Penis and scrotum
Benign tumors
Condyloma acuminatum

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 2 April 2018, last major update February 2010

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Condyloma acuminatum[TIAB] penis

Cite this page: Cubilla, A., Chaux, A. Condyloma acuminatum. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumcondyloma.html. Accessed July 16th, 2018.
Definition / general
Terminology
  • Also known as genital wart
Epidemiology
  • Transmitted through skin to skin contact during oral, genital or anal sex
  • Most commonly affects young males in teens and 20s
  • HPV is most common sexually transmitted disease in U.S. but many HPV infections don't lead to condyloma
Sites
  • Most common sites (in decreasing frequency) are glans, foreskin, meatus and shaft
  • Often near coronal sulcus and inner surface of foreskin
Etiology
  • Most frequently caused by HPV genotypes 6 and 11
  • Other genotypes identified include HPV 16, 18, 30 - 32, 42 - 44 and 51 - 55
  • Related to verruca vulgaris (common wart)
Clinical features
  • Benign
  • Small lesions detected with topical acetic acid
  • Malignant transformation is very rare
Case reports
  • 46 year old HIV+ man with condyloma overgrowth caused by immune reconstitution inflammatory syndrome (Urology 2009;74:1013)
Treatment
  • Medical treatment includes imiquimod cream, 20% podophyllin antimitotic solution, 0.5% podofilox solution, 5% 5-FU cream and trichloroacetic acid (TCA)
  • Also freezing, burning (electrocautery), CO2 laser (Eur J Dermatol 2008;18:153) or surgical excision (if large)
  • Recurs but does not evolve into invasive cancer
Clinical images

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Severe lesion

Gross description
  • Papillary, fungating, wart-like, often multiple lesions and 1 mm or larger
  • Must section and examine lesion thoroughly to rule out verrucous carcinoma
Gross images

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Cauliflower-like lesion

Large scrotal lesion

Microscopic (histologic) description
  • Arborescent (tree-like, complex) "condylomatous" spiky papillae with prominent central fibrovascular cores
  • Surface koilocytosis (koilocytes have hyperplastic epithelium with wrinkled hyperchromatic nuclei, perinuclear halos and frequent bi and multinucleation)
  • Sharply defined base without invasion
  • Preservation of orderly maturation of epithelial cells
  • T lymphocytes (CD4+) present
  • May have reactive atypia but no evidence of invasion
  • Variable acanthosis and hyperkeratosis
  • Note: koilocytosis is not evident in some cases but the histological pattern is otherwise characteristic
Microscopic (histologic) images

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Low power shows acanthosis and papillarity



Images hosted on other servers:

Low power shows acanthosis and papillarity

Hyperkeratosis and koilocytosis

Scrotal lesion - low power

Cytology description
  • Cytopathologic detection of HPV infection in penile samples collected for liquid based cytology is low (Cancer 2008;114:489)
Molecular / cytogenetics description
  • Lesions with HPV 6 and 11 by in situ hybridization usually have perinuclear halos and nuclear atypia
  • Lesions with HPV DNA by PCR only may contain only a focally thickened granular layer associated with epithelial crevices (Am J Surg Pathol 1992;16:269)
Differential diagnosis