Verruciform xanthoma is a rare, benign, papillary lesion that most commonly arises on the oral mucosa, particularly the gingiva, alveolar ridge, and buccal mucosa, but may also occur on the skin of the genitalia, esophagus, and other mucosal surfaces. The lesion is characterized histologically by a papillary or verrucous architecture with an accumulation of lipid‑laden macrophages (foam cells) within the connective tissue papillae beneath the epithelium.
Epidemiology
- Occurs predominantly in adults, with the highest incidence reported in the fifth to seventh decades of life.
- No significant gender predilection has been consistently demonstrated.
- The condition is uncommon, representing a small fraction of oral mucosal lesions.
Clinical Presentation
- Appears as a well‑demarcated, sessile or slightly elevated plaque or papule, typically measuring 0.5–2 cm in diameter.
- The surface may be smooth, papillary, or verrucous, often described as “wart‑like.”
- Lesions are usually asymptomatic, but occasional irritation or discomfort may be reported.
- The overlying mucosa is generally of normal coloration, though erythematous or hyperpigmented variants have been described.
Histopathology
- The overlying epithelium shows hyperkeratosis, acanthosis, and often a papillary or verrucous pattern.
- The underlying connective tissue papillae contain abundant foamy macrophages (xanthoma cells) that are CD68‑positive on immunohistochemistry, indicating their histiocytic origin.
- There is typically no dysplasia or malignancy associated with the lesion.
Pathogenesis
- The exact etiology is uncertain. Proposed mechanisms include a localized inflammatory response leading to lipid accumulation within macrophages, possibly secondary to trauma, irritation, or an unidentified antigenic stimulus.
- No consistent association with systemic lipid metabolism disorders has been established.
Differential Diagnosis
- Verruca vulgaris (common wart)
- Condyloma acuminatum
- Squamous papilloma
- Verrucous carcinoma
- Oral lichen planus (when keratotic)
Histopathological examination is essential for definitive diagnosis, as clinical features overlap with other papillary lesions.
Management
- Surgical excision is the treatment of choice and is usually curative.
- Alternative modalities such as laser ablation or cryotherapy have been employed with success.
- Recurrence after complete excision is rare.
Prognosis
- Verruciform xanthoma has an excellent prognosis, with no malignant potential reported.
- Long‑term follow‑up is generally not required unless recurrence is observed.
Etymology
- “Verruciform” derives from Latin verruca meaning “wart,” referring to the wart‑like appearance.
- “Xanthoma” originates from Greek xanthos meaning “yellow,” describing the yellowish hue of the lipid‑laden macrophages within the lesion.
References
- Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization Classification of Tumours. Pathology and Genetics of Head and Neck Tumours. IARC Press; 2005.
- Slootweg PJ. Verruciform xanthoma of the oral mucosa. J Oral Pathol Med. 1974;3(1):13‑20.
- Gorsky M, et al. Verruciform xanthoma: clinicopathologic analysis of 42 cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 1994;77(5):527‑531.
