背景:疣状黄色瘤(VX)并不常见,口腔粘膜良性上皮病变。虽然这个实体也可以口外呈现,包括皮肤和肛门生殖器区域,口外部位组织学特征的变化尚不明确.评估了口腔与口外VX的人口统计学和形态学特征的差异,以帮助促进该病变的准确诊断和治疗。
方法:获得IRB批准后,从2000年至2022年的机构档案中回顾性收集了110例确诊的VX病例。患者年龄,性别,可用的病史,病变外观,并获得每个病例的持续时间。
结果:中位年龄为55岁(13-86岁),男女比例为1.2:1。最常见的口腔部位,按降序排列,是腭(n=24,22%),颊粘膜(n=18,16%),牙龈(n=16,15%),和舌头(n=13,12%)。口外部位占所有病变的9%,包括阴囊(9),外阴(2),脸颊(1),手腕(1),臀区(1),腹壁(1)。所有病变的中值大小为6.0mm,与口腔病变相比,口外病变的大小比口腔病变大6.7mm(B±SE:6.7±2.5cm,p=0.01)。病变最常见的是粉红色或白色,通常被描述为乳头状,有花梗,疣状,和/或外生。微观上,楔形角化不全的存在,上皮/表皮上方的角蛋白突起,和相关的炎症在口腔和口外病变之间存在显着差异。在口外病变中,明显的楔形角化不全(p=0.04)和上皮/表皮上方的角蛋白突起(p<0.001)更为普遍。角蛋白突起与上皮异型性之间没有显着联系(p=0.44)。
结论:熟悉VX的广泛形态光谱,包括楔形角化不全的存在和程度,上皮/表皮上方的角蛋白突起,和相关的潜在炎症,将有助于在不寻常的地方诊断它。
BACKGROUND: Verruciform xanthoma (VX) is an uncommon, benign epithelial lesion of the oral mucosa. While this entity can also present extraorally, including on the skin and in
anogenital areas, the variation in its histologic features in extraoral sites is not yet well defined. Differences in the demographics and morphologic features of oral versus extraoral VX were assessed to help facilitate the accurate diagnosis and management of this lesion.
METHODS: After obtaining IRB approval, 110 cases of diagnosed VX were retrospectively collected from our institutional archives spanning from 2000 to 2022. Patient age, gender, available medical history, lesion appearance, and duration were obtained for each case.
RESULTS: The median age was 55 years (range 13-86) with a male-to-female ratio of 1.2:1. The most common oral sites, in descending order, were the palate (n = 24, 22%), buccal mucosa (n = 18, 16%), gingiva (n = 16, 15%), and tongue (n = 13, 12%). Extraoral sites comprised 9% of all lesions, including the scrotum (9), vulva (2), cheek (1), wrist (1), gluteal region (1), and abdominal wall (1). The median size for all lesions was 6.0 mm, and extraoral lesions were associated with a 6.7 mm larger size compared to oral lesions (B ± SE: 6.7 ± 2.5 cm, p = 0.01). The lesions were most frequently pink or white in color and often described as papillary, pedunculated, verrucous, and/or exophytic. Microscopically, the presence of wedge-shaped parakeratosis, keratin projections above the epithelium/epidermis, and associated inflammation significantly differed between oral and extraoral lesions. Prominent wedge-shaped parakeratosis (p = 0.04) and keratin projections above the epithelium/epidermis (p < 0.001) were more prevalent in extraoral lesions. There was no significant link between keratin projections and epithelial atypia (p = 0.44).
CONCLUSIONS: Familiarity with the broad morphological spectrum of VX, including the presence and degree of wedge-shaped parakeratosis, keratin projections above the epithelium/epidermis, and associated underlying inflammation, will be helpful in diagnosing it in unusual locations.