Xantoma verruciforme

Verruciform xanthoma (VX) is an uncommon benign lesion of adults and was first described by Shafer in 1971 in the oral mucosa.[1] Subsequently, extra-oral cases have been reported in the anogenitalmucosa and skin including vulva, penis, and scrotum.[2–4] Oral VX presents as a demarcated, granular, soft, and asymptomatic lesion exhibiting a flat to papillary or verrucous surface. Verruciformxanthoma can be solitary or multiple and can be found in masticatory mucosal sites with a predilection of involvement in the gingival margin, hard palate, and tongue.[5–7] Irrespective of the intra- orextra-oral location of the lesion, the accumulation of lipid-laden macrophages or foamy histiocytes (xanthoma cells) in the elongated connective tissue papillae between the acanthotic squamousepithelial ridges of uniform depth is the characteristic microscopic feature of VX.[4, 8] Despite the distinct histological findings, the clinical differential diagnosis of VX encompasses several benign andmalignant lesions. We discuss the diagnostic pitfalls and pathogenesis of this rare entity in light of information from the literature.
Case Report
A 38-year-old non-smoking female presented with alesion at the left ventral surface of the tongue, that exhibited a mild dull pain, that she first noticed 2.5 months prior to seeking medical care. The plaque was about 1 cm in size, yellowish-pinkcolored, and slightly elevated with an irregular surface consisting of numerous papulesthat resembled fish eggs (Fig. 1). Her past medical history, including her family history was unremarkable. Nohistory of frank trauma to the relevant side of the tongue was declared. Because the clinical features were not suggestive of any specific and usual oral lesion, diagnostic punch biopsy was performed.Histopathological examination revealed focal parakeratosis, mild epithelial acanthosis with regularly elongated rete and subepithelial cellular infiltrates composed uniformly of foamy macrophages, which...