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.



  • Human papillomavirus (HPV)


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

  • Buschke-Löwenstein tumor (giant condyloma)


  • Exophytic and verruciform nonmalignant epithelial lesions


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



  • 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


  • 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


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

  • Diagnosis is straightforward on histological grounds


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

  • For medium-sized and large tumors: Surgical excision

  • Giant condyloma: Wide local excision


  • 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


General Features

  • Papillary cauliflower-like exophytic tumor

  • Size ranges from few mm to several cm

  • Average size of giant condylomata is 5-10 cm


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


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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