Oral verruciform xanthoma (OVX) is a rare benign lesion of the oral mucosa that typically presents as a small, well-circumscribed, papillary or verrucous plaque. Although its clinical appearance may pose diagnostic challenges, its histopathologic features – papillary or verrucous epithelial hyperplasia and the accumulation of lipid-laden foamy macrophages within the connective tissue papillae – are distinctive. In this study, we report an unusually large OVX arising from the mandibular gingiva and exhibiting destructive intraosseous extension. In addition, we analyze 28 cases with respect to clinical variables (age, sex, location, medical and dental history, and follow-up period) and histopathologic features (architectural type, degree of inflammation, predominant inflammatory cell type) Clinically, among 28 patients (18 males, 10 females; mean age 49.2 ± 15.1 years), the gingiva was the most commonly affected site (89%), followed by the tongue (11%). Autoimmune disease and malignancy were each identified in two patients (7%). Prosthesis-associated lesions occurred in four patients (14%). The mean clinical follow-up period was 10.0 months (available for 12 patients). Reappearance of OVX was noted in four cases with a mean interval of 20.5 months after the first excision. Histologically, OVXs were classified as verrucous type (61%) or papillary type (39%). The degree of inflammation was graded as mild in 10 cases (36%), moderate in 16 (57%), and severe in 2 (7%). Lymphocytes (75%) were the most frequent inflammatory cells, whereas plasma cells (21%) and neutrophils (4%) were occasionally admixed. This study highlights an uncommon biologic behavior of OVX and underscores practical importance of complete removal and histopathologic evaluation.

• 한승용(연세대학교 치과대학 구강병리학교실) | Seung-Yong Han (Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, Korea)
• 조수빈(연세대학교 치과대학 구강병리학교실, 연세대학교 구강종양연구소) | Sue Bean Cho (Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, Korea, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea)
• 한다울(연세대학교 치과대학 구강병리학교실, 연세대학교 구강종양연구소) | Dawool Han (Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, Korea, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea)
• 김현실(연세대학교 치과대학 구강병리학교실, 연세대학교 구강종양연구소) | Hyun Sil Kim (Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, Korea, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea) Corresponding author
• 최윤주(연세대학교 치과대학 영상치의학교실) | Yoon Joo Choi (Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea)
• 남웅(연세대학교 치과대학 구강악안면외과학교실) | Woong Nam (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea)