Detection of HPV and Immunohistochemical Analysis of Oral Verruciform Xantoma With Multifocal Occurrence

Objectives: Verruciform Xantoma (VX) is a relatively unfrequent clinicopathological entity, with intraoral and extraoral involvement, of uncertain etiopathogenesis, however immunologic factors as well as local factors are documented.
VX clinically presents as a papilar or verrucoid lesion, sessile of solitary or multiple occurrence.

Aim:The purpose of the present study was to detect the HPV presence and immunohistochemical analysis of Oral Verruciform Xantoma.
Methods: A case of Oral VX presented in a 58 year old female was assessed. The patient was clinically examined presenting multiple papillary lesions on lateral border of the tongue, varying in size, sessile, firm, slightly brownish in color. No contributory systemic diseases were reported.Tobacco consumption was informed. Complementary blood tests were indicated and excisional biopsy was performed. Histopathological examination revealed stratified squamous epithelium with a parakeratinized papilar surface, immediately subjacent numerous foamy histiocytes were observed. In order to investigate the exact cell phenotype an immunohistochemical analysis was done using the following antibodies: S100 protein, CD68, CD163 to establish the definite diagnosis of VX and following standardized protocol. To analyzed the presence of HPV in VX, 3 µm sections were obtained from paraffin blocks to perform p16 as a marker of HPV infection as well as Colorimetric in situ hybridization (CISH).
Results: CD68 and CD163 showed positive immunoreactivity at histiocytes present in the lesion. p16 protein was focally positive at surface epithelium.
Conclusions: This study emphasized the clinicopathological and immunohistochemical correlation in VX diagnosed cases with unusual multifocal mucosal presentation and verrucoid appearance to rule out other HPV papillary related lesions.