Anal condyloma acuminatum is a human papillomavirus (HPV) that affects the mucosa and skin of the anorectum and genitalia. Anal condyloma acuminatum is . Condylomata acuminata (also known as anogenital warts or venereal warts) are manifestations of human papillomavirus (HPV) infection that. Condylomata acuminata (CA), also known as anogenital warts, are manifestations of anogenital human papillomavirus (HPV) infection.
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Condyloma acuminatum, intraepithelial neoplasia, and squamous cell carcinoma are three relatively frequent vulvar lesions. Condyloma acuminatum is induced by low risk genotypes of human papillomavirus HPV. Vulvar intraepithelial neoplasia VIN and squamous cell carcinoma have different etiopathogenic pathways and are related or not with high risk HPV types.
The goal of this paper is to review the main pathological and clinical features of these lesions.
A special attention has been paid also to epidemiological data, pathological classification, and clinical implications acuminatta these diseases. Vulvar human papillomavirus HPV infection is responsible for the development of benign tumors condylomata acuminataof one type of preneoplastic lesions, and of certain types of squamous cell carcinoma SCC [ 1 condylomx. This allows to distinguish two types of VIN: The incidence of HPV-associated VIN, unlike that of vulvar carcinomas, has been increasing over the past 20 years, especially in women of reproductive age, with the highest frequency acuninata in women of 20—35 years old [ 7 — 9 ].
The reported incidence rates are 1: The mean age at presentation is 60—74 years [ 714 ]. Vulvar carcinoma may infrequently occur in younger women and adolescents [ 1516 ]. The peak incidence of vulvar cancer comdyloma Belgium Belgian Cancer Registry is observed in condylom over the age of More than types of HPV have been identified, of which 40 can infect the genital areas. HPV are highly specific viruses showing both species and regional specificity.
They represent the adwlah common sexually-transmitted disease STD and are highly contagious. The prevalence of CA peaks in the early sexually active years, with two-thirds of the respective sexual partners complaining of warts. The median time between infection and development of lesions acjminata about months among women. The following risk factors have been described, including smoking, hormonal contraceptives, multiple sexual partners, and early coital age.
Patients who develop CA complain of painless bumps and, less frequently, of pruritus, discharge, or bleeding. Lesions are commonly multiple multicentric and multifocal, also affecting the perianal, vaginal, and cervical regions, but oral and laryngeal regions may also be involved.
Latent illness may become active, particularly with pregnancy and immunosuppression. CA are soft, raised masses, with smooth, verrucous, or lobulated aspects that may appear as pearly, filiform, fungating, or plaque-like eruptions. The surface commonly shows finger-like projections, generally nonpigmented. CA are perceived as disfiguring, they impact sexual lifestyle, causing anxiety, guilt, and loss of self-esteem and creating concerns about cancer risk.
Condyloka most common treatments are painful and nonspecific, addressing the clinically evident lesions rather than the viral cause. First episode patients should be STD screened.
Management should include partner notification.
Anal condyloma acuminatum.
The initial site of infection is thought to be either basal cells of the immature squamous epithelium that HPV reaches presumably through defects in the epithelium. Once HPV enters the cells, two distinct biological sequences are possible. Latent infections do not show morphologic alterations and can only be identified using molecular methods.
HPV has been found in approximately one fourth of genital warts. CA shows a striking adalay architecture. Papillae of different sizes and shapes are lined by acanthotic squamous epithelium and have a fibrovascular stroma, often containing scattered chronic inflammatory cells.
Hyperkeratosis, aduminata, hypergranulosis, and basal cell hyperplasia are seen. Koilocytic changes rigid perinuclear halos, binucleated nuclei, and slightly enlarged nuclei with irregular contours and coarse chromatinsometimes focal, are present in the most superficial layers of the squamous epidermis.
Mitotic figures acu,inata observed in the lower third of the epidermis Figure 1 [ 14 ]. However, this test may lack sensitivity [ 4 ]. Each course of podophyllotoxin treatment comprises self-application twice daily for 3 days, followed by four rest days. Podophyllotoxin is contraindicated during pregnancy, and women of childbearing age must use contraception. It is applied to the warts three times a week at bedtime. Treatment continues until wart clearance, or for a maximum of 16 weeks.
It presents minimal systemic absorption but causes erythema, irritation, ulceration, and pain at application site. Erythema is often seen as a side effect with imiquimod therapy and sometimes appears to acumonata clinical resolution. Occasionally, severe inflammation is seen necessitating discontinuation of therapy.
It consists in a preparation of green tea catechins sinecatechins. Evidence suggests that the mechanism of action is made through antiproliferative mechanisms. The ointment is applied three times a day until complete clearance, acmuinata for up to 4 months. It cannot be used internally or during pregnancy.
Local side effects occur as frequently as with other topical therapies. They are generally graded as mild and typically include redness, burning, itching, and pain at the site of avuminata. It rapidly penetrates and cauterizes skin, keratin, and other tissues. Although caustic, this treatment causes less local irritation and systemic toxicity and has low cost.
TCA can be used safely during pregnancy. A freeze-thaw-freeze technique is applied to each lesion at each session. Application techniques are difficult to zcuminata and there may be significant intraoperator differences. Cryotherapy presents the advantages of being simple, inexpensive, rarely causes scarring or depigmentation, and is safe during pregnancy. They include electrosurgery, curettage, scissors excision, and laser therapy. Surgery may be used as primary therapy, and the majority of patients can be treated under local anaesthesia.
When performed carefully, simple surgical approach leaves highly satisfactory cosmetic results. Many patients either fail to respond to treatment or recur after adequate response resulting in patient dissatisfaction.
A quadrivalent HPV vaccine is available for prevention of HPV-associated dysplasia and neoplasia including cervical cancer, precancerous genital lesions, and genital warts associated with HPV types 6, 11, 16, and Vaccine efficacy is mediated by humoral immune responses following immunization.
It is indicated for prevention of CA caused by HPV types 6 and 11 in boys, men, girls, and women aged 9—26 years.
Previously, other terms had been used to describe histologically similar lesions: Both types of VIN have the potential to progress to vulvar cancer. Usual-type VIN warty, basaloid, or mixed occurs in young women. The incidence peaks at 45—49 years old, and has increased in recent years and has nearly doubled in the last decades, especially in young women.
It is causally related to HPV infection. Other risk factors include smoking and immunosuppression. The lesions are frequently multifocal and have the potential to progress to invasive carcinoma. Differentiated VIN affects older women, tends to be unifocal, and unicentric. It is not associated with HPV infection, but it is associated adslah vulvar dermatosis, mainly lichen sclerosus.
Pathology Outlines – Condyloma acuminatum
It also has the potential to progress to invasive carcinoma. When symptomatic, the main complaints include itching, pruritus, pain, and dyspareunia. The appearance is variable from unique to multifocal lesions, flat, raised, or eroded, white, grey, red, or brown. After visual or colposcopic examination, such lesions should be biopsied for histological examination.
A complete gynaecologic examination is of paramount adalsh to exclude any multicentric lesions that may affect the cervix, the vagina, and the anal region. The diagnosis of VIN can be subtle. Condylima avoid delay, the physician must exercise a high degree of suspicion.
Vulvar biopsy should be used liberally. The viral oncoproteins E6 and E7 play a key role in the pre malignant transformation. After viral DNA integration in human host-cells, these viral oncoproteins E6 and E7 are overexpressed.
Then, E6 degrades the tumor suppressor protein p53, therefore inducing the absence of cell cycle arrest [ 39 ]. Moreover, E7 induces an inactive retinoblastoma tumor suppressor gene product, resulting in hyperproliferation of host cells, with overexpression of the cell cycle-related marker p16 [ 39 ]. Based on their associations with cervical and anogenital cancers, a nonexhaustive number of anogenital HPVs HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66,… have been classified by the International Agency for Research on Cancer IARC as oncogenic [ 40 ].
Typical low-grade VIN appears as pale areas, whereas high-grade VIN lesions appear as white or erythematous papules or macules that frequently coalesce or show a verrucous growth. Approximately two thirds of VIN lesions are multifocal Figure 2 [ 1 ]. Dysplastic squamous cells with scant cytoplasm and hyperchromatic nuclei are accompanied by dyskeratotic cells with eosinophilic cytoplasm.
Nuclear pleomorphism and hyperchromasia are present. However, nucleoli are uncommon. Loss of cell maturation and increased mitotic activity, including abnormal mitotic figures, are also seen [ 145 ].
The warty type shows a striking papillary codyloma, acanthosis, with cytological signs of viral infection koilocytic changes, multinucleation, and coarse granules [ 14 ].
The basaloid type presents a flat surface and is composed of a homogeneous population of small atypical parabasal type cells on nearly whole thickness of the epidermis. The epithelium lacks cellular maturation and koilocytic changes which are condyloa seen [ 14 ]. Sometimes, these two types are present within the same lesion [ 14 ].
Based on the level of involvement of the thickness of the epithelium by the dysplastic cells, uVIN were graded in 3 grades WHO terminology [ 5 ]: VIN 3 is synonymous with carcinoma in situ.