12/1/2017 Anus and perianal area - Condyloma acuminatum

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Anus and perianal area

Premalignant lesions
Condyloma acuminatum
Reviewer: Nicole Riddle, M.D. (see Reviewers page)

Revised: 5 August 2014, last major update July 2014

Copyright: (c) 2002-2014, PathologyOutlines.com, Inc.

PubMed Search: Condyloma acuminatum [title] anus

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General
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A benign hyperplastic squamous proliferation caused by the human papilloma virus

Terminology
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Also called condyloma, verruca (not the preferred term in the genital area), wart

Epidemiology
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Associated with Human Papilloma Virus (HPV)
Annual incidence is 1%
HPV in genital area in general is considered the most common sexually transmitted disease, with prevalence
believed to exceed 50%
Highest prevalence and risk is in 2nd -3rd decades
Associated with other HPV lesions (anal dysplasia / CIS, verrucous carcinoma, squamous cell carcinoma /
basaloid carcinoma)
In US, 3,000 new annual cases of HPV-associated anal cancers are diagnosed in women, 1,700 in men
Caucasian women are more likely than women of other races to have high risk HPV
African American men are more likely than other races to have high risk HPV

Prognostic factors
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Prognosis varies based on type of HPV infection (high risk vs. low risk)
There are over 100 types, 14 are known to cause cancer
High risk:
16 & 18 - together cause ~75% of genital cancers
Also 31, 33, 35, 45, 51, 52, 56, 58, 59, 66, & 68
Note: Non-Caucasians are more likely to have non-16/18 types - affects testing and vaccination efficacy
Low risk:
6 & 11 - together cause ~ 90% of all genital warts

Treatment
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Topicals: podophyllotoxin (Condylox, Wartec, Warticon), Imiguimod (Aldera), Sinecatechins (Veregen,
Polyphenon E), Trichloroacetic acid, Interferon
Cryosurgery
Removal: excisional biopsy, surgical excision

Clinical images

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Severe case
Gross description
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Papillary excrescences, 1-2 mm to several centimeters

Gross images
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Vaginal
condyloma
Micro description
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Hyperplastic papillary squamous epithelium with parakeratosis, variable koilocytotic atypia (nuclear wrinkling
with perinuclear clearing)
Variable dysplastic changes: increased nuclear atypia / size, increased / atypical mitosis - should be
commented on, especially if high-grade

Micro images
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Large papillary Hyperplastic dermal papillae with

structures parakeratosis, mild nuclear atypia
with perinuclear halos

Cytology description
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Similar to cervical cytopathology: enlarged nuclei with halos
May see marked atypia if high grade dysplasia

Cytology images
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LSIL, Pap

Positive stains
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LMW keratins (CAM5.2, CK5/6) and p63 - stain positive similar to all squamous mucosa
p16
Ki-67 may be helpful in determining dysplasia - amount and location near surface

Differential diagnosis
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Anal dysplasia / CIS
Squamous cell carcinoma
Verrucous carcinoma

Additional references
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Gastroenterol Nurs 2009;32:342, Condylomata acuminata (anogenital warts) - UpToDate

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End of Anus and perianal area > Premalignant lesions > Condyloma
acuminatum

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