Verruciform xanthoma is a benign lesion of the oral cavity and skin, which is characterized by aggregates of bland foamy histiocytes (xanthoma cells) within the connective tissue and underlying acanthotic, parakeratotic hyperplastic epithelium with elongated rete ridges. We describe a rare case of vulval verruciform xanthoma in an 84-year-old, which was clinically mistaken for malignant tumor. Immunohistochemistry confirmed the histiocytic nature of the foamy cells and electron microscopy showed the cytoplasmic vacuoles to contain lipid. A finding as yet undocumented in the literature was the presence of foamy histiocytes within the draining lymph nodes. This case highlights clinical mimicry of a malignant tumor by anogenital verruciform xanthoma.
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