Condyloma Acuminatum (Genital Wart)

 Irregular wrinkled nuclei


image Bi- and multinucleation

image Perinuclear vacuolization


• Old lesions may mimic seborrheic keratoses




Ancillary Tests




• Immunostain for p16 is negative (there is no overexpression)

• In situ hybridization and PCR usually show presence of low-risk HPV (HPV 6 to 11)


Top Differential Diagnoses




• Verrucous carcinoma

• Warty carcinoma

• Papillomatosis of glans corona (pearly penile papules)

• Bowenoid papulosis

• Squamous cell carcinoma in situ or warty/basaloid penile intraepithelial neoplasia

image
Low-Power View of Condyloma Acuminatum
Condyloma acuminatum shows an exophytic papillomatous growth, regular and broad tumor base, and easily recognizable fibrovascular cores image.


image
Prominent Koilocytosis in Condyloma Acuminatum
Condyloma acuminatum is characterized by marked acanthosis, slight (as in this example) to marked papillomatosis, and a sharply demarcated, bulbous base image. Note the focal parakeratosis image.

image
Higher Power View of Koilocytic Change
Condyloma acuminatum is characterized by koilocytic change (nuclear wrinkling, a perinuclear halo image, and often bi- and multinucleated nuclei). Koilocytosis tend to be confined to upper levels of the epithelium in contrast with warty carcinoma, where koilocytic change extends to deep infiltrative foci.

image
Binucleated Koilocytes in Condyloma Acuminatum
Koilocytes have eosinophilic cytoplasm and are characterized by clear perinuclear halos and wrinkled and hyperchromatic nuclei. Binucleation is common image.


TERMINOLOGY


Synonyms




• Genital wart


Definitions




• Exophytic and verruciform benign epithelial lesions


ETIOLOGY/PATHOGENESIS


Infectious Agents




• Caused by HPV
image Low-risk serotypes 6 and 11 (90% of cases)

image Other serotypes include 16, 18, 30-32, 42-44, 51-55

image > 1 serotype may be found in lesion


CLINICAL ISSUES


Epidemiology




• Incidence
image Very common STD

image Penile lesions are more common in uncircumcised men than in circumcised ones

image Topical treatment of vulvar dermatosis with corticosteroids and tacrolimus may reactivate old/latent lesions

image Penile subclinical lesions appear to be more frequent in sexual partners of women with cervical intraepithelial neoplasia

• Age
image Most frequent in young adults
– 2nd and 3rd decades of life

image Uncommon in children
– Such cases should raise suspicion of sexual abuse

– HPV has been detected in young girls with lichen sclerosus without history of sexual abuse

– Spontaneous regression is common in children
image ~ 50% of cases

• Sex
image Affect both sexes


Site




• Predilection for anogenital area
image Males: Glans, prepuce, shaft

– May extend to meatus

image Females: Labia minora, interlabial sulcus, area around introitus

– May extend into introitus

image Both sexes: Perianal and more rarely oral cavity

image Other less frequent locations: Abdomen, breast (nipple/areola)


Presentation




• Soft fleshy verruciform plaques

• Filiform lesions

• Lesion in coronal sulcus and vulva may be bulkier and macerated

• Flat (nearly macular lesions) may occur

• Tiny inconspicuous lesions may be difficult to detect

• Immunocompromised patients may show extensive lesions


Natural History




• Usually sexually transmitted
image Spreads rapidly

• Variable incubation period
image Usually 2-3 months

• Condylomas tend to recur
image In ~ 30% of cases

image May be due to persistence of HPV DNA in dermis &/or hair follicles


Treatment




• For small tumors: Cryosurgery, electrofulguration, laser ablation, and topical treatments

• For medium-sized and large tumors: Surgical excision

Apr 24, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Condyloma Acuminatum (Genital Wart)
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