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Table of Contents
Essential features | Terminology | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Treatment | Clinical images | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Condyloma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvacondyloma.html. Accessed July 16th, 2017.
Essential features
- Predominantly a sexually transmitted infection caused by human papillomavirus (HPV) and spread through oral, anal and genital sexual contact
- Vertical transmission and autoinoculation also reported (Int J STD AIDS 1997;8:78, Arch Dis Child 2006;91:696)
Terminology
- Condyloma acuminata
- Condyloma plana (flat)
- Genital warts
Epidemiology
- Prevalence estimates range between 0.13% and 0.20% (BMC Infect Dis 2013;13:39)
- Risk factors: higher number of sexual partners, unprotected intercourse, history of sexually transmitted infections, smoking (Int J Colorectal Dis 2014;29:899)
- More prevalent in immunosuppressed individuals including HIV positive patients or transplant recipients (Obstet Gynecol 1997;89:690)
- Correlated with presence of abnormal cervical cytology (Can J Public Health 1991;82:264, Asian Pac J Cancer Prev 2014;15:1177)
Sites
- Female: vulva, vagina, cervix, urethra, anal canal, perianal skin, crural folds
- Male: penis, scrotum, urethra, anal canal, perianal skin, crural folds
Etiology
- Caused by human papillomavirus (HPV)
- Majority due to low risk HPV subtypes 6 or 11 but many lesions have multiple HPV subtypes (J Clin Microbiol 1993;31:2667, Exp Neurol 1979;64:225)
- High risk HPV subtypes also found, especially in specimens from immunosuppressed patients (Exp Neurol 1979;64:225)
Clinical features
- Flat, dome shaped, keratotic, pedunculated or cauliflower shaped
- Singly or in clusters
- White, skin colored, pink, purple, red or brown (Dermatol Online J 2006;12:5)
- Most are asymptomatic but may exhibit symptoms of pruritus, burning or pain
- May spontaneously regress (Am J Clin Pathol 1994;102:768)
- Largely benign, but rarely associated with verrucous carcinoma, namely giant condyloma acuminata/Buschke-Lowenstein tumor (Vaccine 2008;26:K17)
Diagnosis
- Can be diagnosed by direct inspection withi bright light and magnification
- Small lesions best appreciated with application of 3 - 5% acetic acid on colposcopic examination
- Biopsy only recommended when lesions are unresponsive to therapy, ulcerated, show sudden growth, have increased pigmentation or are fixed to underlying structures (Clin Infect Dis 2002;35:S210)
- Detection and typing of HPV not currently recommended for diagnosis
Treatment
- Podophyllotoxin, imiquimod (Aldara), sinecatechins, surgical excision, electrosurgical excision, cryotherapy, laser therapy
Clinical images
Images hosted on other servers:
Severe case of external
genital warts on a female
Gross images
Images hosted on other servers:
Foreskin
Microscopic (histologic) description
- Acanthosis, dyskeratosis, parakeratosis, hyperkeratosis and a prominent granular layer
- Superficial chronic inflammatory infiltrate in the dermis
- Perinuclear cytoplasmic “halos” with “raisinoid” pyknotic nuclei or slightly enlarged nuclei (koilocytosis) in superficial epithelial cells
- Binucleated and multinucleated squamous cells
- Parabasal hyperplasia with accentuated intracellular bridges
- Enlarged parabasal cells with foamy or ground glass nuclear chromatin
- Regressing condylomas have increased stromal CD4+ T lymphoctyes (Am J Clin Pathol 1994;102:768)
- May contain areas of intraepithelial neoplasia especially in immunosuppressed patients
Microscopic (histologic) images
Images hosted on other servers:
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Genital wart
Flat condyloma
Condyloma acuminatum
Positive stains
- Ki67 staining in at least 2 epithelial cells in upper 2 / 3 of the epithelial thickness is associated with the detection of HPV (Am J Surg Pathol 2000;24:1393)
Differential diagnosis
- Condyloma latum: secondary to syphilis; deep inflammatory infiltrates with plasma cells
- Dysplastic or benign nevi
- Fibroepithelial polyp: fibrovascular core, no atypia
- Molluscum contagiosum: umbilicated, caused by poxvirus
- Seborrheic keratosis
- Squamous papilloma: no atypia
- Vulvar intraepithelial neoplasia: abnormal mitotic figures, lack of maturation, nuclear pleomorphism, enlargement and hyperchromasia
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