Clinical history: 82 year old male with polypoid scrotal lesion.
What is the most probable diagnosis?
Cutaneous Verruciform Xanthoma
Verruciform xanthoma is a warty lesion characterized by acanthosis, hyperkeratosis, and parakeratosis, with long rete ridges associated with a neutrophilic infiltrate. A variable (often prominent) xanthomatous infiltrate occupies the dermis between the rete ridges. This lesion is usually solitary and arises in the oral cavity, and only a few genital lesions have been described (scrotal, penile, and vulvar areas). Despite the architectural resemblance of verruciform xanthoma to other verruciform mucocutaneous lesions of the penis related to HPV infection, this lesion is most likely not an HPV-associated penile lesion.