Background Oral verruciform xanthoma (OVX) is a rare lesion. The purpose of the present study is to describe the clinical features of 13 OVXs and review all cases reported in the English literature. Material and methods Thirteen cases of OVX diagnosed during a 47-year period were retrospectively collected. The patients gender and age, as well as the main clinical features of the lesions were retrieved from the biopsy request forms. Pubmed, Scopus and Google ScholarTM electronic databases were searched with the key word verruciform xanthoma. Only cases of histologically confirmed OVX were included in the study. Results The 13 OVXs represented approximately 0.04% of 35,617 biopsies accessioned during the study period. They affected 13 patients, 8 males and 5 females with a mean age of 48.8±14 years. They mainly appeared as asymptomatic granular nodules or plaques, with elastic or normal consistency and white color, in the gingiva or hard palate. Literature review yielded 416 cases of OVX. With the addition of cases of the present study, 429 cases of OVX have been presented in the English literature. OVX has a slight male predominance with a male to female ratio of 1.4:1 and the majority of patients are in the 5th to 7th decade of life. Clinically, OVX mainly presents as an asymptomatic, single, papillary or granular plaque or nodule, with elastic or soft consistency and white, red or pink color. It measures approximately 1cm and is most commonly located on the gingiva, tongue, hard palate or buccal mucosa. The treatment of choice is surgical excision with little rates of recurrence. Conclusions Verruciform xanthoma is a rare lesion most often encountered on the ginigival mucosa. As its clinical presentation is not pathognomonic, it should be included in the differential diagnosis of verrucous or papillary lesions.

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Oral verruciform xanthoma: Report of 13 new cases and review of the literature.

A careful examination of lips is often neglected by the members of the medical and dental professions; yet the lips reveal a heterogeneous group of lesions ranging from congenital abnormalities to benign and malignant neoplasms. Verruciform Xanthoma (VX) is an uncommon benign inflammatory mucocutaneous condition that occurs in the oral cavity which was first described by Shafer in 1971. It is often associated with pre-existing epithelial and/or inflammatory disorder and is characterized histopathologically by papillary epithelial hyperplasia and the presence of foamy macrophages in connective tissue papillae. We report a case with VX which presented as a well-defined, soft, painless swelling on the lower lip having different clinical features.

A verruciform xanthoma of the lower lip and review of the differential diagnosis.

We present a case of Verruciformxanthoma (VX) occurring on faucial pillar of oral cavity. VX is an uncommon benign mucocutaneous lesion of unknown etiology. It usually appears as single or multiple plaques or papules may be raised or flat with verrocous or pappilary rough surface texture, colour varying from reddish pink to yellowish gray, mainly affecting masticatory mucosa, especially gingiva and hard palate. Histologically, VX is characterized by the presence of parakeratinized epithelium with thin rete ridges and connective tissue papillae extending up to the surface. The papillae characteristically consist of foam cells, also called xanthoma cells. We report a case of VX in the faucial pillar which is not been reported in the literature and discuss their clinical and histopathological findings.

Verroucas Xanthoma of Faucial Pillar -A Case Report

Postmenopausal estrogen deficiency and ethanol (EtOH) abuse are known risk factors for different diseases including bone tissues. However, little is known about the synergic effects of EtOH abuse and estrogen deficiency on alveolar bone loss in women. The present study evaluated the effects of EtOH chronic exposure and ovariectomy on the alveolar bone loss in female rats. For this, 40 female Wistar rats were randomly divided into 4 groups: control, EtOH exposure, ovariectomy (OVX), and OVX plus EtOH exposure. Initially, half of the animals were ovariectomized at 75 days of age. After that, the groups received distilled water or EtOH 6.5 g/kg/day (20% w/v) for 55 days via gavage. Thereafter, animals were sacrificed and the mandibles were collected, dissected, and separated into hemimandibles. Alveolar bone loss was evaluated by measuring the distance between the cementoenamel junction and the alveolar bone crest through a stereomicroscope in 3 different anatomical regions of the tissue. One-way ANOVA and post hoc Tukey were used to compare groups ( ). The results showed that the ovariectomy and EtOH exposure per se were able to induce alveolar bone loss, and their association did intensify significantly the effect. Therefore, OVX associated with heavy EtOH exposure increase the spontaneous alveolar bone loss in rats.

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Effects of Chronic Ethanol Consumption and Ovariectomy on the Spontaneous Alveolar Bone Loss in Rats.

Influence of chronic alcoholism and estrogen deficiency on the immunohistochemical expression of regulatory proteins of the bone resorption process in the periodontium of Wistar rats

Verruciform xanthoma (VX) is a relatively rare benign lesion and oral predominantly, which occasionally affects skin and genital mucosa. It appears as a papule or single plaque showing a verrucous or papillomatous aspect, with variable color from reddish pink to gray. In majority of oral cases, it affects gingiva and alveolar mucosa such a solitary lesion. Histopathological findings are foamy histiocytes within elongated dermal papillae. Treatment consists of conservative excision surgery and recurrence is rare. A clinical case is reported, located in anterior gingiva, showing good prognosis, without recurrence. There was no concomitant oral lesion associated. Local trauma was the only possibility suggested to be related to etiology. No relevant alterations in laboratory exams (hemogram, total cholesterol, HDL, LDL, VLDL, glycose and glycolized hemoglobin) were found. The origin of the lesion remains unclear and investigation for possible associations with other lesions that could present greater risk of carcinogenesis is required.

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Verruciform xanthoma located in anterior gingiva

The immune system plays an important role in the pathogenesis of periodontal diseases. The host may modulate periodontal inflammatory reactions and it determines variances in the individual susceptibility and in the periodontal disease progression speed. Osteoporosis and alcoholism are described as risk indicators of periodontal disease among the systemic acquired factors. Objective: The current study aims to analyze chronic alcohol consumption influence on induced periodontitis in rats presenting estrogen deficiency. Material and Methods: Sixty rats approximately 90 days old were used in the experiment; they were divided into two groups: correlated surgery (OVZ) or surgical ovariectomy simulation (SHAM). Each group was divided into three subgroups: (C) control diet, (A) ethanol containing 20% liquid diet and (I) par-fed control diet. Thirty days after castration the diet and the experimental periodontitis induction were kept for 56 days. Interproximal regions between the first and the second lower left molar and the respective contralateral site without periodontal disease induction were assessed for inflammatory features. Results: Hormone deficiency resulted in important inflammatory changes concerning the meaning of SHAM-C and OVZ-C. The ethanol diet has resulted in inflammatory changes to both groups SHAM-A and OVZ-A in the absence of periodontitis, with also greater severity when combined with ovariectomy. Conclusion: It was concluded that the association between estrogen deficiency and 20% ethanol was just relevant for sites without periodontitis disease induction, since it induces stronger severity in the inflammatory process in the presence of the inflammatory cells scattered in the conjunctive tissue and of the disorientation of periodontal ligament fibers. Keywords Alcoholism; Osteoporosis; Ovariectomy; Periodontal disease.

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Juliana Madureira de Souza Lima Alonso

Papers

Verruciform xanthoma located in anterior gingiva

Periodontal inflammation induced by chronic ethanol consumption in ovariectomized rats