Genital verruciform xanthoma: lessons from a contemporary multi-institutional series

Area of Science:

• Dermatopathology
• Genitourinary pathology

Background:

• Verruciform xanthoma (VX) is an uncommon lesion.
• Typically found on oral mucosa, it rarely occurs on cutaneous genital sites.
• Exceptional presentations often dominate existing literature.

Purpose of the Study:

• To assess the clinical and histological features of routine, consecutive genital verruciform xanthoma cases.
• To compare findings with previously published series.

Main Methods:

• Retrospective review of clinicopathological features of genital VX.
• Analysis of 25 lesions from 24 patients across four academic centers.
• Evaluation for classic diagnostic criteria and presence of xanthomatous cells.

Main Results:

• Genital VX occurred predominantly on the scrotum (84%), penis (8%), and perineum/vulva (8%).
• Clinical suspicion for VX was never established; differential diagnoses included fibroepithelial polyps to squamous cell carcinoma.
• Classic histopathological features were present focally in all lesions, though xanthomatous cells were scarce in 24% of cases.
• The median patient age was 62 years.

Conclusions:

• Consecutive genital VX cases reliably exhibit classic histopathological features.
• The essential finding of xanthomatous cells can be scarce.
• Fewer penile and vulvar examples were noted compared to meta-analyses of published cases.
• The median age in this cohort was older than in published series, which often emphasize syndromic associations.