Gingival Verruciform Xanthoma: A Rare Case Report With Updated Insights Into Pathogenesis

Verruciform xanthoma (VX) is a rare, reactive oral mucosal lesion that can mimic other papillary or verrucous hyperplastic conditions. The present report is of a gingival VX that clinically resembled other papillary lesions. A 14-year-old male reported a painless papillary lesion on the gingiva between the left mandibular central and lateral incisors, accompanied by erythematous anterior gingival margins. Based on clinical presentation, a provisional diagnosis of inflammatory gingival hyperplasia was considered. An excisional biopsy was performed, and histopathological examination revealed a hyperkeratotic, proliferative surface epithelium with elongated rete ridges and papillary projections filled with numerous foam cells, confirming the final diagnosis of VX. The patient has remained under follow-up for 1 year with no evidence of recurrence. The present case highlights the importance of recognizing VX as a distinct entity in the diagnosis of oral papillary lesions. It discusses possible etiopathogenic factors associated with gingival involvement in adolescents.