual lesion characterized by verrucous epithelial proliferation accompanied by a prominent replacement of the dermal papillae with foamy histiocytes. We describe a case of verruciform xanthoma on the glans penis. The most striking histopathological finding was the presence of numerous acantholytic cells in the upper layers of the epithelium. We discuss the differential diagnosis with other acantholytic disorders of the genital area and conclude that our findings can be interpreted as an additional example of incidental acantholysis.

Disseminated verruciform xanthoma

“…Additional lymphocytes, plasma cells, neutrophils and a few eosinophils can be observed under and within the xanthomatous cells. Occasionally, exocytosis of neutrophils in the upper epidermis may be observed 1–3 . The present case shows all the typical features of VX with no histopathological differences between the cutaneous and mucosal lesions.…”

“…S ir , Verruciform xanthoma (VX) is a rare histopathological entity first described by Shafer in 1971 1 . VX usually consists of a solitary lesion most commonly occurring on the oral mucosa, although several reports have described VX involving other mucosal surfaces including the anogenital area 2,3 and the skin 4 . Multifocal cutaneous involvement is extremely rare and frequently associated with a pre‐existing inflammatory process 4 .…”

“…VX is a rare mucocutaneous entity usually consisting of a solitary lesion with special predilection for the oral cavity 1,4 . Extraoral occurrence of VX is rare and has been reported mainly involving the anogenital area including the vulva, 2 penis, 3 scrotum 3 and anal region 5 . Only a few cases with cutaneous involvement different from the genital area have been reported 4 .…”

Mimickers of classic acantholytic diseases

“…Many reports of acantholytic changes in the epidermis overlying or adjacent to a number of benign and malignant neoplasms have been reported including basal cell carcinoma (Fig. ), dermatofibroma, keratoacanthoma, psoriasis, elastolytic granuloma, superficial fungal infections, leukocytoclastic vasculitis, angiomas and a verruciform xanthoma . Some authors have suggested that the finding of FAD indicates generalized epidermal photodamage and is a precancerous marker for mutagenesis and tumor development .…”

“…13), dermatofibroma, keratoacanthoma, psoriasis, elastolytic granuloma, superficial fungal infections, leukocytoclastic vasculitis, angiomas and a verruciform xanthoma. [59][60][61][62] Some authors have suggested that the finding of FAD indicates generalized epidermal photodamage and is a precancerous marker for mutagenesis and tumor development. 63 Conclusive evidence supporting this hypothesis is lacking, and further studies are needed to establish the relationship, if any, to photodamage-associated dysplasia.…”