Anus & perianal area

Premalignant

Condyloma acuminatum



Last author update: 22 September 2022
Last staff update: 22 September 2022

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PubMed Search: Condyloma acuminatum anal

Erna Forgó, M.D.
Teri A. Longacre, M.D.
Page views in 2022: 33,888
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Cite this page: Forgó E, Longacre TA. Condyloma acuminatum. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/anuscondyloma.html. Accessed January 28th, 2023.
Definition / general
  • Benign papillomatous squamous proliferation with a fibrovascular core, caused by human papillomavirus (HPV) infection
  • Giant condyloma acuminatum with features of deep growth and local destruction, also known as Buschke-Löwenstein tumor
Essential features
  • Benign papillomatous squamous proliferation with a fibrovascular core
  • Koilocytic change in upper 33% of squamous epithelium
  • Caused by HPV serotypes 6 and 11
  • High grade dysplasia and carcinoma prevalence higher in HIV positive patients
Terminology
  • Anal wart
  • Anogenital wart
  • Anal condyloma
ICD coding
Epidemiology
Sites
  • Most common: upper anal canal and anal transition zone
  • Less common: lower anal canal and perianal skin
  • May be associated with coinfection in other genital sites (i.e., cervix, vulva, penis)
Pathophysiology
  • HPV transient productive infection of basal layer of squamous epithelium
  • Low oncogenic risk subtypes: HPV serotypes 6, 11
Clinical features
  • Most common: asymptomatic
  • Discomfort, pruritis, bleeding, eczematous rash
  • Painless mass
Diagnosis
  • Anoscopy with biopsy
Radiology description
Prognostic factors
  • Recurrence ranges from 5% to 70% depending on treatment
  • High grade dysplasia and carcinoma prevalence is higher in HIV positive patients (Dis Colon Rectum 2017;60:1078)
  • Giant condyloma acuminatum (Buschke-Löwenstein tumor) has aggressive destructive local behavior with propensity for infections and fistulations (Ann Ital Chir 2018;89:291)
Case reports
Treatment
Clinical images

Contributed by Erna Forgó, M.D.

Single warty lesion

Multiple flat lesions



Images hosted on other servers:

Severe case

Gross description
  • Fleshy, warty, cauliflower-like lesion
  • May be flat lesion in anal canal
  • Single or multiple (more common)
Gross images

Contributed by Jian-Hua Qiao, M.D.
Vaginal condyloma

Vaginal condyloma

Microscopic (histologic) description
  • Hyperplastic papillary exophytic squamous epithelium
  • Marked acanthosis
  • Parakeratosis
  • Fibrovascular core
  • Koilocytosis (irregular nuclei, bi and multinucleation, perinuclear vacuolization) confined to upper third of squamous epithelium
  • No dysplasia or invasive squamous cell carcinoma
  • Low grade squamous intraepithelial lesion (LSIL [condyloma acuminatum]) terminology applied according to the Lower Anogenital Squamous Terminology (LAST) project (Arch Pathol Lab Med 2012;136:1266)
Microscopic (histologic) images

Contributed by Erna Forgó, M.D. and AFIP images

Koilocytosis

Papillary exophytic squamous epithelium

Hyperplastic squamous epithelium

Papillary exophytic squamous epithelium

Large papillary structures

Negative p16 expression (nonblock positivity)

Virtual slides

Images hosted on other servers:

Condyloma acuminatum

Cytology images

Images hosted on other servers:

LSIL, Pap

Positive stains
Negative stains
  • Negative p16 if without dysplasia (no overexpression / nonblock positivity)
Molecular / cytogenetics description
  • In situ hybridization (ISH) and PCR positive for low risk HPV 6 and 11 serotypes
Sample pathology report
  • Anus, perianal lesion, biopsy:
    • Low grade squamous intraepithelial lesion (AIN 1 / condyloma acuminatum)
Differential diagnosis
Board review style question #1


A 50 year old HIV positive man is found to have a papillary perianal growth. The H&E section above demonstrates papillary squamous epithelium with koilocytic change in the upper third of the squamous epithelium, without cytologic atypia. p16 immunohistochemical stain is also shown. Which of the following HPV serotypes are associated with this lesion?

  1. HPV 6 and 11
  2. HPV 16 and 18
  3. HPV 31, 33 and 35
  4. HPV 45
Board review style answer #1
A. HPV 6 and 11

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Reference: Condyloma acuminatum
Board review style question #2
According to the Lower Anogenital Squamous Terminology (LAST) project, what is the appropriate terminology for anal condyloma acuminatum?

  1. AIN 1
  2. ASIN-L
  3. Condyloma acuminatum
  4. LSIL
  5. LSIL (condyloma acuminatum)
Board review style answer #2
E. LSIL (condyloma acuminatum)

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Reference: Condyloma acuminatum
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