Case Number : Case 3031 - 17 February 2022 Posted By: Saleem Taibjee

Verruciform xanthoma, the deeper vessels and plasma cell rich infiltrate are just reactive in nature?

Agree with verruciform xanthoma

There is no doubt that there are histological features of verruciform xanthoma present.  The clinical photo however, is very suggestive of a pyogenic granuloma and there is a prominent dermal vascularity which Saleem has highlighted in the last three slides.  There is a report (below) of a case where a verruciform xanthoma was associated with an arterio-venous malformation and I wonder if something similar is going on here.  Perhaps I am over-interpreting the dermal changes.

Ref; Kishimoto S, Takenaka H, Shibagaki R, Nagata M, Katoh N, Yasuno H. Verruciform xanthoma arising in an arteriovenous haemangioma. Br J Dermatol. 1998;139:546–548. doi: 10.1046/j.1365-2133.1998.02434.x. [PubMed] [CrossRef] [Google Scholar] [Ref list]

6 hours ago, Richard Logan said:

There is no doubt that there are histological features of verruciform xanthoma present.  The clinical photo however, is very suggestive of a pyogenic granuloma and there is a prominent dermal vascularity which Saleem has highlighted in the last three slides.  There is a report (below) of a case where a verruciform xanthoma was associated with an arterio-venous malformation and I wonder if something similar is going on here.  Perhaps I am over-interpreting the dermal changes.

Ref; Kishimoto S, Takenaka H, Shibagaki R, Nagata M, Katoh N, Yasuno H. Verruciform xanthoma arising in an arteriovenous haemangioma. Br J Dermatol. 1998;139:546–548. doi: 10.1046/j.1365-2133.1998.02434.x. [PubMed] [CrossRef] [Google Scholar] [Ref list]

Agree. Traumatic scratching doesn’t fully explain the vascularized stroma. We pathologist like the single and exclusive diagnosis, but many times have to surrender to lesional association. 

agree with verruciform xanthoma

Hi. I must admit that I have just accepted this to be a nice example of verruciform xanthoma. It is either uncommon, or frequently mis-diagnosed as a squamous papilloma if one fails to notice the xanthomatised cells within the dermal papillae. I hadn't knowlingly seen a case for a while, and then funnily enough another case also came across my desk shortly after this one. With regards to the vascularised stroma which many of you have commented upon, I don't think it is very specific, and perhaps reflects the anatomical site. Even 'ordinary' fibroepithelial polyps/skin tags can sometimes show prominent vessels. So personally I do not think that there are 2 pathologies here.

BW, Saleem