Scrotal cutaneous verruciform xanthoma
with monocyte chemoattractant
protein-1 immunohistochemical study: a
case report
Abstract
Introduction: Verruciform xanthoma is a rare, benign lesion characterized by hyperkeratosis and
aggregates of foam cell macrophages. Here, we describe a case of verruciform xanthoma on the
scrotum, in which the immunohistochemical localization of monocyte chemoattractant protein-
1, a chemokine of the C-C or beta family that has been shown to induce the recruitment of
monocytes for injured tissue, was analyzed to determine which cells release chemoattractants
for macrophages.
Case presentation: A 75-year-old Japanese man with a well-defined nodule on the left scrotum
was admitted to the hospital. An excision biopsy revealed epidermal papillary proliferation with
parakeratosis, hyperkeratosis, and infiltration of foam cell macrophages, whereby a
pathological diagnosis of benign cutaneous verruciform xanthoma was made.
Immunohistochemically, monocyte chemoattractant protein-1 was observed predominantly on
cytokeratin AE1/AE3-positive differentiating keratinocytes in the prickle cell layer. However,
while infiltrating macrophages were densely stained for monocyte chemoattractant protein-1,
keratinocytes in the basal and parabasal layers were almost negative.
Conclusions:I demonstrated that keratinocyte-derived monocyte chemoattractant protein-1
plays an important role in the establishment of particular histological features of verruciform
xanthoma. However, in the present case, unlike in previous reports, monocyte chemoattractant
protein-1 immunostaining in keratinocytes in the basal and parabasal layers was not prominent.
We speculate that in the active phase of verruciform xanthoma, when continuous stimuli that
release monocyte chemoattractant protein-1 from keratinocytes to the surrounding stromal
area are present, the apparent immunostaining of monocyte chemoattractant protein-1 can be
underestimated because of the void created by accelerated keratinocyte release from the
cytoplasmic fraction.
Introduction yellowish, reddish, or grayish rough and granular surface
Verruciform xanthoma (VX) is an uncommon, benign [6], mimicking conventional papilloma, verrucous car-
lesion first reported in the oral cavity in 1971 [1]. A sur- cinoma and squamous cell carcinoma [7]. Histologically,
vey of 282 cases of VX involving different mucocuta- VX is characterized by papillomatosis, parakeratosis, and
neous sites has established the lesion as a distinct accumulation of foam cell macrophages [1,8,9].
clinicopathologic entity [2]. It occurs mainly in oral mu- This study describes a case of VX on the scrotum and
cosa and occasionally at extra-oral sites, including those analyzes the immunohistochemical localization of the
on the penis [3], the scrotum [4], and the vulva [5]. Clin- major macrophage chemotactic factor, monocyte chemo-
ically, the lesion is painless, asymptomatic, slow growing attractant protein-1 (MCP-1), to elucidate the particular
(up to 2cm in size), and slightly elevated with a tumor-macrophage interaction in VX.
Case presentation
A 75-year-old Japanese man was admitted to our hos-
pital with a gradually growing cutaneous polypoid mass
with monocyte chemoattractant
protein-1 immunohistochemical study: a
case report
Abstract
Introduction: Verruciform xanthoma is a rare, benign lesion characterized by hyperkeratosis and
aggregates of foam cell macrophages. Here, we describe a case of verruciform xanthoma on the
scrotum, in which the immunohistochemical localization of monocyte chemoattractant protein-
1, a chemokine of the C-C or beta family that has been shown to induce the recruitment of
monocytes for injured tissue, was analyzed to determine which cells release chemoattractants
for macrophages.
Case presentation: A 75-year-old Japanese man with a well-defined nodule on the left scrotum
was admitted to the hospital. An excision biopsy revealed epidermal papillary proliferation with
parakeratosis, hyperkeratosis, and infiltration of foam cell macrophages, whereby a
pathological diagnosis of benign cutaneous verruciform xanthoma was made.
Immunohistochemically, monocyte chemoattractant protein-1 was observed predominantly on
cytokeratin AE1/AE3-positive differentiating keratinocytes in the prickle cell layer. However,
while infiltrating macrophages were densely stained for monocyte chemoattractant protein-1,
keratinocytes in the basal and parabasal layers were almost negative.
Conclusions:I demonstrated that keratinocyte-derived monocyte chemoattractant protein-1
plays an important role in the establishment of particular histological features of verruciform
xanthoma. However, in the present case, unlike in previous reports, monocyte chemoattractant
protein-1 immunostaining in keratinocytes in the basal and parabasal layers was not prominent.
We speculate that in the active phase of verruciform xanthoma, when continuous stimuli that
release monocyte chemoattractant protein-1 from keratinocytes to the surrounding stromal
area are present, the apparent immunostaining of monocyte chemoattractant protein-1 can be
underestimated because of the void created by accelerated keratinocyte release from the
cytoplasmic fraction.
Introduction yellowish, reddish, or grayish rough and granular surface
Verruciform xanthoma (VX) is an uncommon, benign [6], mimicking conventional papilloma, verrucous car-
lesion first reported in the oral cavity in 1971 [1]. A sur- cinoma and squamous cell carcinoma [7]. Histologically,
vey of 282 cases of VX involving different mucocuta- VX is characterized by papillomatosis, parakeratosis, and
neous sites has established the lesion as a distinct accumulation of foam cell macrophages [1,8,9].
clinicopathologic entity [2]. It occurs mainly in oral mu- This study describes a case of VX on the scrotum and
cosa and occasionally at extra-oral sites, including those analyzes the immunohistochemical localization of the
on the penis [3], the scrotum [4], and the vulva [5]. Clin- major macrophage chemotactic factor, monocyte chemo-
ically, the lesion is painless, asymptomatic, slow growing attractant protein-1 (MCP-1), to elucidate the particular
(up to 2cm in size), and slightly elevated with a tumor-macrophage interaction in VX.
Case presentation
A 75-year-old Japanese man was admitted to our hos-
pital with a gradually growing cutaneous polypoid mass
