Cystic Verruciform Xanthoma: Case Report and Review of Literature

Summary: 49-year-old male presented to the dermatology clinic with a subcutaneous nodule in the suprapubic region. The lesion was asymptomatic, and the clinical differential diagnosis included an epidermal inclusion cyst. An excisional punch biopsy was obtained, which demonstrated a cystic lesion with a central punctum, with bulbous nodules of squamous epithelium. The stroma contained numerous foamy histiocytes, which aggregated in foci abutting the cystic lining. The squamous epithelium transitioned to parakeratosis with some dyskeratotic cells, but overt atypia was not observed. The diagnosis of cystic verruciform xanthoma was made. Verruciform xanthomas are typically asymptomatic, solitary, warty plaques or nodules with a predilection for the oral cavity, although they can appear on many cutaneous sites including the pubic region. 1 Many patients who develop these lesions are otherwise healthy, but some may have underlying autoimmune disorders or genetic syndromes.1 This appears to be the first reported case of a cystic verruciform xanthoma reported in the suprapubic region. Cystic verruciform xanthoma is an exceedingly rare diagnosis, having only been described in two prior case reports. Verruciform xanthomas are uncommon lesions that may resemble squamous cell carcinoma. Pathologists should be aware of rare variants of this entity in order to avoid misdiagnosing benign lesions as malignant and subjecting patients to unnecessary procedures.