Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Winship Cancer Institute at Emory University, 500 Peachtree St. NE, Atlanta, GA, 30308, USA.
Head Neck Pathol. 2023 Sep;17(3):673-678. doi: 10.1007/s12105-023-01568-4. Epub 2023 Jul 7.
Verruciform xanthoma (VX) is an uncommon, benign epithelial lesion of the oral mucosa. While this entity can also present extraorally, including on the skin and in anogenital areas, the variation in its histologic features in extraoral sites is not yet well defined. Differences in the demographics and morphologic features of oral versus extraoral VX were assessed to help facilitate the accurate diagnosis and management of this lesion.
After obtaining IRB approval, 110 cases of diagnosed VX were retrospectively collected from our institutional archives spanning from 2000 to 2022. Patient age, gender, available medical history, lesion appearance, and duration were obtained for each case.
The median age was 55 years (range 13-86) with a male-to-female ratio of 1.2:1. The most common oral sites, in descending order, were the palate (n = 24, 22%), buccal mucosa (n = 18, 16%), gingiva (n = 16, 15%), and tongue (n = 13, 12%). Extraoral sites comprised 9% of all lesions, including the scrotum (9), vulva (2), cheek (1), wrist (1), gluteal region (1), and abdominal wall (1). The median size for all lesions was 6.0 mm, and extraoral lesions were associated with a 6.7 mm larger size compared to oral lesions (B ± SE: 6.7 ± 2.5 cm, p = 0.01). The lesions were most frequently pink or white in color and often described as papillary, pedunculated, verrucous, and/or exophytic. Microscopically, the presence of wedge-shaped parakeratosis, keratin projections above the epithelium/epidermis, and associated inflammation significantly differed between oral and extraoral lesions. Prominent wedge-shaped parakeratosis (p = 0.04) and keratin projections above the epithelium/epidermis (p < 0.001) were more prevalent in extraoral lesions. There was no significant link between keratin projections and epithelial atypia (p = 0.44).
Familiarity with the broad morphological spectrum of VX, including the presence and degree of wedge-shaped parakeratosis, keratin projections above the epithelium/epidermis, and associated underlying inflammation, will be helpful in diagnosing it in unusual locations.
疣状黄瘤（VX）是一种罕见的口腔黏膜良性上皮病变。虽然这种病变也可以发生在口腔外，包括皮肤和肛门生殖器区域，但在口腔外部位的组织学特征的差异尚未得到很好的定义。本研究评估了口腔与口腔外 VX 在人口统计学和形态学特征上的差异，以帮助准确诊断和管理这种病变。
在获得机构审查委员会批准后，我们从 2000 年至 2022 年的机构档案中回顾性收集了 110 例确诊的 VX 病例。获取了每个病例的患者年龄、性别、可用病史、病变外观和病程。
中位年龄为 55 岁（范围 13-86 岁），男女比例为 1.2:1。最常见的口腔部位依次为 palate（24 例，22%）、buccal mucosa（18 例，16%）、gingiva（16 例，15%）和 tongue（13 例，12%）。口腔外部位占所有病变的 9%，包括 scrotum（9 例）、vulva（2 例）、cheek（1 例）、wrist（1 例）、gluteal region（1 例）和 abdominal wall（1 例）。所有病变的中位大小为 6.0mm，口腔外病变比口腔病变大 6.7mm（B±SE：6.7±2.5cm，p=0.01）。病变颜色多为粉红色或白色，常呈乳头状、有蒂、疣状和/或外生性。显微镜下，口腔和口腔外病变的楔形角化过度、上皮/表皮上方的角蛋白突起以及相关炎症的存在存在显著差异。口腔外病变中，显著的楔形角化过度（p=0.04）和上皮/表皮上方的角蛋白突起（p<0.001）更为常见。角蛋白突起与上皮异型性之间无显著关联（p=0.44）。
熟悉 VX 的广泛形态学谱，包括楔形角化过度的存在和程度、上皮/表皮上方的角蛋白突起以及相关的潜在炎症，将有助于在不常见的部位诊断该病。
