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PubMed1985

The changing concepts of condyloma. A retrospective study of colposcopically directed cervical biopsies.

Human papillomavirus has been implicated in the etiology of cervical intraepithelial neoplasia. A retrospective audit was conducted on all colposcopically directed biopsies performed from June through November, inclusive, in the years 1980 and 1982, a total of 317 cases. In 1980, the misdiagnosis rate for condyloma was 88.9% (69 of 78) and, in 1982, the misdiagnosis rate was reduced to 28.5% (40 of 140). On review, the association of cervical intraepithelial neoplasia with condyloma was 73% (107 of 146), p less than 0.005. The differences in mean ages of patients with condyloma alone, cervical intraepithelial neoplasia with condyloma, and cervical intraepithelial neoplasia alone were significant, p less than 0.02. When condyloma is not recognized, the pathologist tends to overdiagnose grade 3 cervical intraepithelial neoplasia as shown in 28 original cases; 16 of 28 (57.1%) were condyloma alone on review. Fifteen (53.6%) of these 28 patients underwent a cone biopsy or hysterectomy when a less radical procedure would have been acceptable. The morphologic changes indicating cervical condyloma were not fully appreciated by the pathologist, and this resulted in overdiagnosis and later overtreatment by the gynecologist.

Adult↗

PubMed1998

The natural history of condyloma in children.

BACKGROUND: Condyloma acuminatum, an infection caused by human papillomavirus (HPV), has become one of the most common sexually transmitted diseases. Correspondingly, anogenital warts are more frequently diagnosed in children. Twenty-five years ago a landmark prospective study showed that untreated common cutaneous warts in children spontaneously regress within 2 years in two thirds of cases, but a similar study of condyloma has not been published. Several treatment options are available for condyloma in adults; none have been studied or approved by the US Food and Drug Administration for treatment of children. OBJECTIVE: Our purpose was to review a cohort of children with condyloma to determine the natural history. METHODS: Of 75 originally identified subjects with condyloma, 41 qualified for further retrospective or prospective evaluation, including distribution of lesions, duration of disease, gender, and treatment, if any. RESULTS: Overall, condylomas in 31 of 41 children (76%) experienced resolution. Spontaneous resolution occurred within 5 years in 22 of 41 subjects (54%), including 6 of 8 (75%) who never received treatment, and 16 of 33 (49%) in whom treatment failed. In 9 of 33 treated children (27%), resolution occurred during treatment. Girls presented three times more often than boys and resolution occurred comparatively more often in girls. CONCLUSION: Spontaneous resolution of pediatric condyloma occurred in more than half of our subjects. Nonintervention is a reasonable initial approach to managing venereal warts in children.

Age Distribution↗

PubMed1977

Condyloma acuminatum and squamous carcinoma of the vulva.

Reported is the association of condyloma acuminatum and squamous carcinoma of the vulva in three cases and condyloma followed by squamous dysplasia in a fourth case. This association has previously been reported in both male and female genitalia and in the perianal area. In our four cases, cancer or squamous dysplasia followed long-standing or extensive condyloma, but there was no evidence of transformation from condyloma to carcinoma. In one of the cases, areas of squamous dysplasia occurred in multiple foci within a large condyloma. It is not known whether condyloma acuminatum is a precancerous skin lesions, but long-standing or extensive condylomas should alert one to the possibility of carcinoma.

Adult↗

PubMed1993

[A new method, based on in situ DNA hybridization, for the detection of papillomavirus in condyloma patients and their partners].

The detection and typing analysis of human papillomavirus (HPV) were carried out by means of BIOHIT in situ HPV DNA hybridization screening and typing kits in condyloma tissues of patients with genital condyloma acuminatum, in cytological smears of their asymptomatic female consorts, and in female patients with vulval condyloma acuminatum. "Low"-risk HPV 6 and HPV 11 were demonstrated most frequently in the condyloma tissues of the male patients. It is noteworthy that all but one female consorts carried similar HPV type(s) in their cervical smears to those of their sexual partners in condyloma tissues. "Medium" and "high"-risk HPV 18, 31 and 33 types (frequently associated with high-grade dysplastic lesions and carcinomas) were demonstrated more frequently in female condylomas than in male. These three HPV types were identified in both tissues in a female patient with condyloma acuminatum and carcinoma epidermoids cornescens.

Adolescent↗

PubMed1986

Squamous cell carcinoma in situ in condyloma acuminatum.

This is the 14th case report of squamous cell carcinoma in situ developing in perianal condyloma acuminata. A 72-year-old nonhomosexual man suffered this lesion 11 months after his condyloma was first fulgurated. The lesion was excised locally. He received no local or systemic chemotherapy. Random biopsies on several occasions since that time have not shown any evidence of local recurrence. Squamous-cell carcinoma in situ in perianal condyloma must be distinguished from Bowen's disease and extramammary Paget's disease of the perianal skin, both of which have associated skin rashes. Although Bowen's disease and extramammary Paget's disease frequently are associated with either local or distant malignancies, no such association has been found for squamous cell carcinoma in situ in condyloma unless the patient also has the acquired immunodeficiency syndrome (AIDS). Since this lesion is a premalignant lesion like Bowen's disease and extramammary Paget's disease, squamous cell carcinoma in situ in condyloma is treated by local excision. If the margins are free of tumor, the resection is curative. No local or systemic recurrence of this condition has been reported following adequate local resection. Patients with condyloma acuminata should undergo treatment to eliminate all of the warts. When the condylomata recur, or when the patient has AIDS, the lesions should be examined histologically for evidence of premalignant or malignant degeneration.

Aged↗

PubMed2003

Preoperative immune status determines anal condyloma recurrence after surgical excision.

PURPOSE: Immunosuppression is an important risk factor for anal condyloma progression; however, its effects on postoperative outcomes remain unclear. In the present study, we investigated risk factors and recurrence rates in immunocompromised patients requiring surgery for medically intractable anal condyloma. METHODS: A retrospective review was performed on 63 consecutive patients who underwent surgical intervention for medically intractable anal condyloma at a single institution. Patient cohorts included immunosuppressed patients (e.g, HIV-seropositive, leukemia, idiopathic lymphopenic syndrome, or transplant patients; n = 45) and immunocompetent patients (n = 18). Recurrence rates and time to recurrence after surgery were determined for both groups. Preoperative CD4 count and viral load within the HIV subpopulation were also determined. The majority of the patients were male (90 percent), with a median age of 36 years. RESULTS: Anal condyloma recurred in 66 percent of the immunosuppressed patients compared with 27 percent of the immunocompetent group. Recurrence time expressed in months was shorter in immunosuppressed patients than in immunocompetent patients (6.8 +/- 1.5 vs. 15 +/- 5.7 months; P< 0.05). In the subpopulation of HIV-seropositive patients, no association was found between recurrence rates and viral loads; however, CD4 counts were significantly lower in those who had recurrence than in those who did not (226 +/- 31.7 vs. 401 +/- 51.2 cells/microl; P< 0.05). CONCLUSIONS: After surgery, anal condyloma in immunosuppressed patients recurs significantly more often and within a shorter period of time than in patients with a competent immune system. Additionally, in HIV-seropositive patients, CD4 counts should be maximized to prevent early recurrence of anal condyloma.

Adolescent↗

PubMed1988

Genital condylomas in pregnancy: use of trichloroacetic acid and laser therapy.

Genital condylomas in pregnancy pose several management problems for the obstetrician, including the mechanical problems of large condylomas and the issues relating to transmission of the human papillomavirus to the fetus during delivery. Transmission of papillomavirus occurs infrequently, but respiratory papillomatosis can result in mortality or lifelong morbidity. We evaluate our experience in treating condylomas in 32 pregnant women, using carbon dioxide laser therapy and 85% trichloroacetic acid. Condylomas in 31 (97%) of 32 women were controlled with this combination therapy. The only maternal complication was an episode of acute pyelonephritis secondary to urethral catheterization. One patient had premature rupture of the membranes 4 days after laser therapy and subsequently was delivered of a healthy neonate at 36 4/7 weeks. Prenatal photovaporization of condylomas appears to offer a method of treatment with a low complication and recurrence rate and helps avert the dilemma of whether patients with extensive genital condylomas should be delivered by cesarean section.

Adolescent↗

PubMed1983

Condyloma and cervical epithelial atypias in young women.

One hundred and three adolescent women with cervical cytology suggestive of mild to moderate dysplasia were studied for the presence of condylomatous lesion. The analysis of smears revealed cells suggestive of condyloma in 81% of the cases. In histopathologic studies cervical lesions typical of condyloma were observed in 59 preparations. Of these 16 were papillary and 35 were flat condylomas, and in 8 cervices both papillary and flat condylomatous lesions were present. Colposcopic examination showed an atypical transformation zone in 57 cases. Papillary condylomas were present in 24 cervices in 7 cases combined with an atypical transformation zone. In addition to the cervical epithelial atypias there were 18 cases in which colposcopic and histologic examination of vagina revealed papillary warts, 13 of them combined with cervical condylomas. In four patients vaginal leucoplakia was seen and all were histologically flat condylomas. Thus, in 68 cases or in 66% of adolescent women having abnormal cervical cytology, histological investigation revealed condylomatous changes.

Adolescent↗

PubMed2005

Screening methods for high-grade dysplasia in patients with anal condyloma.

UNLABELLED: Human papilloma virus (HPV) is one of the most common sexually transmitted diseases in the United States. HPV infection can cause anal condylomas and is a risk factor for dysplasia. High-grade dysplasia may progress to squamous cell carcinoma. Currently, biopsy and histological examination are required to grade dysplasia. The purpose of this study is to determine whether anal cytology, morphological characteristics, and/or the presence of high-risk oncogenic HPV-types are effective noninvasive methods to detect high-risk anal condylomas. PATIENTS AND METHODS: From November 2003 to June 2004, all patients with anal condyloma were prospectively evaluated for anal cytology, high-risk oncogenic HPV-types, and tissue biopsies. The Bethesda classification system was used to classify cytologic findings and histological examination, which were grouped as high-risk (HRL) and low-risk (LRL) lesions. Histology results served as true disease for all comparisons. RESULTS: Forty-seven patients with anal condyloma were studied; 43 (91.5%) were men, and the mean age was 39 +/- 11 years. Histology showed 19 (40.5%) patients with HRL, and 28 (59.5%) patients with LRL. Cytology correctly identified 8 patients with HRL and 27 patients with LRL (sensitivity 42% and specificity 96%). High-risk oncogenic HPV-types were found in 84.2% of HRL and 39.3% of LRL (P = 0.0029). Combining cytology with oncogenic HPV-testing, the sensitivity of detecting HRL increased to 89%, and specificity decreased to 42%. CONCLUSION: Anal cytology alone is not accurate for detecting HRL in patients with anal condylomas. Combining oncogenic HPV-testing with cytology is more sensitive in detecting HRL in patients with anal condyloma, and therefore, a more effective screening tool.

Adult↗

PubMed2003

Giant condyloma acuminatum.

BACKGROUND: Giant condyloma acuminatum is a warty lesion that is characterized by its large size and propensity to infiltrate into deeper tissues contrasting with its microscopically benign pattern. It is proposed that giant condyloma represents an intermediate lesion between condyloma acuminatum and verrucous carcinoma. OBJECTIVE: A primary therapeutic option of giant condyloma is radical surgery with or without adjunctive chemotherapy. Because of the tumor's large extent in this case, curative therapy would have been achieved by wide surgical excision. METHOD: We present a morphologically and histologically classic example of giant condyloma with respect to origin from common genital warts. The reason for extensive exophytic growth was due to delay in therapy because of the patient's self neglect but not due to immune deficiency. The patient was treated with wide surgical excision. RESULTS: The postoperative period was uneventful, allowing satisfactory functional and cosmetic results. CONCLUSION: This case is an interesting case because of its exceptionally huge size without any deep tissue involvement and tissue atypia. This suggests that giant condyloma is an intermediate condition that exhibits a continuous tendency for growth.

Condylomata Acuminata↗

PubMed2005

Occurrence of cervical intraepithelial neoplasia in generally healthy women with exophytic vulvar condyloma acuminata.

AIM: To disclose possible association between exophytic vulvar condyloma acuminata and cervical intraepithelial neoplasia in generally healthy, sexually active women. METHODS: This retrospective study included 74 patients (study group) who were referred for laser vaporization therapy of exophytic vulvar condyloma acuminata, and 88 asymptomatic volunteers without evidence of exophytic vulvar condyloma acuminata (control group) who were referred for screening Papanicolaou (Pap) test cervical evaluation including colposcopy. The diagnosis of cervical intraepithelial neoplasia was based on Pap smear, colposcopy and/or biopsy. RESULTS: On Pap smear, atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions were found in 10 (13.5%) women with exophytic vulvar condyloma acuminata and in 2 (2.3%) asymptomatic volunteers (p < 0.05). Cervical intraepithelial neoplasia was found in 8 women with exophytic vulvar condyloma acuminata and in none of the asymptomatic volunteers (p < 0.05). CONCLUSION: An association was found between exophytic vulvar condyloma acuminata and abnormal Pap smear or positive cervical biopsy, in generally healthy women.

Adult↗

PubMed1988

Condyloma and intraepithelial neoplasia of the uterine cervix: a case-control study.

Cervical condyloma and cervical intraepithelial neoplasia are related to human papillomavirus infections, some of which may be involved in the etiology of cancer of the uterine cervix. This case-control study was designed to assess the relation of age at first sexual intercourse, number of sexual partners, and cigarette smoking to the risk of cervical condyloma and cervical intraepithelial neoplasia. Cases and controls were premenopausal women under age 50 years who had been referred for examination at the Colposcopy Clinic of Saint-Sacrement Hospital in Quebec from 1982 to 1985. These were 136 cases of histologically confirmed cervical condyloma and 247 cases of cervical intraepithelial neoplasia. The 137 controls were women without anogenital condyloma, dysplasia, or carcinoma. Information on personal characteristics and exposures of subjects was obtained by interview. Associations observed with age at first intercourse were different for condyloma and cervical intraepithelial neoplasia. Relative risk of condyloma varied little with age at first intercourse. In contrast, relative risk of cervical intraepithelial neoplasia increased as age at first intercourse decreased. For the two types of lesions, relative risk was elevated among women with more than one sexual partner and increased steadily with increasing number of cigarettes smoked per day. The association with cigarette smoking was, however, somewhat stronger for cervical intraepithelial neoplasia.

Adult↗

PubMed1989

Correlation of the histologic appearance of intraepithelial neoplasia of the cervix with human papillomavirus types. Emphasis on low grade lesions including so-called flat condyloma.

Cervical condylomas and intraepithelial neoplasia (CIN) were correlated with human papillomavirus (HPV) types and analyzed for the presence of abnormal mitotic figures. Colposcopically directed cervical biopsies were divided in half and processed for routine microscopy and Southern blot hybridization. Of 83 specimens from 71 patients, 70 (84%) contained HPV-DNA sequences. The HPV distribution was as follows: HPV 16 in 6/25 flat condylomas (FC), 2/8 CIN I, 8/18 CIN II, 12/14 CIN III; HPV 18 in 1/25 FC; HPV 31 in 3/25 FC, 3/18 CIN II, and 1/14 CIN III; HPV 6/11 in 12/18 exophytic condylomas (EC), 5/25 FC, 2/8 CIN I, and 3/18 CIN II. Uncharacterized HPVs were identified in 4/18 EC, 5/25 FC, 2/8 CIN I, and 1/18 CIN II. A similar heterogeneous distribution of HPV types was found in flat condylomas and CIN I. A more homogeneous distribution was noted in the exophytic condylomas and high grade CIN lesions, with HPV 6/11 found in the former and predominantly HPV 16 in the latter. Abnormal mitotic figures were predominantly seen in the high grade CIN lesions. Based on our findings, we would recommend that the term flat condyloma be abandoned and that low grade flat lesions of the cervix be graded according to CIN criteria.

Blotting, Southern↗

PubMed1984

[Two cases of giant condyloma with malignant degeneration].

We report two rare cases of giant condyloma with malignant degeneration. Case 1: A 70-year-old male noticed a small nodule on his glans penis 5 years ago that had recently grown larger and larger. After admission, the biopsy of the mass revealed giant condyloma with malignant degeneration. Partial amputation of the penis was performed. Meatoplasty was performed by Whisnant 's procedure. Case 2: A 49-year-old male had received exstirpation of the condyloma of the penis eleven years earlier. Local recurrence and exstirpation were repeated. In June 1981, the mass was diagnosed as giant condyloma. In December malignant degeneration was suspected. In 1982, radiation therapy failed to reduce the mass and it made an ulcer on the penis. Total amputation of the penis was performed. The pathological diagnosis was invasive keratinizing squamous cell carcinoma. Meatoplasty was performed, applying Toyoda 's ureterocutaneostomy and Abercrombie 's procedure. Though giant condyloma is pathologically benign, in many cases it is clinically indistinguishable from squamous cell carcinoma and may have a malignant potential like our cases. It may be concluded that giant condyloma should be treated as malignant and that partial or total penectomy may be the best treatment because conservative treatment including local excision is not effective.

Aged↗

PubMed1995

[Detection of human papillomavirus in condyloma acuminata tissues].

UNLABELLED: We used immunohistochemical technique, in situ hybridization and polymerase chain reaction to detect HPV capsid antigen (HPV-Ag) and HPV-DNA sequences in genital condyloma and pseudocondyloma of vulvae tissues. We also observed the relation between HPV distribution in condylomas and their histological changes. RESULTS: 71.4% of condylomas were positive for HPV-Ag with IMHC, 96.5% of condylomas were positive for HPV6/11 DNA with ISH, and 100% of condylomas were positive for HPV6/11/16/18DNA with PCR. Only 21.4% of pseudocondylomas of vulvae were positive for HPV6/11/16/18DNA with PCR. By observing the distribution of labelled HPV-Ag and HPV-DNA, we found a close relation between HPV proliferative infection and the specific changes of condylomas.

Antigens, Viral↗

PubMed2000

Squamous papilloma of the urinary tract is unrelated to condyloma acuminata.

BACKGROUND: To the authors' knowledge, there is no previous report of squamous papilloma of the urinary tract. It is uncertain whether there is a correlation between squamous papilloma, condyloma acuminatum, and verrucous carcinoma. METHODS: The authors evaluated the clinical and pathologic features of squamous papilloma (5 of the bladder, 2 of the urethra), condyloma acuminatum (3 cases), and verrucous carcinoma (3 cases) of the urinary bladder and performed human papillomavirus (HPV) DNA in situ hybridization studies to determine whether HPV was a common feature shared by these lesions. In addition, DNA ploidy evaluation by image cytometry and p53 immunohistochemical staining were performed. RESULTS: Squamous papilloma of the urinary tract occurred in elderly women and followed a benign clinical course with infrequent recurrence. All squamous papillomas were HPV DNA negative and DNA diploid with no or minimal p53 nuclear accumulation. Condyloma acuminata of the bladder contained HPV DNA, increased p53 protein expression, and aneuploid DNA content. All three cases of condyloma acuminata were associated with coexistent condylomata of the external genitalia, and two required pelvic exenteration for uncontrolled expansile growth. Verrucous carcinoma of the bladder occurred in elderly patients. All three cases of verrucous carcinoma were negative for HPV DNA and DNA aneuploid, and they exhibited consistent p53 expression. CONCLUSIONS: These data indicate that squamous papilloma is a distinct entity not related to condyloma or verrucous carcinoma. These lesions are benign, HPV DNA negative, DNA diploid, and they lack p53 overaccumulation.

Adult↗

PubMed2002

Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid.

BACKGROUND AND OBJECTIVES: To determine the feasibility of photodynamic therapy (PDT) of vulvar and vaginal condyloma and intraepithelial neoplasia (VIN, VAIN) and to compare PDT results with conventional treatments. STUDY DESIGN/MATERIALS AND METHODS: Thirty-eight patients with vulvar or vaginal intraepithelial neoplasia (VIN) grade II/III (n = 22) or condyloma (n = 16) had 10% 5-aminolevulinic acid (ALA)-gel applied topically. After 2-4 hours, 80-125 J/cm(2) laser light at a wavelength of 635 nm was applied. PDT was compared to conventional treatments for condyloma (CO(2) laser evaporation) and for VIN III (laser evaporation, surgical excision). RESULTS: The complete clearance rate for condyloma treated by PDT was 66% and the rate for IN was 57% (as determined by biopsy). Of the neoplasia patients, none with hyperkeratotic VIN (n = 4) responded, and only one of four with increased pigmentation cleared. No scarring occurred, and postoperative discomfort lasted 4.9 +/- 3.4 days. Reduced disease-free survival (DFS) was associated with multifocal VIN (P = 0.02, OR 2.17, 95% CI 1.15-4.08), but DFS did not vary with treatment mode. CONCLUSIONS: Although PDT is not equally efficacious for all subgroups, PDT for condyloma and intraepithelial neoplasia appears to be as effective as conventional treatments, but with shorter healing time and excellent cosmetic results.

Administration, Topical↗

PubMed1983

Human papilloma virus infection (condyloma) of the cervix and cervical intraepithelial neoplasia: a histopathologic and statistical analysis.

Two hundred fifty consecutive cases previously diagnosed as advanced intraepithelial neoplasia (CIN 2 and CIN III) were reviewed and examined for the presence of coexisting condyloma. When the mean ages and age distributions were analyzed, there was a consistent shift of the age distribution to a younger age among women with CIN and condyloma as opposed to CIN alone. Furthermore, when the relationship between age and case accumulation was normalized from a curvilinear to a linear relationship, there were significant differences in the slope of the accumulation rate between cohorts of CIN III with and without condyloma. These differences suggest that the concordant observation of both lesions in a given patient is not a random process resulting from two independent events but rather indicates an underlying dependence between the two (i.e., condyloma and CIN). It cannot, however, be determined statistically whether the associated condyloma is directly responsible for the CIN lesion or hastens its transit time.

Adult↗