Penis & scrotum
Inflammatory
Cutaneous verruciform xanthoma
Authors: Alcides Chaux, M.D., Antonio L. Cubilla, M.D.
Topic Completed: 1 February 2010
Minor changes: 13 February 2019
Copyright: 2002-2019, PathologyOutlines.com, Inc.
PubMed Search: Cutaneous verruciform xanthoma
Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Differential diagnosisCite this page: Chaux A, Cubilla AL. Cutaneous verruciform xanthoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumcutaneousverruciform.html. Accessed August 6th, 2020.
Definition / general
- Rare disorder of foam cell aggregates in vascularized submucosa or papillary dermis, associated with verrucous epithelial hyperplasia (eMedicine: Verruciform Xanthoma [Accessed 30 March 2018])
Epidemiology
- Mean age 52 years
Sites
- Usually in oral mucosa, penis and rarely in scrotum
Etiology
- Uncertain etiology, although probably a reactive process following epithelial damage
- Initial keratinocyte damage attracts neutrophils, then dermal dendrocytes phagocytosize necrotic keratinocyte debris (Am J Surg Pathol 1998;22:479)
- Foam cells most likely derived from CD68+ dermal dendritic cells
- Some cases are PUVA related (PUVA is Psoralen + UVA treatment for eczema, psoriasis, vitiligo and mycosis fungoides)
- Consistently HPV- (Arch Pathol Lab Med 2005;129:e62)
Clinical features
- Slow growing, painless, solitary exophytic tumors measuring 0.5 - 2.0 cm
Case reports
- 57 year old man with palate lesions (Case of the Week #82)
- Penile lesion (Arch Dermatol 1981;117:516)
- Multiple, coexisitng verruciform xanthomas of anogenital region associated with cutaneous trauma (J Cutan Pathol 2010;37:895)
Treatment
- Excision; does not recur (J Formos Med Assoc 2007;106:141)
Clinical images
AFIP
Granular, elevated
tan white mass
of distal shaft and
coronal sulcus
Gross description
- Solitary, raised or polypoid with cup shaped craters
- Can simulate a verruciform penile tumor such as condyloma (typical or giant) or warty or verrucous carcinoma
Microscopic (histologic) description
- Foam cell aggregates in vascularized submucosa or papillary dermis, associated with verrucous epithelial hyperplasia with acanthosis, papillomatosis, hyperkeratosis with no granular layer and prominent parakeratosis between papillae (Am J Surg Pathol 1998;22:479)
- Cup shaped craters are filled with parakeratotic cells blending into keratinocytes
- Also variable neutrophilic infiltrate near surface of epidermis between plump parakeratotic cells and keratinocytes
- Bandlike plasma cell infiltrate at base of epidermis
- Absence of atypical epithelial changes
Microscopic (histologic) images
AFIP
Papillary epithelial hyperplasia and stromal histiocytes with foamy cytoplasm in papillary cores
Scrotum: crater shaped verrucoid lesion
Scrotum: numerous
foamy macrophages
between elongated
rete ridges
Palate: 57 year old man with papillary lesions
Images hosted on other servers:
H&E and CD68
Tongue: focal parakeratosis, mild epithelial acanthosis and xanthoma cells
Tongue: CD68
Positive stains
- Factor VIIIa, CD68 and Mac387
- Cytokeratin (weak)
Negative stains
Electron microscopy description
- Xanthoma cells contain membrane bound lysosomes, myelin figures and fragmented desmosomes
Differential diagnosis
- Condyloma acuminatum: prominent koilocytotic atypia in upper epidermis, no prominent foamy macrophages
- Squamous cell carcinoma: marked atypia, no prominent foamy macrophages
- Verrucous carcinoma: ulcerating or fungating lobules of mature squamous epithelium, minimal atypia but no prominent foamy macrophages
