Verruciform xanthoma associated with reactivation of Epstein-Barr virus.

Verruciform xanthoma is a rare benign tumor first described by Shafer in 1971. It usually arises on the oral mucosa. An 11-year-old boy was referred to our outpatient clinic for evaluation of a lesion that had been present on the tongue for 6 weeks and was slightly tender on palpation. The child had been diagnosed with acute myeloblastic leukemia 4 years earlier and had received 2 allogeneic bone marrow transplants, the first 3 months after the diagnosis and the second 3 years later. At the time we saw the patient, he was in complete remission, with full chimera of the transplant, and he had never presented signs of graft-versus-host disease (GVHD). He had not received immunosuppressant treatment for the previous 7 months. Physical examination revealed an elevated, oval-shaped, sessile tumor with a long axis of about 2 cm. The tumor was located on the left lateral surface of the tongue and had a whitish, verrucous surface that was not ulcerated (Fig. 1). Two months before the lesion appeared, asymptomatic reactivation of Epstein-Barr virus (EBV) infection had been detected, evidenced by an increase in the viral load on serial measurements performed as part of the routine follow-up of the patient’s hematologic disease. Biopsy showed verrucous acanthosis with hyperkeratosis and isolated plaques of parakeratosis, and there were numerous foamy histiocytes in the dermal papillae (Figs. 2 and 3). The lesion was diagnosed as verrucous xanthoma. The tumor was completely excised and there were no signs of recurrence during 2 months of follow-up. Verrucous xanthoma usually presents clinically as a slowgrowing asymptomatic lesion with a yellowish, reddish, or