Verruciform xanthoma of the palatal gingiva: a report of two cases
A 35-year-old man was referred to our clinic for evaluation of a lesion that developed on his hard palate. The patient became aware of the lesion one month prior to his first visit. During consultation, he complained that the lesion became sensitive when it came in contact with hot and salty foods, but he experienced no other specific symptoms. The patient had a history of an unknown sexually transmitted disease, which he contracted one year prior to his first visit and completely recovered from by the time of consultation. In addition, the patient had a 20-year history of heavy smoking. No other specific general diseases or exceptional medical history were noted. During the clinical examination, which was conducted during his first consultation, a soft sessile mass with a verrucous, papillary surface resembling a strawberry was found on the palatal gingiva of the left maxillary second premolar and first molar. The lesion was 2.5×1.0 cm in size, well demarcated, and pinkish in color. It was not painful when palpated. He also had a normal response in the percussion, mobility, and vitality tests of his teeth, however; the palatal aspect of his left maxillary first molar showed mild gingival recession. The radiological examination, including periapical and panoramic radiographs, did not yield specific results. Further, there was no enlargement or induration of his bilateral neck lymph nodes on palpation. Though we could not obtain more information about his medical history in regard to his sexually transmitted disease, we suspected a relationship. We diagnosed the lesion with differentials that included syphilis and malignancies such as squamous cell carcinoma or verrucous carcinoma. An incisional biopsy for a definitive diagnosis was performed one week after the initial examination. During histopathologic examination, histology slides obtained from the biopsy showed a papillary squamous epithelial cell layer covered with parakeratotic surface () and xanthoma cells in the subepithelial connective tissue layer (), distinctive features of VX. Conservative surgical resection was performed after the results of the biopsy were confirmed. Postoperative follow-up examination showed a well-healed surgical site, and the patient had no complaints.\nFour years after this resection, the patient returned to our clinic for the recurrent appearance of the lesion at the same site. The lesion appeared to have grown to a similar size, and its shape was also similar to the one resected previously. Further, the recurring mass affected the same part of the buccal gingiva around his left maxillary second premolar and first molar. Once a clinical diagnosis of a recurrent lesion of the pre-existing VX was made, a wide surgical resection, which included seemingly normal tissues surrounding the lesion, was performed. The results of the histopathologic examination of the recurrent lesion were the same as that of the initial lesion. The patient has been followed-up at regular intervals of fewer than six months for the past ten years, and there has been no evidence of VX recurrence.