Verruciform xanthoma of the oral mucosa: a clinicopathological study with immunohistochemical findings relating to pathogenesis.

Verruciform xanthoma is an uncommon benign lesion with unknown aetiology and pathogenesis. In this study, we report ten cases of verruciform xanthoma and document their clinical and histopathological findings. An immunohistochemical investigation was performed using antibodies to macrophage, leukocyte common antigen, T lymphocytes, B lymphocytes, S-100 protein, lysozyme and alpha-1-antichymotrypsin. Our results were similar to the other reported cases. Eighty percent of our cases were found on the gingiva. Candidal hyphae were found in the superficial parakeratotic layers in five cases. The clinical diagnosis of the lesion ranged between papilloma and squamous cell carcinoma. It is important for clinicians to take into consideration the possibility of verruciform xanthoma in the differential diagnosis of papillary and granular lesions of oral mucosa. Immunohistochemically, all foam cells were strongly stained with antimacrophage antibodies. T lymphocytes were the predominant infiltrating lymphocytes in the lesion. Langerhans cells in the epithelia were fewer than those in corresponding normal tissue. Our immunohistochemical findings suggest that verruciform xanthoma is may be a local immunological disorder, with a cell mediated mechanism.