Verruciform xanthoma of the scrotum with evidence of carcinoma in situ

Verruciform xanthoma, first described by Shafer in 1971 in the oral cavity, is a rare lesion characterized by acanthosis of the epidermis and by elongated papillae filled by foamy cells. A 62-year-old man presented with a 2-year-history of a verrucous, pink-brownish, pedunculate papilloma localised on the anterior side of his scrotum. He was otherwise in good general health. Histopathologic findings revealed verruciform xanthoma occurring in combination with atypical mitotic figures. Biologic molecular studies were performed: DNA extracted from formalin embedded tissue was amplified by PCR with HPV consensus primers MY09/MY11 and HPV general primers GP5+/GP6+. These studies did not reveal the presence of HPV virus in the lesion. It is possible that verruciform xanthoma represents a pattern reactive to different epidermal changes induced by various causes. Reports on verruciform xanthoma occurring within a carcinoma in situ are uncommon: so far only 5 cases have been described. In our case carcinoma in situ characterized by numerous atypical mitotic figures was evident.