Verruciform xanthoma of the palatal gingiva: a report of two cases
A 37-year-old man visited our hospital (Gangnam Severance Hospital in Seoul, Korea) because of a poorly healing wound on his palate. The patient accidentally discovered the wound one year prior to his first visit. Although the patient did not experience any pain, he described the lesion as being somewhat uncomfortable or sensitive when irritated by food or palpation. The patient was advised to undergo a biopsy even though the lesion did not seem to progress and change in size, shape, or position.\nThe patient did not report any significant past medical history, history of trauma, or exceptional medical or family history. He reported a 13-year smoking history but no other specific social habits. During the intraoral examination, a well-demarcated soft and pedunculated papule with a verruciform papillary surface was found on the left side of the hard palate. The lesion was approximately 1.5 cm in diameter, reddish in color, and clinically asymptomatic.() No other intraoral or skin lesions were identified. During the radiological examination, complete with periapical and panoramic radiographs, no specific findings were observed.() Considering the results of the clinical and radiographic examinations, we identified multiple provisional diagnoses of this lesion, including leukoplakia, papilloma, condyloma acuminatum, and malignancies such as squamous cell carcinoma or verrucous carcinoma. Given the lesion's size, history, well-demarcated margin, and the results of a neck node examination, however, the probability of malignancy was quite low. An excisional biopsy, rather than an incisional biopsy, was then planned and performed in order to resect the total lesion and obtain a definitive diagnosis. Histopathological examination revealed a papillary proliferation of the stratified squamous epithelial cell layer, which was covered with a hyperkeratotic layer of uniform thickness, about that of the stratum spinosum.() Distinctive foam cells, also referred to as xanthoma cells, as well as macrophages with vacuolated cytoplasm could be seen in the connective tissue layer when magnified under a high-resolution microscope.()\nAfter the lesion was totally resected, the surgical site underwent normal secondary healing processes. The patient had no complications, and there was no evidence of recurrent disease during the three-year follow-up period.()