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Pathology for Urologists

Condyloma Acuminatum

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  • Etiologic agent: Human papilloma virus.
  • Clinical features: typically a disease of young adults; most cases are sexually transmitted; presence in children suspects child abuse.
  • Incidence: involves ~5% of men in 20s to 40s.
  • Incubation period: variable, ranging from weeks to months to years.
  • Gross features: flat, warty, papillary or cauliflower-like lesions usually on glans or penile meatus, but may be seen on scrotum, and perineum as well as perianal region.

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  • Histology:
    • Papillomatosis, hyperkeratosis (thickened keratin layer), parakeratosis (keratin layer with pyknotic nuclei) and koilocytes (raisinoid cells within a clear "halo") are characteristic features
      (image A), (image B), (image C) & (image D).
    • Penile condylomas are usually cytologically benign, although treatment with podophyllin or lasers may cause marked cytologic atypia – a history of prior treatment is therefore always appreciated.
    • Viral strains 6 and 11 are common in typical condyloma without dysplasia, while strains 16, 18, 31 and 33 are more common in the dysplastic forms of condyloma.
  • Prognosis and treatment: may spontaneously regress (50%); recurrence is common; otherwise treat with podophyllin or laser.


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