HPV-associated Lesions



HPV-associated Lesions


Antonio L. Cubilla, MD

Alcides Chaux, MD

Elsa F. Velazquez, MD










Exophytic tumoral multicentric image growth with a “cobblestone” and cauliflower-like appearance replaces most of distal penis, which corresponds to a giant condyloma.






Condyloma acuminatum shows an exophytic papillomatous growth, regular and broad pushing tumor base, and easily recognizable fibrovascular cores image.


TERMINOLOGY


Abbreviations



  • Human papillomavirus (HPV)


Synonyms



  • Genital wart, benign or typical condyloma (condyloma acuminatum)


  • Buschke-Löwenstein tumor (giant condyloma)


Definitions



  • Exophytic and verruciform nonmalignant epithelial lesions


ETIOLOGY/PATHOGENESIS


Infectious Agents



  • Evidence of HPV infection found in most cases


  • Low-risk serotypes (6, 11) predominate


  • Incidence of HPV-6 is higher than HPV-11


  • Other serotypes identified include 16, 18, 30-32, 42-44, and 51-55


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Condyloma acuminatum



      • Very common in sexually active young males


    • Giant condyloma



      • Very unusual


  • Age



    • Condyloma acuminatum



      • Prevalence is higher in 2nd to 3rd decades of life


    • Giant condyloma



      • Patients tend to be older than those with condyloma acuminatum


Site



  • Predilection for anogenital area


  • Condyloma acuminatum



    • Glans is most frequently affected site, followed by foreskin, meatus urethralis, and penile shaft


  • Giant condyloma



    • Tend to affect foreskin and coronal sulcus


Presentation



  • Clinically may be confused with molluscum contagiosum, Fordyce spots, or condyloma latum


  • Diagnosis is straightforward on histological grounds


Treatment



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


  • For medium-sized and large tumors: Surgical excision


  • Giant condyloma: Wide local excision


Prognosis



  • Malignant transformation is rare in condyloma acuminatum


  • Giant condyloma has tendency to locally recur


  • Giant condyloma often harbors carcinomatous foci


  • Increased risk for anogenital cancers


MACROSCOPIC FEATURES


General Features



  • Papillary cauliflower-like exophytic tumor


  • Size ranges from few mm to several cm


  • Average size of giant condylomata is 5-10 cm


MICROSCOPIC PATHOLOGY


Histologic Features



  • Arborescent papillae with prominent fibrovascular cores


  • Variable parakeratosis and orthokeratosis



  • Conspicuous surface koilocytosis


  • Typical koilocytes exhibit perinuclear vacuolization, wrinkled and hyperchromatic nuclei with frequent binucleation


  • Sharply defined base that is broad and pushing


  • Morphological features in giant condyloma are more prominent


  • Giant condyloma presents characteristic and evident endophytic pattern of growth


  • Cutaneous fistulae can sometimes be observed with giant condyloma


DIFFERENTIAL DIAGNOSIS


Warty Carcinoma



  • Affects older patients


  • Higher cytologic grade and nuclear atypia


  • Koilocytes frequently show pleomorphism


  • More abundant mitoses


  • Jagged and irregular tumor base


  • Stromal invasion


  • Presence of high-risk HPV


  • Usually positive for p16 overexpression

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on HPV-associated Lesions
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