Abstract
Verruciform xanthoma (VX) is a rare benign lesion of unknown etiology, with a rough or papillary aspect, painless, sessile, well-defined, most lesions do not exceed 2 cm in their largest diameter, the degree of keratinization of the surface influences color, varying white to red, affecting mainly the gingiva and alveolar mucosa, and can also be seen in skin and genital. Herein, we present a report a clinical case of oral verruciform xanthoma in the buccal mucosa associated with the lichen planus lesion, as well as the morphological and immunohistochemical characteristics of the lesion. The clinical diagnostic hypothesis of oral lichen planus of the white reticular lesions on the buccal mucosa and on the tongue was confirmed by histopathology before a subepithelial connective tissue exhibiting intense inflammatory infiltrate in a predominantly lymphocytic band. In contrast, the hypothesis of the verrucous lesion in the left buccal mucosa was leukoplakia, with histopathological evidence showing exophytic and digitiform proliferations with parakeratin plugs between the papillary projections. Subepithelial connective tissue was characterized by macrophages with foamy cytoplasm (xanthoma cells). An immunohistochemical examination was performed, showing positivity for CD68, a macrophage marker, in addition to testing by Schiff's periodic acid (PAS) with diastasis, which was detected the presence of lipids inside these macrophages. The patient is free of recurrences of verruciform xanthoma and is being monitored due to the presence of lesions of oral lichen planus.
Highlights
Verruciform xanthoma (VX) is an uncommon lesion of uncertain etiology, first described in the oral mucosa by Shafer in 1971, but which can affect the skin and other human mucous membranes.[1-4]
Among the hypotheses suggested for its development is chronic irritation caused by trauma, which would favor epithelial cell degeneration and consequent release of lipid material, which would be phagocyted by macrophages.[3,6,10,13,14]
VX was located in the buccal mucosa, agravating factors or trauma in the region were not identified, discarding this possible etiology
Summary
Verruciform xanthoma (VX) is an uncommon lesion of uncertain etiology, first described in the oral mucosa by Shafer in 1971, but which can affect the skin and other human mucous membranes.[1-4]. It presents as a sessile, asymptomatic lesion, with a warty, papillary or granular surface, ranging from whitish-yellow to red.[3-9] In general, it consists of small lesions located mainly on the gums, tongue, hard palate and buccal mucosa, and a differential diagnosis with other lesions that may affect the oral mucosa is possible, such leukoplakia, hyperkeratosis and white spongy nevus .
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