Skip to main content

Vegas (Verruciform Genital-Associated) Xanthoma: A Comprehensive Literature Review

Abstract

Introduction

Verruciform xanthoma is a wart-like benign lesion. The classic histologic appearance consists of foamy histiocytes within elongated dermal papillae and epithelial acanthosis. The lesion most commonly occurs in the oral cavity, but has been reported in extra-oral sites such as the penis, scrotum, and vulva. The clinical and histologic characteristics of verruciform genital-associated (Vegas) xanthomas of the penis, scrotum, and vulva are reviewed.

Methods

PubMed was used to search the following term: verruciform xanthoma. The relevant papers were obtained and reviewed.

Results

There have been 193 cases of genital-associated verruciform xanthomas. There were 164 in men and 29 in women. Similar to verruciform xanthomas of the oral mucosa, they presented as asymptomatic lesions, demonstrated foam cells in the dermal papillae, and were typically managed successfully with surgical excision.

Conclusion

Verruciform xanthoma is a benign lesion characterized by a wart-like growth that is most commonly seen in the oral mucosa. Verruciform xanthomas of the genital region have been coined Vegas xanthomas. Vegas xanthomas have been reported in association with a variety of diseases, as well as in healthy individuals. Biopsy is required for diagnosis, and complete surgical excision is typically curative.

Introduction

Verruciform xanthoma is a benign tumor that typically occurs in the oral mucosa [186]. Extraoral lesions have been most commonly described on the penis (Table 1), scrotum (Table 2), and vulva (Table 3). Tumors in genital locations have recently been referred to as Vegas (Verruciform Genital-Associated) xanthomas [63]. The characteristics of verruciform xanthomas of the genitalia are reviewed. This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Table 1 Verruciform xanthomas of the penis
Table 2 Verruciform xanthomas of the scrotum
Table 3 Verruciform xanthomas of the female genitalia

History

Verruciform xanthoma is a wart-like lesion that most commonly occurs in the oral mucosa. It was first described as a xanthoma-like nevus by Sachs in 1903 [78]. In 1971, Shafer coined the term “verruciform xanthoma” while describing 15 cases in the oral cavity [64]. These lesions were reported as asymptomatic, pale or hyperkeratotic, with a pebbly surface and verrucous appearance. The most common extraoral verruciform xanthomas are reported in the genital region; however, other reported extra-oral locations include the anal region, ear, forearm, foot, hand, leg, nose, and sacrum [6571, 74].

In 2003, Philipsen et al. did a profile of 282 oral verruciform xanthomas [79]. They found a slight male predominance below the age of 50, with a male:female ratio of 1.6:1, and a slight female predominance above the age of 50, with a male:female ratio of 0.8:1; 73.4% of the oral verruciform xanthomas were on the masticatory mucosa. The majority of cases were reported in Caucasians (139 patients) and Japanese (109 patients), but there were also reports of African Americans, Asians, and South Americans [79].

Differential Diagnosis

Clinically, verruciform xanthomas have a similar appearance to bowenoid papulosis, condyloma acuminatum, erythroplasia of Queyrat, granular cell tumor, giant molluscum contagiosum, seborrheic keratosis, squamous cell carcinoma, verruca vulgaris, verrucous carcinoma, and vulvar intraepithelial neoplasia (Fig. 1) [11, 27, 40, 75, 76]. A biopsy is necessary to confirm the diagnosis of verruciform xanthoma.

Fig. 1
figure1

Distant (a) and closer (b) views showing a pedunculated papule protruding from the patient’s left side of the scrotum of an 83-year-old heterosexual monogamous man who had no history of sexually transmitted diseases and no reported HIV risk factors. He presented with an asymptomatic lesion of 3-year duration. Cutaneous examination revealed a flesh-colored 8 × 5 mm wart-like elongated papule localized to the left side of his scrotum. A snip excision was performed for biopsy and removal of the lesion

The histologic differential diagnosis of verruciform xanthoma includes condyloma accuminatum, granular cell epulis, granular cell tumor, verruca vulgaris, and verrucous carcinoma [30]. The characteristic pathologic features of verruciform xanthoma allow it to be distinguished. These features include acanthotic epidermis with parakeratosis that extends deep into the epithelium, uniformly elongated rete ridges, neutrophilic infiltrate in the dermis, and foamy histiocytes throughout the dermal papillae (Fig. 2) [64]. The foam cells stain Periodic Acid Schiff-positive and express CD68 antigen, indicating the presence of glycogen granules in monocyte-macrophage lineage cells [12, 13, 17, 52, 55].

Fig. 2
figure2

Microscopic examination of the lesion from the 83-year-old man was performed. Low magnification (a) shows a pedunculated tumor with acanthosis, papillomatosis, and elongation of the rete ridges. Intermediate magnification (b, c) reveals parakeratosis and neutrophilic inflammation in the dermis. High magnification (d) reveals numerous foamy histiocytes in the widened dermal papillae. Correlation of the clinical features and the pathologic changes establish a diagnosis of verruciform xanthoma. The lesion was completely removed at the time of biopsy, and the patient applied mupirocin 2% ointment to the site. The excision site has since completely healed without recurrence. (Hematoxylin and Eosin: a = ×2, b = ×10, c = ×20, d = ×40)

Pathogenesis

The pathogenesis of verruciform xanthoma is unknown. The majority of patients with verruciform xanthomas do not have any systemic lipid abnormalities. It has been hypothesized that the lesions are associated with human papilloma virus [30], but multiple studies have found this association to be unlikely [9, 18, 82, 83].

Zegarelli et al. postulated that a local irritant leads to epithelial degradation that initiates an inflammatory response [81]. He states that the inflammatory response damages keratinocytes, which release lipids that are then engulfed by macrophages, leading to the accumulation of foam cells. Mohsin et al. found that damaged keratinocytes release cytokines that attract neutrophils and stimulate rapid growth of the epidermis, supporting Zegarelli et al.’s hypothesis [18].

Other investigators have speculated that verruciform xanthomas may be due to an immunologic reaction [28, 84, 86]. Oliveira et al. proposed that verruciform xanthomas are formed by an autoimmune reaction inducing apoptosis of epithelial cells, similarly to lichen planus [84]. This is supported by multiple cases of verruciform xanthomas reported in association with lichen planus [43, 85].

However, there is not sufficient evidence to conclude a clear mechanism of pathogenesis associated with verruciform xanthomas.

Verruciform Xanthomas of the Penis (Table 1)

The first verruciform xanthoma of the penis was reported in 1981 by Kraemer et al. [11]. To date, there are 31 cases of penile verruciform xanthomas in the literature that have been described in 29 men. The age of onset of the lesions ranged from 8 to 85 years, with a mean of 54.5 years. Most of the lesions occurred in Caucasians.

The duration of the penile verruciform xanthomas prior to establishing the diagnosis ranged from 2 weeks to 25 years, with a mean duration of 3.7 years. The locations (of the 27 lesions for which the site was specified) include the coronal sulcus (18.5%, n = 5), glans (37.0%, n = 10), prepuce (29.6%, n = 8), and shaft (14.8%, n = 4). The colors varied; including brown, erythematous, pink, and yellow.

Verruciform xanthomas of the penis have been reported following necrotizing fasciitis of the anogenital region [3], radical removal of initial verruciform xanthoma with grafting of the foreskin [13], and transurethral prostate resection [4].

Verruciform Xanthomas of the Scrotum (Table 2)

The first scrotal verruciform xanthoma was described in 1984 by Al-Nafussi et al. [32]. Fukuda and Saito carried out a review of the Japanese literature and found that 81% of verruciform xanthomas in the pubic area were located on the scrotum [34]. Including the 102 cases reviewed by Fukuda and Saito, there have been 135 reported cases of scrotal verruciform xanthomas.

Kono suggested that the verruciform xanthomas may be related to irritation of the scrotum by the Japanese custom of sitting on the floor [80]. This is an interesting hypothesis since there is a significant number of scrotal verruciform xanthomas reported in the Japanese literature [34, 35, 42]. These findings support Zegarreli et al.’s proposal that verruciform xanthoma formation may be linked to epithelial degeneration due to irritation [81].

The age of onset was given for 26 of the scrotal lesions, and ranged from ages 19 to 83 years, with a mean age of 59.5 years. The duration of the tumors, prior to establishing the diagnosis, varied from 3 weeks to 20 years. The color of the tumor was most commonly pink.

Scrotal lesions have been associated with arteriovenous haemangioma [29], epidermolytic acanthoma [25, 34], graft versus host disease following bone marrow transplant for acute lymphoblastic leukemia [83], human papillomavirus [30], and psoriasis in a patient undergoing psoralen and ultraviolet A (PUVA) therapy [31]. One scrotal lesion was reported following a kidney transplant [28].

Verruciform Xanthomas of the Inguinal Fold

In addition to the scrotal and penile tumors, verruciform xanthoma of the genitalia has been reported on the inguinal folds. The man had a 7 × 5 cm well-demarcated plaque on his left inguinal fold that extended over the thigh and onto the scrotum. He also had a 1 × 2 cm plaque in the right inguinal fold [69].

Verruciform Xanthomas of the Female Genitalia (Table 3)

The first reported extraoral lesions were two cases of verruciform xanthoma of the vulva, described by Santa Cruz and Martin in 1979 [54]. A total of 28 additional vulvar verruciform xanthomas have since been reported in 27 women. Vulvar verruciform xanthomas have been described in a variety of patients, including African American, Chinese, Caucasian, Columbian, and Japanese women.

The age of onset of the female genital lesions ranges from shortly after birth [in association with congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD syndrome)] to age 85 years, with a mean age of 43.2 years. A total of 27 locations have been reported, which included the clitoris (11.1%, n = 3), external genitalia and groin (3.7%, n = 1), fourchette (7.4%, n = 2), genital mucosa (3.7%, n = 1), inguinal fold (7.4%, n = 2), labia majora (25.9%, n = 7), labia minora (18.5%, n = 5), and vulva not otherwise specified (22.2%, n = 6). The color of the lesion was most commonly yellowish orange.

Vulvar lesions have been found in association with CHILD syndrome [44, 47, 49, 52, 59, 60], fibroepithelial polyp [57], leiomyomatosis of uterus [55], lichen planus [43], lichen sclerosus [43, 54], lymphangioma circumscriptum with severe lymphedema [50], radiodermatitis [43], and vulvar Paget’s disease [43].

Treatment

The verruciform xanthomas are cured by complete excision; however, cases of recurrence have been described [13, 43, 76]. One case of recurrence occurred when the lesion was not completely excised [43]. CO2 laser ablation resulted in the recurrence in two cases of vulvar lesions [43, 76]. However, Joo et al. successfully removed a scrotal xanthoma with shave debulking and fractionated CO2 laser ablation [22]. Guo et al. successfully treated a large (7 × 5 mm) lesion of the labia minora with imiquiod cream 5% [51].

Conclusion

Verruciform xanthomas are benign, asymptomatic wart-like lesions most commonly found in the oral cavity. Although they appear similarly to skin lesions caused by tumors or viral infections, they can be distinguished based on histologic evaluation. The defining pathologic features include hyperkeratosis with parakeratosis, acanthosis, elongated rete ridges, neutrophilic inflammation in the dermis, and foam cells in the dermal papillae.

There have been 194 cases of verruciform genital-associated (Vegas) xanthomas reported in the literature. Patients may seek treatment because of concern of a sexually transmitted disease or the lesion may be discovered as an incidental finding during complete cutaneous skin examination. Verruciform xanthomas of the genitalia share similar histologic characteristics with verruciform xanthomas of the oral cavity. The lesions have been reported in association with a variety of cutaneous diseases and systemic conditions.

Verruciform xanthomas are usually asymptomatic and may be present for many years before being treated. Complete surgical excision is the standard method of treatment, and is typically curative. Fractionated CO2 laser therapy and imiquimoid cream have also been used to successfully remove the lesions. Verruciform xanthoma should be considered in the differential diagnosis of an acquired genital tumor.

References

  1. 1.

    Arzberger E, Oliveira A, Hofmann-Wellenhof R, Zalaudek I, Cerroni L, Komericki P. Dermoscopy and reflectance confocal microscopy in verruciform xanthoma of the glans penis. J Am Acad Dermatol. 2015;72:e147–9 (PMID 25981017).

    Article  PubMed  Google Scholar 

  2. 2.

    Joshi R, OVhal A. Verruciform xanthoma: report of five cases. Indian J Dermatol. 2012;57:479–82 (PMID 23248367).

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Cumberland L, Dana A, Resh B, Fitzpatrick J, Goldenberg G. Verruciform xanthoma in the setting of cutaneous trauma and chronic inflammation: report of a patient and brief review of literature. J Cutan Pathol. 2010;37:895–900 (PMID 19958440).

    Article  PubMed  Google Scholar 

  4. 4.

    Sinnya S, Wheller L, Carroll M, Williamson R, De’Ambrosis B. Verruciform xanthoma of the penis: a rare Australian case. Australas J Dermatol. 2015;56:e99–101 (PMID 24689840).

    Article  PubMed  Google Scholar 

  5. 5.

    Cuozzo DW, Vachher P, Sau P, Frishberg DP, James WD. Verruciform xanthoma: a benign penile growth. J Urol. 1995;153:1625–7 (PMID 7714990).

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Requena L, Sarasa JL, Martin L, Pique E, Farina MC, Olivares M, Escalonilla P. Verruciform xanthoma of the penis with acantholytic cells. Clin Exp Dermatol. 1995;20:504–8 (PMID 8857349).

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Balus S, Breathnach AS, O’Grady AJ. Ultrastructural observations on ‘foam cells’ and the source of their lipid in verruciform xanthoma. J Am Acad Dermatol. 1991;24:760–4 (PMID 1869650).

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Sette CS, Wachholz PA, Brandão LS, Marques GF, Casafus FS, Soares CT. Verruciform xanthoma on the penis: an unusual location. Clin Exp Dermatol. 2015;40:807–8 (PMID 25787016).

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Ersahin C, Szpaderska AM, Foreman K, Yong S. Verruciform xanthoma of the penis not associated with human papillomavirus infection. Arch Pathol Lab Med. 2005;129:e62–4 (PMID 15737058).

    PubMed  Google Scholar 

  10. 10.

    Ronan SG, Bolano J, Manaligod JR. Verruciform xanthoma of penis. Light and electron-microscopic study. Urology. 1984;23:600–3 (PMID 6730134).

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Kraemer BB, Schmidt WA, Foucar E, Rosen T. Verruciform xanthoma of the penis. Arch Dermatol. 1981;117:516–8 (PMID 7259249).

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Miake S, Nakahara T, Kurihara Y, Hachisuka J, Moroi Y, Furue M. Verruciform xanthoma of the glans penis mimicking squamous cell carcinoma—role of scavenger receptor positive macrophages. Eur J Dermatol. 2012;22:391–2 (PMID 22469571).

    PubMed  Google Scholar 

  13. 13.

    Lora V, Kanitakis J, Bertozzi E, Amantea A, Cota C. Recurrent verruciform xanthoma on a skin autograft of the penis. Eur J Dermatol. 2013;23:905–7 (PMID 24185265).

    PubMed  Google Scholar 

  14. 14.

    Amantea A, Gaudio E, Catricalà C, Donati P, Balus L. Xantoma verruciforme del pene. G Ital Dermatol Venereol. 1989;124:37–40 (PMID 2767716).

    CAS  PubMed  Google Scholar 

  15. 15.

    Laguna Urraca G, Concha López A, Tudela Patón MP. Xantoma verruciforme de pene. Actas Urol Esp. 1990;14:210–3 (PMID 2122638).

    CAS  PubMed  Google Scholar 

  16. 16.

    Canillot S, Stamm C, Balme B, Perrot H. Xanthome verruciforme du gland. Ann Dermatol Venereol. 1994;121:404–7 (PMID 7702268).

    CAS  PubMed  Google Scholar 

  17. 17.

    Xia TL, Li GZ, Na YQ, Guo YL. Verruciform xanthoma of the penis: report of a case. Chin Med J (Engl). 2004;117:150–2 (PMID 14733794).

    Google Scholar 

  18. 18.

    Mohsin SK, Lee MW, Amin MB, Stoler MH, Eyzaguirre E, Ma CK, Zarbo RJ. Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells. Am J Surg Pathol. 1998;22:479–87 (PMID 9537477).

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Teixeira V, Reis JP, Tellechea Ó, Vieira R, Figueiredo A. Verruciform xanthoma: report of two cases. Dermatol Online J. 2012;18:10 (PMID 22630580).

    PubMed  Google Scholar 

  20. 20.

    Takiwaki H, Yokota M, Ahsan K, Yokota K, Kurokawa Y, Ogawa I. Squamous cell carcinoma associated with verruciform xanthoma of the penis. Am J Dermatopathol. 1996;18:551–4 (PMID 8902105).

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Ogata D, Tsuchida T. Characteristic dermoscopic features of verruciform xanthoma: report of three cases. J Dermatol. 2015;42:1103–4 (PMID 26211896).

    Article  PubMed  Google Scholar 

  22. 22.

    Joo J, Fung MA, Jagdeo J. Successful treatment of scrotal verruciform xanthoma with shave debulking and fractionated carbon dioxide laser therapy. Dermatol Surg. 2014;40:214–7 (PMID 24320039).

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Ito C, Kitazawac R, Makita K, Watanabe T, Toda A, Haraguchi R, Tanaka S, Kitazawa S. Scrotal cutaneous verruciform xanthoma with monocyte chemoattractant protein-1 immunohistochemical study: a case report. J Med Case Rep. 2012;6:260 (PMID 22937911).

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Ohnishi T, Shiraishi H, Fukaya S, Tanaka T, Watanabe S. Verruciform xanthoma: report of three patients with comparative dermoscopic study. Clin Exp Dermatol. 2015;40:156–9 (PMID 25476138).

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Fujimoto N, Asano C, Ono K, Tajima S. Verruciform xanthoma results from epidermal apoptosis with galectin-7 overexpression. Eur Acad Dermatol Venereol. 2013;27:922–3 (PMID 22835084).

    CAS  Article  Google Scholar 

  26. 26.

    Helm TN, Richards P, Lin L, Helm KF. Verruciform xanthoma with porokeratosis-like features but no clinically apparent lymphedema. J Cutan Pathol. 2012;39:887–8 (PMID 22765052).

    Article  PubMed  Google Scholar 

  27. 27.

    Gill BJ, Chan AJ, Hsu S. Verruciform xanthoma. Dermatol Online J. 2014;20:12 (PMID 24456956).

    Google Scholar 

  28. 28.

    Kanitakis J, Euvrard S, Butnaru AC, Claudy A. Verruciform xanthoma of the scrotum in a renal transplant patient. Br J Dermatol. 2004;150:161–3 (PMID 14746641).

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Kishimoto S, Takenaka H, Shibagaki R, Nagata M, Katoh N, Yasuno H. Verruciform xanthoma arising in an arteriovenous haemangioma. Br J Dermatol. 1998;139:546–8 (PMID 9767315).

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Khaskhely NM, Uezato H, Kamiyama T, Maruno M, Kariya KI, Oshiro M, Nonaka S. Association of human papillomavirus type 6 with a verruciform xanthoma. Am J Dermatopathol. 2000;22:447–52 (PMID 11048983).

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Yamamoto T, Katayama I, Nishioka K. Verruciform xanthoma in a psoriatic patient under PUVA therapy. Dermatology. 1995;191:254–6 (PMID 8534948).

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Al-Nafussi AI, Azzopardi JG, Salm R. Verruciform xanthoma of the skin. Histopathology. 1985;9:245–52 (PMID 3988247).

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Kimura S. Verruciform xanthoma of the scrotum. Arch Dermatol. 1984;120:1378–9 (PMID 6486853).

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Fukuda H, Saito R. Verruciform xanthoma in close association with isolated epidermolytic acanthoma: a case report and review of the Japanese dermatological literature. J Dermatol. 2005;32:464–8 (PMID 16043921).

    Article  PubMed  Google Scholar 

  35. 35.

    Takizawa H, Ohnishi T, Watanabe S. Verruciform xanthoma. Report of a case with molecular biological analysis of HPV and immunohistochemical analysis of cytokeratin expression. Clin Exp Dermatol. 2001;26:730–1 (PMID 11722468).

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Orchard GE, Wilson Jones E, Russel Jones R. Verruciform xanthoma: an immunocytochemical study. Br J Biomed Sci. 1994;51:28–34 (PMID 7841833).

    CAS  PubMed  Google Scholar 

  37. 37.

    Kukreja M, Kamal M, Ray R, Mannan AA. Verruciform xanthoma of the penis in a young male masquerading as squamous cell carcinoma: case report. Gulf J Oncol. 2011;10:65–8 (PMID 21724532).

    Google Scholar 

  38. 38.

    Torrecilla Ortíz C, Marco Perrez LM, Dinares Prat J, Autonell J. Xantoma verruciforme de pene. Actas Urol Esp. 1997;21:797–9 (PMID 9412234).

    PubMed  Google Scholar 

  39. 39.

    George WM, Azadeh B. Verruciform xanthoma of the penis. Cutis. 1989;44:167–70 (PMID 2758866).

    CAS  PubMed  Google Scholar 

  40. 40.

    Geiss DF, Del Rosso JQ, Murphy J. Verruciform xanthoma of the glans penis: a benign clinical simulant of genital malignancy. Cutis. 1993;51:369–72 (PMID 8513690).

    CAS  PubMed  Google Scholar 

  41. 41.

    Shindo Y, Mikoshiba H, Okamoto K, Morohashi M. Verruciform xanthoma of the scrotum. J Dermatol. 1985;12:443–8 (PMID 3914496).

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Nakamura S, Kanamori S, Nakayama K, Aoki M. Verruciform xanthoma on the scrotum. J Dermatol. 1989;16:397–401 (PMID 2600278).

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Fite C, Plantier F, Dupin N, Avril MF, Moyal-Barracco M. Vulvar verruciform xanthoma: ten cases associated with lichen sclerosus, lichen planus, or other conditions. Arch Dermatol. 2011;147:1087–92 (PMID 21576553).

    Article  PubMed  Google Scholar 

  44. 44.

    Gantner S, Rutten A, Requena L, Gassenmaier G, Landthaler M, Hafner C. CHILD syndrome with mild skin lesions: histopathologic clues for the diagnosis. J Cutan Pathol. 2014;41:787–90 (PMID 25093865).

    Article  PubMed  Google Scholar 

  45. 45.

    Lonsdale RN. Verruciform xanthoma of the penis. Br J Urol. 1992;70:574–5 (PMID 1467872).

    CAS  PubMed  Google Scholar 

  46. 46.

    Mehra S, Li L, Fan CY, Smoller B, Morgan M, Somach S. A novel somatic mutation of the 3beta-hydroxysteroid dehydrogenase gene in sporadic cutaneous verruciform xanthoma. Arch Dermatol. 2005;141:1263–7 (PMID 16230564).

    Article  PubMed  Google Scholar 

  47. 47.

    Xu XL, Huang LM, Wang Q, Sun JF. Multiple verruciform xanthomas in the setting of congenital hemidysplasia with ichthyosiform Eeythroderma and limb defects syndrome. Pediatr Dermatol. 2015;32:135–7 (PMID 24147604).

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Sopena J, Gamo R, Iglesias L, Rodriguez-Peralto JL. Disseminated verruciform xanthoma. Br J Dermatol. 2004;151:717–9 (PMID 15377372).

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Zamora-Martinez E, Martin-Moreno L, Barat Cascante A, Castro-Torres A. Another CHILD syndrome with xanthomatous pattern. Dermatologica. 1990;180:263–6 (PMID 2358107).

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Ijichi A, Mitoma C, Yasukochi Y, Uchi H, Furue M. Vulvar verruciform xanthoma developing in acquired lymphangioma circumscriptum. J Dermatol. 2016. doi:10.1111/1346-8138.13490. (Epub ahead of print PMID 27334742).

  51. 51.

    Guo Y, Dang Y, Toyohara JP, Geng S. Successful treatment of verruciform xanthoma with imiquimod. J Am Acad Dermatol. 2013;69:184–6 (PMID 24034392).

    Article  Google Scholar 

  52. 52.

    Barr RJ, Plank CJ. Verruciform xanthoma of the skin. J Cutan Pathol. 1980;7:422–8 (PMID 7451704).

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Tang R, Kopp SA, Cobb C, Halpern AV. Disseminated verruciform xanthoma: a case report. Cutis. 2014;93:307–10 (PMID 24999643).

    PubMed  Google Scholar 

  54. 54.

    Santa Cruz DJ, Martin SA. Verruciform xanthoma of the vulva. Report of two cases. Am J Clin Pathol. 1979;71:224–8 (PMID 425938).

    CAS  Article  PubMed  Google Scholar 

  55. 55.

    de Rosa G, Barra E, Gentile R, Boscaino A, Di Prisco B, Ayala F. Verruciform xanthoma of the vulva: case report. Genitourin Med. 1989;65:252–4 (PMID 2807284).

    PubMed  PubMed Central  Google Scholar 

  56. 56.

    Furue M, Suzuki H, Kodama T, Hiramoto T, Sugiyama H, Tamaki K. Colocalization of scavenger receptor in CD68 positive foam cells in verruciform xanthoma. J Dermatol Sci. 1995;10:213–9 (PMID 8593263).

    CAS  Article  PubMed  Google Scholar 

  57. 57.

    Kishimoto S, Takenaka H, Shibagaki R, Nagata M, Yasuno H. Verruciform xanthoma in association with a vulval fibroepithelial polyp. Br J Dermatol. 1997;137:816–20 (PMID 9415249).

    CAS  Article  PubMed  Google Scholar 

  58. 58.

    Leong FJ, Meredith DJ. Verruciform xanthoma of the vulva. A case report. Pathol Res Pract. 1998;194:661–5 (PMID 9793968).

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    Fedda F, Khattab R, Ibrahim A, Hayek S, Khalifeh I. Verruciform xanthoma: a special epidermal nevus. Cutis. 2011;88:269–72 (PMID 22372163).

    PubMed  Google Scholar 

  60. 60.

    Hashimoto K, Prada S, Lopez AP, Hoyos JG, Escobar M. CHILD syndrome with linear eruptions, hypopigmented bands, and verruciform xanthoma. Pediatr Dermatol. 1998;15:360–6 (PMID 9796585).

    CAS  Article  PubMed  Google Scholar 

  61. 61.

    Minamitsuji Y, Kishi H, Saga K, Masukawa J. A female case of verruciform xanthoma. Jpn J Clin Dermatol. 1996;50:1026–8 (in Japanese).

    Google Scholar 

  62. 62.

    Daimaru Y, Hatano C, Sato S. A case of verruciform xanthoma of the vulva. Jpn J Clin Dermatol. 1997;51:733–5 (in Japanese).

    Google Scholar 

  63. 63.

    Beutler BD, Cohen PR. Verruciform genital-associated xanthoma: report of patient with verruciform xanthoma of the scrotum and literature review. Dermatol Online J. 2015;21:1087–2108 (PMID 26437158).

    Google Scholar 

  64. 64.

    Shafer WG. Verruciform xanthoma. Oral Surg Oral Med Oral Pathol. 1971;31:784–9 (PMID 5280461).

    CAS  Article  PubMed  Google Scholar 

  65. 65.

    Griffel B, Cordoba M. Verruciform xanthoma in the anal region. Am J Proctol Gastroenterol Colon Rectal Surg. 1980;31:24–5 (PMID 7386619).

    CAS  PubMed  Google Scholar 

  66. 66.

    Jensen JL, Liao SY, Jeffes EW. Verruciform xanthoma of the ear with coexisting epidermal dysplasia. Am J Dermatopathol. 1992;14(5):426–30 (PMID: 1329573).

    CAS  Article  PubMed  Google Scholar 

  67. 67.

    Blankenship DW, Zech L, Mirzabeigi M, Venna S. Verruciform xanthoma of the upper-extremity in the absence of chronic skin disease or syndrome: a case report and review of the literature. J Cutan Pathol. 2013;40(8):745–52 (PMID:23656213).

    Article  PubMed  Google Scholar 

  68. 68.

    Mountcastle EA, Lupton GP. Verruciform xanthoma of the digits. J Am Acad Dermatol. 1989;20:313–7 (PMID:2644320).

    CAS  Article  PubMed  Google Scholar 

  69. 69.

    Connoly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD. Management of cutaneous verruciform xanthoma. J Am Acad Dermatol. 2000;42:343–7 (PMID 10640929).

    Article  Google Scholar 

  70. 70.

    Huguet P, Toran N, Tarragona J. Cutaneous verruciform xanthoma arising on a congenital lymphoedematous leg. Histopathology. 1995;26(3):277–9 (PMID: 7797206).

    CAS  Article  PubMed  Google Scholar 

  71. 71.

    Than T, Birch PJ, Dawes PJ. Verruciform xanthoma of the nose. J Laryngol Otol. 1999;113(1):79–81 (PMID: 10341929).

    CAS  Article  PubMed  Google Scholar 

  72. 72.

    Zhou H. Verruciform xanthoma of the glans penis: report of a case. Zhonghua Bing Li Xue Za Zhi. 2012;41:127. (PMID 22455893 in Chinese).

  73. 73.

    Allen CM, Kapoor N. Verruciform xanthomai n a bone marrow transplant recipient. Oral Surg Oral Med Oral Pathol. 1993;75:591–4 (PMID 8488027).

    CAS  Article  PubMed  Google Scholar 

  74. 74.

    Cooper TW, Santa Cruz DJ, Bauer EA. Verruciform xanthoma. Occurrence in eroded skin in a patient with recessive dystrophic epidermolysis bullosa. J Am Acad Dermatol. 1983;8:463–7 (PMID 6853779).

    CAS  Article  PubMed  Google Scholar 

  75. 75.

    Frankel MA, Rhodes HE, Euscher ED. Verruciform xanthoma in an adolescent: a case report. J Low Genit Tract Dis. 2012;16:70–4 (PMID 22126832).

    Article  PubMed  Google Scholar 

  76. 76.

    Reich O, Regauer S. Recurrent verruciform xanthoma of the vulva. Int J Gynecol Pathol. 2004;23:75–7 (PMID 14668556).

    Article  PubMed  Google Scholar 

  77. 77.

    Pellice C Jr, Sole M, Pellice C, Carretero P. Verruciform xanthoma of the penis. J Urol (Paris). 1987;93:41–2 (PMID 3559260).

    Google Scholar 

  78. 78.

    Sachs O. Beitrage zur histologie der weichen naevi. Archiv Dermatol Syphillis. 1903;66:101–26. (No PMID).

  79. 79.

    Philipsen HP, Reichart PA, Takata T, Ogawa I. Verruciform xanthoma—biological profilfe of 282 oral lesions based on a literature survey with nine new cases from Japan. Oral Oncol. 2003;39:325–36 (PMID 12676251).

    CAS  Article  PubMed  Google Scholar 

  80. 80.

    Kono Y. Verruciform xanthoma. Hifu Rinsho. 1985;27:1082–83. (No PMID).

  81. 81.

    Zegarelli DJ, Zegarelli-Schmidt EC, Zegarelli EV. Verruciform xanthoma. Further light and electron microscopic studies, with the addition of a third case. Oral Surg Oral Med Oral Pathol. 1975;40:246–56.

    CAS  Article  PubMed  Google Scholar 

  82. 82.

    Travis WD, Davis GE, Tsokos M, Lebovics R, Merrick HF, Miller SP, Gregg RE, Di Bisceglie AM, Parker RI, Ishak KG, et al. Multifocal verruciform xanthoma of the upper aerodigestive tract in a child with systemic lipid storage disease. Am J Surg Pathol. 1989;13:309–16 (PMID 2539022).

    CAS  Article  PubMed  Google Scholar 

  83. 83.

    Helm KF, Höpfl RM, Kreider JW, Lookingbill DP. Verruciform xanthoma in an immunocompromised patient: a case report and immunohistochemical study. J Cutan Pathol. 1991;20:84–6 (PMID 8385681).

    Article  Google Scholar 

  84. 84.

    Oliveira PT, Jaeger RG, Cabral LA, Carvalho YR, Costa AL, Jaegar MM. Verruciform xanthoma of the oral mucosa. Report of four cases and a review of the literature. Oral Oncol. 2001;37:326–31 (PMID 11287290).

    CAS  Article  PubMed  Google Scholar 

  85. 85.

    Miyamoto Y, Nagayama M, Hayashi Y. Verruciform xanthoma occurring within oral lichen planus. J Oral Pathol Med. 1996;25:188–91 (PMID 8809688).

    CAS  Article  PubMed  Google Scholar 

  86. 86.

    Mostafa KA, Takata T, Ogawa I, Ijuhin N, Nikai H. Verruciform xanthoma of the oral mucosa: a clincopathological study with immunohistochemical findings related to pathogenesis. Virchows Arch A. 1993;423:243–8 (PMID 8236821).

    CAS  Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Institute on Aging, Grant T35 AG26757 (PI: Dilip V. Jeste, MD), and the Stein Institute for Research on Aging and the Center for Healthy Aging at the University of California, San Diego. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Katherine M. Stiff and Philip R. Cohen have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Data Availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Open Access

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Author information

Affiliations

Authors

Corresponding authors

Correspondence to Katherine M. Stiff or Philip R. Cohen.

Additional information

Enhanced content

To view enhanced content for this article go to http://www.medengine.com/Redeem/9517F0603C08B0DA.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stiff, K.M., Cohen, P.R. Vegas (Verruciform Genital-Associated) Xanthoma: A Comprehensive Literature Review. Dermatol Ther (Heidelb) 7, 65–79 (2017). https://doi.org/10.1007/s13555-016-0155-0

Download citation

Keywords

  • VEGAS xanthoma
  • Verruciform xanthoma
  • Verruciform xanthoma of the penis
  • Verruciform xanthoma of the scrotum
  • Verruciform xanthoma of the vulva