Central Xanthoma of the Anterior Mandible Mimicking a Radicular Cyst: A Clinicopathological Diagnostic Challenge—A Case Report

Background Central xanthoma is a rare benign intraosseous histiocytic lesion that may mimic common odontogenic pathology clinically, radiographically, and histopathologically. Accurate diagnosis requires clinicopathological correlation and exclusion of secondary xanthomatous processes. Case Report A 45-year-old male patient presented with a painless gingival swelling and intermittent draining sinus involving the anterior mandible. The associated teeth were vital on electric pulp testing. Panoramic radiography and computed tomography demonstrated a well-defined radiolucent lesion crossing the midline. Incisional biopsy suggested a radicular cyst; however, definitive histopathological examination following enucleation and curettage revealed extensive foamy histiocytes with xanthogranulomatous inflammation. The lesional cells showed diffuse CD68 positivity and S100 negativity. Systemic lipid and metabolic evaluation revealed no abnormalities. The patient showed satisfactory early postoperative healing on clinical and panoramic radiographic follow-up. Conclusion Central xanthoma should be considered in the differential diagnosis of radiolucent jaw lesions showing clinicopathological discordance. Integrated clinical, radiographic, histopathological, immunohistochemical, and systemic evaluation is essential for establishing the diagnosis.