Penis & scrotum

Inflammatory

Verruciform xanthoma


Editorial Board Member: Bonnie Choy, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Suzanne J. Tintle, M.D., M.P.H.
Liwei Jia, M.D., Ph.D.

Topic Completed: 19 April 2021

Minor changes: 8 August 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Cutaneous verruciform xanthoma

Suzanne J. Tintle, M.D., M.P.H.
Liwei Jia, M.D., Ph.D.
Page views in 2020: 1,039
Page views in 2021 to date: 1,199
Cite this page: Tintle SJ, Jia L. Verruciform xanthoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumcutaneousverruciform.html. Accessed October 16th, 2021.
Definition / general
  • Rare, nonneoplastic lesion of verrucous epidermal acanthosis, foamy histiocytes aggregates in papillary dermis and neutrophilic inflammation
Essential features
  • Nonneoplastic verrucous lesion characterized by aggregates of lipid laden macrophages in papillary dermis
  • Closely resembles other verrucous lesions clinically and microscopically
ICD coding
  • ICD-10: E75.5 - other lipid storage disorders
Epidemiology
Sites
Etiology
Clinical features
Diagnosis
  • Punch biopsy with subsequent histological examination
Case reports
Treatment
Clinical images

AFIP images

Granular, elevated
tan white mass
of distal shaft and
coronal sulcus

Gross description
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Liwei Jia, M.D., Ph.D.

Verrucous epithelial hyperplasia

Band-like plasma cells

Neutrophilic infiltrates

Foamy histiocytes

Negative stains
Electron microscopy description
Sample pathology report
  • Penis, dorsal, biopsy:
    • Verruciform xanthoma
Differential diagnosis
  • Verruca vulgaris:
    • Koilocytes, coarse hypergranulosis, prominent papillomatosis, rete ridges curve inward
  • Condyloma acuminatum:
    • Prominent koilocytotic atypia in upper epidermis
    • No prominent foamy macrophages
  • Xanthoma:
    • Foamy cells are located in the mid dermis
    • Clinical hyperlipidemia
  • Squamous cell carcinoma:
    • Marked atypia, no prominent foamy histiocytes
  • Verrucous carcinoma:
    • Ulcerating or fungating lobules of mature squamous epithelium
    • Minimal atypia but no prominent foamy histiocytes
  • Bowenoid papulosis:
    • Resembling basaloid PeIN
    • Spotty cytological atypia
Board review style question #1

A 58 year old Caucasian man presents with a 1.0 cm pink, warty lesion on the glans penis. The biopsy shows verruciform hyperplasia of the epidermis with hyperkeratosis, parakeratosis and acanthosis (figure 1). No keratinocyte atypia or dyskeratotic cells are seen. There is a dense infiltrate of lipid laden macrophages (foamy cells) in the papillary dermis (figure 2) which are positive for CD68 and negative for S100. Which statement is true of cutaneous verruciform xanthoma?

  1. It is frequently caused by HPV genotypes 6 and 11
  2. Approximately 2 - 5% will either harbor or progress to a squamous cell carcinoma
  3. It is usually associated with underlying immunosuppression
  4. It is a nonneoplastic lesion that typically does not recur after excision
Board review style answer #1
D. It is a nonneoplastic lesion that typically does not recur after excision. The diagnosis of the lesion is cutaneous verruciform xanthoma.

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Reference: Cutaneous verruciform xanthoma
Board review style question #2
Which best summarizes the immunohistochemical profile of the characteristic cells infiltrating the dermal papillae in cutaneous verruciform xanthoma?

  1. CD68 positive; PAS positive diastase resistant; positive granular cytoplasmic staining of adipophilin; S100 negative
  2. CD68 positive; S100 positive; CD1a positive; Langerin positive
  3. CK5/6 positive; p16 positive; p63 positive
  4. CD10 positive; CK5/6 negative; S100 negative
Board review style answer #2
A. CD68 positive; PAS positive diastase resistant; positive granular cytoplasmic staining of adipophilin; S100 negative

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Reference: Cutaneous verruciform xanthoma
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