Abstract:

Verruciform xanthoma (VX) is a benign, non-dysplastic skin lesion rarely occurring in the genital area and rarer still in the vulva. We present an interesting case of a 44-year-old female with a 6.5cm vulvar wart-like lesion, initially diagnosed as an inflamed condyloma acuminata. She returned to the dermatology clinic six years with four new vulvar lesions at the same site as her previous excision. Histologic evaluation of the new lesions revealed a squamous proliferation with foamy histiocytes within the dermal papillae and neutrophils in the stratum corneum, consistent with VX. There was no appreciable nuclear atypia to support the diagnosis of low-grade dysplasia. Initial pathology slides were reviewed and were found to have similar morphology to the current lesions and were thus reinterpreted as VX. Additionally, we share six cases of VX located in the scrotum, identified during our review of diagnosed genital VX at our institute from 2010 to 2021. The median age was 69, VX was never clinically suspected, and the lesions were solitary with a median greatest dimension of 1.1cm. When these lesions occur in the genital area, there is considerable clinical and histologic overlap with true genital warts that are driven by human papillomavirus (HPV) and are considered low-grade squamous intraepithelial lesions (LSIL). Previous studies have confirmed the absence of HPV in VX. This case series highlights a potential diagnostic pitfall as there is significant clinical and histologic overlap between genital verruciform xanthoma and HPV driven lesions.

Financial Disclosure:
No current or relevant financial relationships exist.

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Eleonora Fiorletta Quiroga, MD