Anus and perianal area
Premalignant lesions
Condyloma acuminatum

Author: Nicole Riddle, M.D. (see Authors page)

Revised: 11 October 2017, last major update July 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Condyloma acuminatum [title] anal

Cite this page: Riddle, N. Condyloma acuminatum. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/anuscondyloma.html. Accessed December 16th, 2017.
Definition / general
  • A benign hyperplastic squamous proliferation caused by the human papillomavirus
Terminology
  • Also called condyloma, verruca (not the preferred term in the genital area), wart
Epidemiology
  • Associated with human papillomavirus (HPV)
  • Annual incidence is 1%
  • HPV in genital area in general is considered the most common sexually transmitted disease, with prevalence believed to exceed 50%
  • Highest prevalence and risk is in second and third decades
  • Associated with other HPV lesions (anal dysplasia / CIS, verrucous carcinoma, squamous cell carcinoma / basaloid carcinoma)
  • In US, 3,000 new annual cases of HPV associated anal cancers are diagnosed in women, 1,700 in men
  • Caucasian women are more likely than women of other races to have high risk HPV
  • African American men are more likely than other races to have high risk HPV
Prognostic factors
  • Prognosis varies based on type of HPV infection (high risk vs. low risk)
  • There are over 100 types, 14 are known to cause cancer
  • High risk:
    • 16 and 18 - together cause ~75% of genital cancers
    • Also 31, 33, 35, 45, 51, 52, 56, 58, 59, 66 and 68
  • Note: Non Caucasians are more likely to have non 16 / 18 types - this affects testing and vaccination efficacy
  • Low risk:
    • 6 and 11 - together cause ~90% of all genital warts
Treatment
  • Topicals: podophyllotoxin (Condylox, Wartec, Warticon), imiguimod (Aldera), sinecatechins (Veregen, Polyphenon E), trichloroacetic acid, interferon
  • Cryosurgery
  • Removal: excisional biopsy, surgical excision
Clinical images

Images hosted on other servers:

Severe case

Gross description
  • Papillary excrescences, 1 - 2 mm to several centimeters
Gross images

Images hosted on other servers:

Vaginal condyloma

Microscopic (histologic) description
  • Hyperplastic papillary squamous epithelium with parakeratosis, variable koilocytotic atypia (nuclear wrinkling with perinuclear clearing)
  • Variable dysplastic changes: increased nuclear atypia / size, increased / atypical mitosis - should be commented on, especially if high grade
Microscopic (histologic) images

Images hosted on PathOut server:

Large papillary structures



Images hosted on other servers:

Hyperplastic dermal papillae with parakeratosis, mild nuclear atypia with perinuclear halos

Cytology description
Cytology images

Images hosted on other servers:

LSIL, Pap

Positive stains
  • LMW keratins (CAM5.2, CK5 / 6) and p63 - stain positive similar to all squamous mucosa
  • p16
  • Ki67 may be helpful in determining dysplasia - amount and location near surface