Bladder, ureter & renal pelvis
Other tumors
Condyloma acuminatum


Topic Completed: 21 January 2020

Minor changes: 21 January 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: Condyloma acuminatum urinary bladder

Iryna Samarska, M.D., Ph.D.
Jonathan Epstein, M.D.
Page views in 2019: 705
Page views in 2020 to date: 901
Cite this page: Samarska I., Epstein J. Condyloma acuminatum. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladdercondyloma.html. Accessed October 24th, 2020.
Definition / general
  • Rare lesion of the urinary bladder, composed of hyperplastic papillary fronds of squamous epithelium with koilocytosis and viral atypia
  • Caused by human papillomavirus (HPV) (both low risk HPV and high risk HPV)
Essential features
  • Polypoid lesion composed of hyperplastic papillary fronds of squamous epithelium with koilocytosis and viral atypia
  • Caused by HPV (both low risk HPV and high risk HPV) but negative RNA in situ hybridization does not exclude condyloma acuminatum
  • Often immunocompromised patients and history of anogenital condylomata
  • Differential diagnosis includes squamous papilloma, squamous metaplasia, verrucous squamous hyperplasia and papillary urothelial carcinoma
ICD coding
  • ICD-10: N32.9 - Bladder disorder, unspecified
Epidemiology
Sites
  • Urethra (more common) and urinary bladder (rare)
Pathophysiology
Etiology
  • Caused by HPV (both low risk HPV and high risk HPV)
Clinical features
Diagnosis
  • Cystoscopy
  • Diagnosis is by biopsy or surgical resection
Prognostic factors
  • Often recurs
  • At risk for in situ and invasive squamous cell carcinoma
Case reports
Treatment
  • Transurethral resection
  • Some studies suggest that BCG, which is often used for recurrent or multiple noninvasive papillary urothelial carcinomas, is also an effective therapy for recurrent penile or uterine cervical condylomata and thus can be used for treatment of condyloma acuminatum of the urinary bladder
Clinical images

Images hosted on other servers:

Cystoscopy

Gross description
  • Depends on the size of the lesion and often not remarkable
  • Smooth, pink-tan, papillary
Microscopic (histologic) description
  • Exophytic lesion
  • Nonkeratinizing, hyperplastic papillary fronds of squamous epithelium
  • Lack free floating papillary fronds
  • Cells with koilocytosis and viral atypia (Am J Surg Pathol 2006;30:883)
Microscopic (histologic) images

Contributed by Jonathan Epstein, M.D.

Prostatic urethra papillary lesion

Urinary bladder hyperplastic lesion

Urinary bladder koilocytosis

Molecular / cytogenetics description
  • RNA in situ hybridization testing for low risk and high risk HPV is needed
  • Can be positive for either low risk or high risk HPV or both (Am J Surg Pathol 2019;43:1547)
  • Negative RNA in situ hybridization for HPV does not exclude condyloma acuminatum if the histology is characteristic (Am J Surg Pathol 2019;43:1547)
Sample pathology report
  • Urinary bladder, papillary lesion, transurethral resection:
    • Condyloma acuminatum (see comment)
    • Comment: The lesion is positive for low risk HPV. Condyloma acuminatum of bladder can be associated with in situ or invasive squamous cell carcinoma. Therefore, close followup is warranted. Additional sampling is recommended to exclude concomitant squamous cell carcinoma if clinically indicated.
Differential diagnosis
  • Squamous papilloma:
    • More common in women
    • Shows free floating papillary fronds
    • Well established fibrovascular cores
    • Lined by a benign squamous nonkeratinizing epithelium
    • Lacks koilocytosis or viral atypia
    • Unrelated to HPV infection
  • Squamous metaplasia:
    • Can be divided into nonkeratinizing and keratinizing types
    • Nonpolypoid flat lesion consisting of a thickened squamous epithelium with an overlying thick keratin layer
    • Squamous dysplasia may be seen
    • Glycogenated squamous metaplasia have cleared out cytoplasm but lacks papillary growth and viral atypia
  • Verrucous squamous hyperplasia:
    • Spiking squamous hyperplasia with marked hyperkeratosis, parakeratosis and elongation of the rete pegs
    • No viral atypia
    • This lesion might be related to invasive squamous cell carcinoma
  • Papillary urothelial carcinoma:
    • Can have clear cytoplasm
    • Lacks viral atypia
    • Typically has more exophytic free floating papillary fronds
  • High-grade noninvasive urothelial carcinoma with FGFR3 mutation:
    • Has a urothelial lining with polygonal cells, distinct cell borders, clear cell to eosinophilic cytoplasm and prominent koilocytic nuclei
Board review style question #1
    A 30 year old woman presents with micturition pain and urinary obstruction symptoms. Transurethral bladder resection revealed a polypoid mass, composed of hyperplastic papillary fronds of squamous epithelium with koilocytosis and viral atypia. What would be the most appropriate ancillary test?

  1. Immunohistochemistry for p40 and p63
  2. Immunohistochemistry for CK20 and p53
  3. RNA ISH for low risk and high risk HPV
  4. Immunohistochemistry for p16
Board review answer #1
C. RNA ISH for low risk and high risk HPV. The lesion may be a urinary bladder condyloma acuminatum.

Reference: Condyloma acuminatum

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Board review style question #2


    Transurethral resection of a bladder mass in a 45 year old man with a history of renal transplantation revealed a condyloma acuminatum of the prostatic urethra. Which lesion can be related to the condyloma acuminatum?

  1. No clinically significant relation known
  2. Squamous cell carcinoma (either invasive or in situ)
  3. Invasive urothelial carcinoma
  4. Squamous metaplasia
Board review answer #2
B. Squamous cell carcinoma (either invasive or in situ). Patients are at risk for concomitant or subsequent squamous cell carcinoma (either invasive or in situ).

Reference: Condyloma acuminatum

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