Document Detail

Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells.
MedLine Citation:
PMID:  9537477     Owner:  NLM     Status:  MEDLINE    
Verruciform xanthoma is a rare clinicopathologic entity of uncertain etiology that occurs primarily in the oral mucosa. Aggregates of foam cells in the submucosal stroma or papillary dermis in association with verrucous epithelial hyperplasia are the hallmark of this lesion. Extraoral (cutaneous) occurrence of verruciform xanthoma is much rarer and has been reported mostly in the genital skin. Five cases of extraoral cutaneous verruciform xanthoma (three from the scrotum, one from the penis, and one from the nose) and one histologic "simulant" (from skin of the nose) were studied. The lesions were solitary, raised, or polypoid with cup-shaped craters filled with parakeratotic cells that blended into keratinocytes of an acanthotic and papillomatous epidermis. There was a neutrophilic infiltrate of varying intensity between plump parakeratotic cells and keratinocytes, near the surface of the epidermis. Aggregates of foam cells were present in the papillary dermis, which was highly vascular. A plasma cell predominant infiltrate was seen at the base in a bandlike fashion. Despite the architectural resemblance of verruciform xanthoma to verrucous mucocutaneous lesions related to human papillomavirus infection, it was not detected by either immunohistochemistry, in situ hybridization, polymerase chain reaction, or Southern blot analysis in any case. The foam cells were weakly positive for cytokeratin and for Factor XIIIa but negative for S-100 protein. The KP1 and Mac 387 immunostain showed focal weak staining in foam cells. We postulate that a cascade of events pursue after initial keratinocytic damage attracting neutrophils, with subsequent phagocytosis of necrotic keratinocytic debris by dermal dendrocytes, eventually leading to the ultimate manifestation of the lesion as verruciform xanthoma. The etiologic agent remains elusive, but based on our findings, we conclude that verruciform xanthoma is most likely not a human papillomavirus-associated squamoproliferative lesion and that the foam cells, a histologic hallmark of the lesion, are most likely derived from dermal dendritic cells.
S K Mohsin; M W Lee; M B Amin; M H Stoler; E Eyzaguirre; C K Ma; R J Zarbo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of surgical pathology     Volume:  22     ISSN:  0147-5185     ISO Abbreviation:  Am. J. Surg. Pathol.     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-04-23     Completed Date:  1998-04-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7707904     Medline TA:  Am J Surg Pathol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  479-87     Citation Subset:  IM    
Department of Pathology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
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MeSH Terms
Biological Markers / analysis
Genital Diseases, Male / pathology*,  virology
In Situ Hybridization
Keratins / analysis
Keratoacanthoma / pathology,  virology
Middle Aged
Nose Diseases / pathology*,  virology
Papillomaviridae / isolation & purification
Polymerase Chain Reaction
Psoriasis / pathology,  virology
Transglutaminases / analysis
Xanthomatosis / pathology*,  virology
Reg. No./Substance:
0/Biological Markers; 68238-35-7/Keratins; EC

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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