Oral Verruciform Xanthoma of the Lower Lip: A Rare Entity

Oral verruciform xanthoma (OVX) is a rare entity, and only a handful of cases have been reported in the literature to date. This innocent-looking lesion can mimic any benign epithelial or connective tissue origin neoplasm. It can present with variations in surface color and texture. Cases have been reported in intra-osseous and extra-osseous sites, mainly in masticatory mucosa and very few in non-keratinized mucosal sites. Literature suggests the xanthoma cells possess a monocyte/macrophage lineage, although the exact etiopathogenesis remains unclear. Our patient was a 20-year-old male who presented with a soft, keratotic growth in the lower lip. It clinically mimicked a mucocele or a traumatic fibroma until the mystery was resolved by histopathology and immunohistochemistry. Histopathology revealed numerous foamy, granular xanthoma cells in the stroma along with inflammation and hyperplastic epithelium. Immunohistochemistry showed positivity to CD68 and Cathepsin-B but negative to S-100. The final diagnosis was made as oral verruciform xanthoma. It was surgically excised and remained recurrence-free on follow-up.