Oral Verruciform Xanthoma within Lichen Planus: A Case Report and Literature Review

Oral verrucous xanthoma with oral lichen planus: a case report

Verrucous xanthoma is a rare benign muco-cutaneous lesion, whereas oral lichen planus is a chronic inflammatory disease relatively common in the clinical setting. Verrucous xanthoma and oral lichen planus can reportedly coexist according to foreign literature. Owing to the low incidence of verrucous xanthoma and the rarity of co-occurrence of these two diseases, the mechanism underlying the co-occurrence of the two diseases remains inconclusive. In this work, a case of oral verrucous xanthoma complicated with oral lichen planus was reported. Related literature was reviewed to discuss the clinical classification, pathological classification, and possible pathogenesis of the two diseases.

Verruciform Xanthomas in the Setting of COVID-19: A Case Series and Review of Other Conditions Associated With This Benign Cutaneous Neoplasm

Verruciform xanthoma is a rare benign neoplasm that predominantly affects the oral mucosa but can also affect cutaneous sites on the face, trunk, extremities, and genitalia. It is usually identified in isolation; however, there are several known associations with other conditions. Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus that emerged in December 2019 and caused a worldwide pandemic. It primarily manifests as a respiratory illness although various associations and sequelae of COVID-19 are still being elucidated. The clinical and pathologic presentations of two cases of Verruciform xanthoma associated with documented COVID-19 infection at our institution after the start of lockdowns during the COVID-19 pandemic in 2020-2021 are described. In addition, we reviewed the literature for other infectious and non-infectious diseases associated with Verruciform xanthomas to see if there is any basis for a potential link between this rare benign neoplasm and novel viral infection.

Oral verruciform xanthoma in chronic graft-versus-host disease patients

BACKGROUND

Verruciform xanthoma (VX) is an uncommon benign epithelial lesion which mainly appears in inflamed oral epithelium. In this study, our aim was to present new cases of oral VX (OVX) in chronic graft-versus-host disease (cGVHD) and review the literature.

METHODS

We conducted a retrospective chart review of cGVHD patients (2012-2019) to reveal cases of OVX. The demographics, medical background, clinical presentation, treatment provided, and follow-up were obtained. Additionally, Medline was searched using the terms "graft-versus-host disease," "verruciform xanthoma," and "oral." Of the articles, the above-mentioned demographic and clinical features were retrieved.

RESULTS

The patient pool included 133 oral cGVHD patients. Three cGVHD patients (males, aged 15-49 years, post-hematologic malignancy) were diagnosed with OVX. All patients had oral mucosal lichenoid lesions, but not in close proximity to the VX lesion. Medline searches revealed 9 cases of OVX in cGVHD patients reported in the literature. Eleven of the 12 patients had oral mucosal lichenoid lesions. Four patients had multiple OVX lesions. All lesions were asymptomatic. Six patients had lesions in the masticatory mucosa (hard palate and gingiva) and 4 patients had lesions in the buccal mucosa.

CONCLUSIONS

To the best of our knowledge, this is the largest published OVX in cGVHD series, including 12 patients. It appears that despite the higher prevalence in cGVHD patients relative to the general population, OVXs do not necessarily develop in sites with lichenoid lesions. It is advised that clinicians be familiar with the clinical and histological features in order to consider OVX in the differential diagnosis of oral lesions in cGVHD patients.