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      Verruciform xanthoma of the tongue

      case-report

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          Abstract

          Verruciform xanthoma is a benign, soft tissue lesion occurring on the orogenital mucosa. Presentation of oral lesions can be pink, yellow, or gray raised plaque or papule with granular, papillary, or verrucous in nature. There are many theories proposed for the etiopathogenesis of verruciform xanthoma. Clinical observations may be misguiding as the lesion resembles malignant and premalignant lesions. Histopathological confirmation is essential for diagnosis and avoiding radical surgery. Once excised, the lesion does not recur. Here, we present a case report of verruciform xanthoma of the tongue in a 50-year-old female patient.

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          Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan.

          H.P Philipsen, P.A Reichart, T Takata … (2003)
          The biological profile of oral verruciform xanthoma (VX) is presented based on a world-wide literature survey of 282 cases. From 1979 onwards, extraoral cases have also been reported. This rare, harmless lesion with a sessile or pedunculated base is a red/pink, papillary/granular/verrucous mucosal growth, occurring in females (mean age, 54.9 yrs) and males (mean age, 44.2 yrs) in a female:male ratio of 1:1.1. The most common location is by far the gingival margin and other areas of the masticatory oral mucosa. Comparison between 173 non-Japanese and 109 Japanese patients with oral VX showed few discrepancies in epidemiological data, indicating only few significant ethnic differences between the two cohorts. Histomorphologically, the epithelium covering the lesion can be divided into three groups: (A) a verrucous, (B) a papillary and (C) a flat pattern. The hallmark of all VX, irrespective of the lesion being intra- or extraoral is, however, the presence of vacuolated, foam or xanthoma cells which ultimately replace the connective tissue between the epithelial ridges. The xanthoma cells have been shown to be cells of the monocyte/macrophage lineage. The present concept of the etiology and pathogenesis of VX, including the possible viral (HPV) association is revised, based on both intra- and some extraoral cases, and it is concluded that it is still far from being clarified. Copyright 2002 Elsevier Science Ltd.
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            Cellular basis of verruciform xanthoma: immunohistochemical and ultrastructural characterization.

            K Kusama, Hiromu Mishima, Anneyuko Saito … (2008)
            Verruciform xanthoma (VX) holds two basic pathogenic interests: (1) Why and how do macrophage foam cells accumulate exclusively in the sub-basal papillae? and (2) What underlies the disease chronicity? Moreover, an unsolved question is which came first - epithelial hyperplasia or foam cell collection? We analyzed 36 oral mucosal lesions to dissect a series of linked cellular changes in VX using immunohistochemical and ultrastructural techniques. Macrophage scavenger receptor-1 (MSR-1), monocyte chemoattractant protein-1 (MCP-1), CCR2, and oxidized low-density lipoprotein (ox-LDL) were all expressed by foam cells. VX epithelium showed reactivity for MCP-1, HLA-DR and IL8 in varying degrees, and showed a nearly 40% reduction in Langerhans cell density. In sub-epithelial inflammatory infiltrates, CD8+ T cells preponderated (>70%), but only a minority were positive for granzyme B (<1%). Keratinocyte/basal lamina complex exhibited disruption of basal lamina, squamatization and cytolysis of basal cells, fragmentation of desmosomes, and intraepithelial migration of macrophages. In severely inflamed papillae, necrotic foam cells were scavenged by adjacent macrophages. Under synergistic regulation of T cells, MCP-1/CCR2-mediated macrophage recruitment in the sub-basal papillae and the lysosomal engulfment of epithelial lipids by MSR-1-bearing macrophages may be central in VX formation. Once developed, ox-LDL-induced foam cell necrosis and macrophage-dependent debris disposal may cyclically perpetuate VX.
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              Oral verruciform xanthoma: a clinicopathologic study of 15 cases.

              Chuan-Hang Yu, Tung-Chieh Tsai, Jeng-Tzung Wang … (2007)
              Oral verruciform xanthoma (VX) is an uncommon oral mucosal lesion. This retrospective study evaluated the clinical and histopathologic features of 15 oral VXs occurring in Taiwanese patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Natl J Maxillofac Surg
                Journal ID (iso-abbrev): Natl J Maxillofac Surg
                Journal ID (publisher-id): NJMS
                Title: National Journal of Maxillofacial Surgery
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0975-5950
                ISSN (Electronic): 2229-3418
                Publication date (Print): Jan-Jun 2017
                Volume: 8
                Issue: 1
                Pages: 78-80
                Affiliations
                [1]Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital, Sangli, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Sanjay Byakodi, Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed University Dental College and Hospital, Sangli, Maharashtra, India. E-mail: sanjaybyakodi@ 123456gmail.com
                Article
                Publisher ID: NJMS-8-78
                DOI: 10.4103/0975-5950.208982
                PMC ID: 5512415
                SO-VID: 1a128912-2bee-4983-85af-fec0008868a7
                Copyright © Copyright: © 2017 National Journal of Maxillofacial Surgery
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: foam cells,tongue,verruciform xanthoma
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: foam cells, tongue, verruciform xanthoma

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