Penis & scrotum
Infectious
Condyloma acuminatum
Authors: Alcides Chaux, M.D., Antonio L. Cubilla, M.D.
Last author update: 1 February 2010
Last staff update: 7 January 2021
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Condyloma acuminatum[TIAB] penis
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Molecular / cytogenetics description | Differential diagnosisCite this page: Chaux A, Cubilla AL. Condyloma acuminatum. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/penscrotumcondyloma.html. Accessed September 27th, 2023.
Definition / general
- Contagious HPV related lesion with a clear predilection for anogenital area (Wikipedia: Genital Wart [Accessed 2 April 2018])
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
AFIP images
Images hosted on other servers:
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
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
AFIP images
Low power shows acanthosis and papillarity
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
- Pearly penile plaques: HPV negative, hyperkeratosis but no koilocytosis and no significant inflammation
- Verruciform tumors (verrucous, papillary and warty carcinomas): invasion is evident
