Verruciform xanthoma in an adolescent: A case report

BACKGROUND: Verruciform xanthoma is a benign mucocutaneous, verrucous, papillary lesion characterized by large foam cells in the parakeratotic layer, lipid-laden macrophages (xanthoma cells), epidermal hyperplasia, and hyperkeratosis. Verruciform xanthoma is thought to be a reactive rather than a neoplastic process secondary to epithelial damage and the presence of foamy histiocytes. The human papillomavirus has not been proven to be a causative factor. Differential diagnoses include verrucous carcinoma, condyloma acuminatum, seborrheic keratosis, verruca simplex, and vulvar intraepithelial neoplasia. CASE: We describe the clinical and pathologic findings of a 16-year-old girl with verruciform xanthoma of the vulva, the third such reported case in an adolescent girl. COMMENT: It is important to recognize this rare entity because it can mimic many other conditions, and the usual treatment modalities for wartlike growths on the vulva (i.e., imiquimod, podophyllin, and trichloroacetic acid) are not effective. Wide local excision seems to be the only effective and curative treatment modality for verruciform xanthoma, as has been reported in the literature and is such with our case.