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Verruciform Xanthoma of the Penis

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by

Sudipta Sinnya

on 7 September 2013

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Transcript of Verruciform Xanthoma of the Penis

Verruciform Xanthoma of the penis - report of a rare case
Case Report


73 year-old Caucasian man was noted to have a single painless papule during a routine skin exam
Size - papule measured 6x5x2mm
Appearance - yellow/pink in colour
Location - inferior aspect of the penile foreskin
Local features - absence of cutaneous or oral lesions
Systemic features - nil regional lymph node involvement
Past Medical History
1. Benign Prostatic Hypertrophy
2. Non-melanoma skin cancers
3. Verruca vulgaris
4. Desmoplastic trichoepithelioma
Benign
Giant Molluscum
Verruca simplex
Condyloma acuminatum/latum
Malignant
Squamous Cell Carcinoma
Verrucous Carcinoma
Skin coloured painless papule on the penile foreskin
Management
Full Blood Count
Electrolytes
Shave biopsy


Presented by: Dr Sudipta Sinnya
Contributors: Dr Laura Wheller, Dr Melissa Carroll, Dr Brian De'Ambrosis

Past Hx Cont..
Denied history of venereal diseases
Denied high-risk sexual relationships
Differential Diagnosis
Investigations
Serology - nil lipid storage abnormalities
Shave biopsy successfully managed the condition
Nil recurrence past 2 years
Ongoing close follow up

Literature Review
VX is a rare benign disorder
Initially described by Shafer 1971
Predilection for the oral mucosa
Cutaneous occurrence was first described in 1979 by Santa Cruz
Involvement of penis relatively rare - 24 cases described in literature
2nd, 4th and 7th decade of life
Marked accumulation of foam cells in the papillary dermis
Verrucous epidermal acanthosis and hyperkeratosis

Hallmark of Diagnosis
Aetiology
Infection
Trauma/irritation
Proclivity to oral and genital sites, role of HPV has been considered.
Keratinocyte necrosis may lead to the release of intracellular lipids - engulfed by histiocytes in the dermis
Summary
VX is an rare benign disorder
associated with many other conditions
Knowledge about the condition will circumvent unnecessary investigations and aggressive surgical management
Clinicians need to be aware that SCC can occur simultaneously (present with keratinocyte atypia)
Clinical suspicion coupled with histopathological review will ensure correct diagnosis and effective management
References
1. Schafer W. Verruciform xanthoma. Oral Surg Oral Med Oral Pathol. 1971;31:784-789.

2.Cobb CM, Holt R, Denys FR. Ultrastructural features of the verruciform xanthoma. J Oral
Pathol. 1976;5:42-52.

3.Santa Cruz DJ, Martin SA. Verruciform xanthoma of the vulva. Report of two cases. Am J Clin Pathol. 1979;71:224-228.

4.Mohsin SK, Lee MW, Amin MB, Stoler MH, Eyzaquirre E, Ma CK et al. Cutaneous verruciform xanthoma: a report of five cases investigating the eitology and nature of xanthomatous cells. Am J Surg Pathol. 1998;22:479-487.

5.Rohwedder A, Murphy M, Carlson FA. Multiple human papillomavirus DNA identified in verruciform xanthoma by nested polymerase chain reaction with degenerate consensus primers.
J Cutan Pathol. 2003;30:344-346.

6.Requena L, Sarasa JL, Martin L, Pique E, Farina MC, Olivares M et al. Verruciform xanthoma of
the penis with acantholytic cells. Clin Exp Dermatol. 1995;20:504-508.

Miake S, Nakahara T, Kurihara Y, Hachisuka J, Moroi Y, Furue M. Verruciform xanthoma of
the glans penis mimicking squamous cell carcinoma - role of scavenger receptor positive macrophages. Eur J Dermatol; 2012;22:391-392.
Acknowledgement
Dr Richard Wiliamson
Dr Fiona Lehane
Epidermal Acanthosis
Papillomatosis
Hyperkeratosis
Papillary Dermis
foamy histiocytes
Foam cells
Mechanism of foam cell formation
Diagnosis
Finding consistent with the diagnosis of Verruciform Xanthoma
Mohsin et al. Am J Surg Pathol. 1998;22:479-487.
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