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Verruciform Xanthoma — MFDS Part 1 MCQ

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HardOral PathologyVerruciform XanthomaMFDS Part 1

An excision biopsy of an asymptomatic 8 mm yellow-red verrucous plaque on the attached gingiva shows parakeratosis and regular papillomatous epithelial hyperplasia with elongated rete ridges, without epithelial dysplasia. Which additional histological finding most specifically confirms verruciform xanthoma?

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Correct answer: D — CD68-positive foamy macrophages concentrated within the connective tissue papillae

The correct answer is D. Verruciform xanthoma has papillomatous or verrucous squamous epithelial hyperplasia, usually with parakeratosis and elongated rete ridges. Its diagnostic hallmark is an accumulation of lipid-containing foamy macrophages, typically CD68 positive, within the connective tissue papillae between the rete ridges. Invasive dysplastic islands with desmoplasia would indicate squamous cell carcinoma rather than this benign lesion. Well-formed granulomas suggest a granulomatous inflammatory disorder. Suprabasal acantholysis with retained basal cells is characteristic of pemphigus vulgaris. Basaloid islands with peripheral palisading and stromal retraction are features of a basaloid neoplasm and are not seen in verruciform xanthoma.

Reference: Kimura T et al. Clinical and Histopathological Features of Oral Verruciform Xanthoma: A Case Series of Three Patients. Clinical Case Reports. 2026. https://pubmed.ncbi.nlm.nih.gov/42022977/