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Verruciform xanthoma (VX) is an uncommon lesion confined mainly to the oral mucosa of unknown etiology. The definitive diagnosis is always made during a histologic examination of the submitted biopsy specimen. Histologically, it is characterized by verrucopapillomatosis, parakeratosis, with aggregates of lipid-laden foam cells (called ‘xanthoma cells’) in the connective tissue papillae. The immunohistochemical study and special stain show foam cells that are positive for CD68 and periodic acid–Schiff (PAS)-positive, diastase resistant. We present a case of oral VX in a 37-year-old Thai female after an incidental finding during a routine oral check-up. The slightly raised lesion with a verrucous surface at the buccal attached and marginal gingiva of the left second lower premolar tooth was observed. In oral examination, clinical differential diagnosis and incisional biopsy were performed. The histopathology, immunohistochemical study and special stain confirmed the diagnosis of oral VX. The aim of this article is to describe a rare case diagnosed as oral VX based on clinical and histopathological findings, and present a brief review of the literature.
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