Skin-nontumor
Infectious disorders
Condyloma

Author: Abha Soni, D.O., M.P.H. (see Authors page)
Editor: Andrzej Slominski, M.D., Ph.D.

Revised: 29 December 2015, last major update December 2015

Copyright: (c) 2003-2015, PathologyOutlines.com, Inc.

PubMed Search: Condyloma [title] skin
Definition / General
Epidemiology
  • 20 million people are infected with HPV in the United States
  • Lifetime incidence is greater than 50%
  • Highest rate of infection in adolescents and young adults
  • Average age of presentation in children is between 2.8 - 5.6 years (Pediatr Rev 2011;32:115)
Sites
Pathophysiology
  • Human papillomavirus (HPV): double stranded DNA virus, with greater than 100 serotypes (Pediatr Dermatol 2006;23:199)
  • HPV infects the basal keratinocytes of the epidermis, where it remains latent
  • With successive replications, the virus matures and is shed in the exfoliative cells of the keratitic layer
  • The virus morphologically alters the epidermis yielding mucosal and cutaneous warts (eMedicine - Condyloma Acuminata)
  • Young age at first intercourse and number of sexual partners both increase the risk of acquiring this infection at an early age
  • HPV proteins E6 and E7 inactivate tumor suppressor proteins p53 and Rb in the host resulting in uncontrolled proliferation and malignant transformation (eMedicine - Condyloma Acuminata)
Etiology
  • HPV infection: the virus lacks an envelope making it sturdy in the environment and resistant to therapy (Int J Dermatol 2001;40:373)
  • HPV types 6 and 11 are most frequently detected in condyloma acuminata
  • HPV types 16, 18, 31, 33, 35 and 45 have oncogenic potential
  • Infection spreads via direct skin contact and sexual activity
Clinical Features
  • Soft, tan, flat or cauliflower-like masses, varying in size and shape (eMedicine - Condyloma Acuminata)
  • Rarely can become irritated and bleed
  • Majority of cases are asymptomatic and underreported
Diagnosis
  • Cytologic / histologic interpretation of cells can reveal the presence of koilocytes
  • Koilocytosis: a cellular change that occurs in an HPV infected cell, characterized by nuclear darkening, irregularity, enlargement and a perinuclear halo (Obstet Gynecol 1976;47:540)
  • Application of acetic acid can aid in detecting grossly inapparent warts (J Urol 1988;139:777)
  • PCR identifies HPV 6 and 11
  • Prevention
Case Reports
Treatment
Clinical Images

Images hosted on Other servers:

Missing Image

Courtesy of Dr. Dhiraj Nikumbh

Missing Image

External genital warts

Missing Image Missing Image

Large external genital wart

Missing Image

Perianal warts

Missing Image

Pearly penile papules

Missing Image

Labial warts

Gross Description
  • Flesh colored, brown or grey
  • Flat or cauliflower-like exophytic growth, varying in size
Gross Images

Images hosted on Other servers:

Missing Image

Courtesy of Dr. Dhiraj Nikumbh

Missing Image

Scrotal condyloma

Missing Image

Foreskin

Micro Description
  • Numerous papillary and polypoid fronds with prominent parakeratosis
  • Koilocytosis with wrinkled nuclei and occasional binucleated cells in epidermis
Micro Images

Images hosted on Other servers:

Missing Image Missing Image

Courtesy of Dr. Dhiraj Nikumbh

Missing Image

Cauliflower-like lesion

Missing Image

From scrotal skin

Missing Image

Hyperkeratosis

Missing Image

Koilocytosis

Missing Image Missing Image Missing Image

Bladder

Cytology Description
  • Koilocytic change can be appreciated on pap smear specimens
Cytology Images

Images hosted on Other servers:

Missing Image Missing Image

Koilocytic change

Positive Stains
  • p16 is a useful marker for identifying high risk HPV
  • Most condylomas are associated with low risk HPV