J Korean Assoc Oral Maxillofac Surg.  2013 Dec;39(6):292-296. 10.5125/jkaoms.2013.39.6.292.

Verruciform xanthoma of the palatal gingiva: a report of two cases

• Ryu DJ
• Lee SH
• Yuk JI
• Kim HJ
• Huh JK
• Park KH

• KMID: 1960980
• DOI: http://doi.org/10.5125/jkaoms.2013.39.6.292

Abstract

Verruciform xanthoma (VX) is a rare, benign lesion that presents in the oral cavity, skin, or genital organs as a verrucous, papillomatous, or flat papule with varying colors. VX has indistinct clinical features, making histopathological examination necessary for a definitive diagnosis. Histologically, VX is characterized by parakeratosis, rete ridges with uniform depth, and an accumulation of the foam cells, which are also known as the "xanthoma cells". These foam cells test positive for antibodies, such as CD-68 and vimentin; it is thought that VX foam cells are derived from the monocyte-macrophage lineage, and that VX's pathogenic mechanism is partly related to an immune mechanism. Nevertheless, the pathogenesis of VX remains unclear. VX can be treated by surgical excision; other medical, chemical, and radiological treatments are not required postoperatively. Recurrence and malignant transformation of VX are rare. Two patients, each with a mass of unknown origin on the palatal gingiva, were presented at our clinic. Excisional biopsies of the masses were performed for a histological diagnosis after clinical and radiological examinations. Histological examination confirmed a diagnosis of VX in both cases.

Keyword

Verruciform xanthoma; Mouth; Foam cells; Immune mechanism

MeSH Terms

Antibodies
Biopsy
Diagnosis
Foam Cells
Genitalia
Gingiva*
Humans
Mouth
Parakeratosis
Recurrence
Skin
Vimentin
Xanthomatosis*
Antibodies
Vimentin

Figure

• 

  Fig. 1 Clinical aspect of the palate lesion in Case 1 on the first visit. A reddish papule with a rough verrucous surface and distinctive margin can be observed.

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  Fig. 2 Radiological examination of Case 1. A. Periapical view. B. A magnified view of orthopantogram. No specifing findings on these two radiograph images.

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  Fig. 3 Histopathological examination of Case 1 after excisional biopsy. A. The tissue has a papillary appearance with hyperparakeratosis and uniform rete peg (H&E staining, ×40). B. High magnification (H&E staining, ×200) illustrates large foam cells (xanthoma cells, black arrows) in the connective tissue papillae.

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  Fig. 4 Follow-up clinical photos of Case 1 representing a good secondary healing state. A. Two weeks postoperative. B. Three weeks postoperative. C. Five weeks postoperative. D. Four months postoperative. E. One year postoperative.

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  Fig. 5 Histopathological examination of Case 2 at the diagnostic incisional biopsy. A. Papillary surface with parakeratosis (H&E staining, ×100). B. Xanthoma cells (black arrows) (H&E staining, ×400).

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