Anus & perianal area

• Benign papillomatous squamous proliferation with a fibrovascular core, caused by human papillomavirus (HPV) infection
• Giant condyloma acuminatum with features of deep growth and local destruction, also known as Buschke-Löwenstein tumor

• Anal wart
• Anogenital wart
• Anal condyloma

• M = F; third decade of life
• More common in young men who have sex with men, HIV positive
• Risk factors: immunodeficient state, increased contacts (J Med Case Rep 2015;9:9, Acta Gastroenterol Belg 2021;84:343)
• Giant condyloma acuminatum: M > F

• Recurrence ranges from 5% to 70% depending on treatment
• High grade dysplasia and carcinoma prevalence is higher in HIV positive patients (Dis Colon Rectum 2017;60:1078)
• Giant condyloma acuminatum (Buschke-Löwenstein tumor) has aggressive destructive local behavior with propensity for infections and fistulations (Ann Ital Chir 2018;89:291)

• Small condyloma can regress and be treated conservatively with patient applied therapies: imiquimod, podophyllotoxin, sinecatechins
• First line clinician administered therapies: cryotherapy, trichloroacetic acid
• Large condyloma and those in anal canal require wide surgical removal: excision, laser, electrosurgery
• References: UpToDate: Condyloma Acuminata [Accessed 4 March 2022], Dermatol Ther 2020;33:e13193, Clin J Gastroenterol 2021;14:439, Int J STD AIDS 2012;23:362, Am J Obstet Gynecol 1985;153:545

Contributed by Erna Forgó, M.D.


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• Fleshy, warty, cauliflower-like lesion
• May be flat lesion in anal canal
• Single or multiple (more common)

Contributed by Jian-Hua Qiao, M.D.

• Hyperplastic papillary exophytic squamous epithelium
• Marked acanthosis
• Parakeratosis
• Fibrovascular core
• Koilocytosis (irregular nuclei, bi and multinucleation, perinuclear vacuolization) confined to upper third of squamous epithelium
• No dysplasia or invasive squamous cell carcinoma
• Low grade squamous intraepithelial lesion (LSIL [condyloma acuminatum]) terminology applied according to the Lower Anogenital Squamous Terminology (LAST) project (Arch Pathol Lab Med 2012;136:1266)

Contributed by Erna Forgó, M.D. and AFIP images

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• Low molecular weight keratins (CAM5.2, CK5/6)
• p63

• WHO Classification of Tumours Editorial Board: Digestive System Tumours, 5th Edition, 2019

A 50 year old HIV positive man is found to have a papillary perianal growth. The H&E section above demonstrates papillary squamous epithelium with koilocytic change in the upper third of the squamous epithelium, without cytologic atypia. p16 immunohistochemical stain is also shown. Which of the following HPV serotypes are associated with this lesion?

1. HPV 6 and 11
2. HPV 16 and 18
3. HPV 31, 33 and 35
4. HPV 45

A. HPV 6 and 11

Comment Here

Reference: Condyloma acuminatum

According to the Lower Anogenital Squamous Terminology (LAST) project, what is the appropriate terminology for anal condyloma acuminatum?

1. AIN 1
2. ASIN-L
3. Condyloma acuminatum
4. LSIL
5. LSIL (condyloma acuminatum)

E. LSIL (condyloma acuminatum)

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Reference: Condyloma acuminatum