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Giant condyloma acuminatum in a baby boy.

A giant condyloma acuminatum developed on the penis of a one and a half-year-old Japanese boy in two months. The histological features of this tumor were compatible with those of ordinary condyloma acuminatum. Although we detected the presence of human papilloma virus (HPV) type 16 by using the polymerase chain reaction system, we could not rule out the possibility that this HPV was present concurrently with other HPV types that cause condyloma acuminatum. The lesion was successfully treated with cryotherapy and topical application of 5% fluorouracil ointment under occlusion.

Condylomata Acuminata↗

Therapeutic evaluation of intralesional 5% 5-fluorouracil in condyloma acuminata.

Condyloma acumianata is one of the most common virally transmitted diseases. Its prevalence has increased many fold throughout the world. Because all the currently available treatments yield low cure rates with side effects, the search for a new alternative continues. Topically, 5-fluorouracil (5-FU) has been in used for many years to treat various skin diseases. When applied topically in condyloma acuminata, 5-FU results in low cure rates with high recurrences. Therefore, intralesional 5% 5-FU is being evaluated to determine its therapeutic efficacy in condyloma acuminata.

Adolescent↗

Human papillomavirus-associated dysplastic condyloma of the tongue treated with Mohs micrographic surgery.

BACKGROUND: Human papillomavirus (HPV) has been causally associated with benign and malignant tumors of the oral mucosa. It is found in the majority of both oral condylomas and oral squamous cell carcinomas. Treatment for these lesions consists of destructive or traditional surgical excision, respectively. OBJECTIVE: Mohs micrographic surgery provides excellent margin control and the highest cure rate for cutaneous malignancies, especially squamous cell carcinoma. Therefore, it represents an excellent alternative for the treatment of HPV-associated malignant and premalignant lesions of the oral mucosa, where the high rate of metastatic potential is compounded by anatomic complexity and the limited amount of normal tissue that may safely be sacrificed with wide excisions. RESULTS: A 38-year-old white man presented with a dysplastic condyloma of the lateral tongue. High-risk HPV-16 deoxyribonucleic acid (DNA) was detected by fluorescent in situ hybridization. Surgical resection of the dysplastic condyloma of the tongue by Mohs micrographic surgery resulted in complete lesion removal, with no evidence of clinical recurrence 8 months after surgery. CONCLUSIONS: Mohs micrographic surgery should be considered as a treatment option for cancerous or precancerous lesions of the oral mucosa, especially when the latter are associated with high-risk HPV.

Adult↗

Condyloma with lichen nitidus.

A 32-year-old black man presented with two separate eruptions on his penis (Figure). He has had a 10-year history of asymptomatic 1-3 mm shiny papules on the shaft of his penis. He also has had one asymptomatic verrucous brown plaque 1.5 cm in diameter on his penis. A small shave biopsy was performed for each process. The former showed lymphocytes and histocytes in the papillary dermis in a "ball-in-claw" relation to the rete ridges of the epidermis. The latter showed an acanthotic epidermis with papillomatosis. Diagnoses of lichen nitidus and condyloma acuminata were respectively made. As the shiny papules did not bother the patient, but he wanted to be rid of the verrucous plaque, only the latter was treated. Liquid nitrogen was applied to the plaque. The patient was also given podofilox 0.5% gel to apply to the condyloma overnight on Monday, Tuesday, and Wednesday, with a 4-day respite. This cycle was to be repeated for 3 more weeks. He was examined several more times and treated with cryotherapy and podofilox gel with the near disappearance of the condyloma over 4 months.

Administration, Topical↗

Symptoms of chronic vaginal infection and microscopic condyloma in women.

The purpose of this study was to determine if women who self-reported symptoms of chronic vaginal infection might be at risk for microscopic condyloma and, therefore, in need of colposcopic examinations. The hypothesis tested was that women who report yeast-type symptom chronicity and who have yeast-negative laboratory studies will have a significant incidence of microscopic vulvar condyloma. The hypothesis was supported by the results. Findings show a need to broaden the use of the colposcope to detect condyloma in women with a chronicity of unexplained yeast-type symptoms.

Adolescent↗

The prevalence of "high-risk" HPV types in penile condyloma-like lesions: correlation between HPV type and morphology.

OBJECTIVE: To evaluate the prevalence of "high-risk" human papilloma virus (HPV) types in penile condyloma-like lesions and to correlate HPV types with clinical and histological features. DESIGN: The study included 94 male patients with signs of penile HPV infection. From acuminate, papular and macular lesions, specimens were collected for HPV DNA hybridisation, using the dot blot and Southern blot techniques. Biopsy specimens from 51 cases were examined by light microscopy for signs of koilocytosis and dysplasia. SETTING: The STD outpatient clinic of the Department of Dermatovenereology of Sahlgrenska Hospital, Göteborg, Sweden. RESULTS: In 79 (90%) of 88 patients HPV DNA was detected by dot blot. Of 51 cases examined by histology 88% disclosed an evident koilocytosis. "High-risk" HPV types (16, 18, 31, 33, 35) were demonstrated in 8% of acuminate, 24% of papular and 56% of macular lesions. In 29% of 51 lesions examined histologically moderate to severe dysplasia was observed. There was a significant correlation between "high-risk" HPV types and dysplasia. CONCLUSION: "High-risk" HPV types are prevalent in papular and especially macular penile condyloma-like lesions. The histological finding of koilocytosis concomitant with dysplasia strongly indicates infection with a "high-risk" HPV type. Although the risk of penile cancer is low, it is from an epidemiological point of view important to diagnose these lesions. Until simple tests for HPV typing are available, biopsy for light microscopy (histology) should be obtained liberally from papular and macular condyloma-like lesions. In atypical cases of balanoposthitis HPV aetiology should also be considered.

Adolescent↗

Warty Carcinoma Arising in Condyloma Acuminatum of Urinary Bladder: A Case Report.

We describe the case of a 62-year-old man with chronic irritation of the urinary bladder resulting in dysuria and hypogastric pain. Three neoplasms measuring 0.5, 1, and 1.5 cm, respectively, were observed by cystoscopy and removed by transurethral resection (TUR). Histologic examination showed a complex folding of squamous hyperplastic epithelium around a connective tissue core. The superficial epithelium contained numerous koilocytes. The double polymerase chain reaction (PCR) detected DNA of type 11 human papillomavirus (HPV). The diagnosis was condyloma acuminatum of bladder. Three months later the patient presented with fever, and a new cytoscopy demonstrated an ulcerated, exophytic 4.5 cm mass. Histopathology showed a squamous carcinoma with papillomatous structure, pronounced viral koilocytosis, and irregular invasive deep margin. HPV type 11 was found with double PCR. The diagnosis was warty carcinoma arising in condyloma acuminatum. To the best of our knowledge, this is the first case of warty carcinoma of the urinary bladder described in the literature. We discuss the relationship between the infection by HPV and the development of condyloma acuminatum, its evolution toward a well-differentiated squamous carcinoma, and its distinction from verrucous carcinoma. Int J Surg Pathol 8(3):253-259, 2000

Journal Article↗

Demonstration of human papilloma virus (HPV) antigens in a case of urethral condyloma.

A 33-year-old women is reported, in whom a urethral condyloma was found 2 years after a preceding condylomatous lesion in the uterine cervix. The urethral condyloma was of the flat type, not previously described in this location, and it was found by an indirect immunoperoxidase-PAP method to contain cells positive for human papilloma virus (HPV) antigens. The role of HPV in the etiology of such condylomas is briefly reviewed and the suggested involvement of HPV in human squamous cell carcinogenesis is discussed.

Adult↗

Treatment of condyloma acuminatum with three different interferons administered intralesionally. A double-blind, placebo-controlled trial.

STUDY OBJECTIVE: To determine the efficacy and toxicity of intralesionally administered interferons in the treatment of condyloma acuminatum. DESIGN: Randomized, double-blind, and placebo-controlled study. SETTING: Outpatient clinics at university medical centers. PATIENTS: Seventy-nine patients with biopsy-proved condyloma acuminatum that was refractory to conventional therapy were enrolled in the study. INTERVENTIONS: Alpha-2b, alpha-nl-, and beta-interferons were used. One wart on each patients was injected three times per week for 4 weeks with either 1 x 10(6) units of interferon or placebo. MEASUREMENTS AND MAIN RESULTS: Forty-seven percent of warts injected with interferon resolved completely, compared with 22% of placebo-injected warts (P = 0.009). In addition, more recipients of interferon had a complete resolution of uninjected lesions. No differences in rates of response were noted among the different interferon groups. Approximately one third of interferon-injected warts recurred, compared with none of four placebo-injected warts. Intralesionally administered interferon was nontoxic and well tolerated, although transient pain on injection was observed frequently. CONCLUSIONS: Intralesional administration of each of these three interferons appears to be useful in treating condyloma acuminatum. However, the frequent recurrence of disease and the failure of many lesions to resolve indicate that different regimens, such as longer courses of therapy or different routes of administration, should be evaluated to maximize beneficial effects of interferon for treating this common sexually transmitted disease.

Adult↗

[Giant anovulvar condyloma acuminata revealing hiv-1 seropositivity in a Centrafrican patient].

As a general rule, genital condylomas present as localized lesions and large masses of warts are observed only during pregnancy. In this report we describe a giant anogenital condyloma in a non-pregnant 18-year-old Centrafrican woman. Soft papillomas completely covered the anterior and posterior perineum and obstructed the vagina. Clinical findings were suggestive of vulvar Buschke and Loewenstein tumor. The extent of the lesions and a history of unprotected relations with several sex partners raised suspicion of HIV infection which was subsequently confirmed. The CD4+ lymphocyte count was 540/min3. Surgical removal led to complete cure after healing of the surgical wound. Histological findings showed that the lesions were benign and ruled out malignant vulvar tumor. This case documents the link between florid genital condylomas and HIV infection with no change in immune status.

Adolescent↗

[Relationship between histopathologic observation of cervical condyloma and human papillomavirus infection].

OBJECTIVE: To study the relationship between histopathologic changes of cervical condyloma and different subtypes human papillomavirus (HPV) infection. METHODS: 158 women with abnormal Pap smears diagnosed by computer assisted cytologic technique (CCT) including 71 cases with atypical squamous cells of undetermined significance (ASCUS), 65 cases with low-grade squamous intraepithelial lesions (LSIL), 17 cases with high-grade squamous intraepithelial lesions (HSIL) and 5 cases with squamous cancers, underwent directed biopsies under colposcopy and were simultaneously detected for HPV6/11, HPV16/18 DNA by polymerase chain reaction (PCR). Koilocytotisis in 73 cases with pathologically proven cervical condyloma were grouped into type I and II according to its atypical degree of nuclei. RESULTS: HPV16/18 infection rate among condylomas cases was 86.0%, which was significantly higher than that of type I (16.7%) (P < 0.01). In LSIL with type II koilocytotisis, HPV16/18 infection rate and abnormal mitotic figures (AMFs) occurrence were 85.7%, significantly higher than those in type I koilocytotisis or cervical intraepithelial neoplasia I. CONCLUSIONS: Type II koilocytotisis was correlated with HPV16/18 infection. LSIL with type II koilocytotisises, distinct atypical nuclei, also associated with high HPV16/18 rate and AMFs, therefore treatment and follow-up should be more aggressive.

Adult↗

[Human papilloma virus infection in vaginal condyloma acuminatum].

The objective of this study was to determine the prevalence of human papillomavirus(HPV) infection in vaginal papillomatous lesions diagnosed in Tsuji Ladies Clinic. From January, 2000 to February, 2001, 52 patients were diagnosed with condyloma acuminata in the Clinic. All the patients received a complete gynecologic examination including colposcopic evaluation, and HPV DNA was assayed for in cervicovaginal lavages using polymerase chain reaction. HPV was detected in 31 of the 52 (60%) patients, and high risk HPV was found in 23 patients(45%). The incidence of high risk HPV infection is very high in vaginal condyloma acuminata. Detection of high risk HPV-positive women suggests that they may also be at risk for developing carcinoma. Therefore, it is very important to follow-up patients with condyloma acuminata.

Adolescent↗

[Condyloma latum, its incidence and association with cervical-uterine cancer and dysplasias].

Cervicouterine carcinoma is a public health problem in México, because of its high rate and mortality. In the present study, the frequency of flat condyloma was 11.06%. Association between dysplasia, cervicouterine carcinoma and flat condyloma was 67.2%. The risk of developing dysplasia or cervicouterine carcinoma if flat condyloma is present is 24%. Age and parity together with grade of lesion arte determinant to choice management. Malignancy must be discarded when a cervical lesion is diagnosed.

Age Factors↗

[The relation of local immune status to efficacy of immunotherapy in patients with condyloma acuminatum].

OBJECTIVE: To study the local immune status and its relation to immunotherapy in patients with condyloma acuminatum. METHODS: Clinical efficacy of 5% imiquimod cream in treating 30 patients with condyloma acuminatum was observed. The expressions of Human Leukocyte Antigen (HLA)-DR, CD1a, CD16 and Intercellular Adhesion Molecule (ICAM)-1 were detected by immunohistochemistry in lesions of these patients before treatment. RESULTS: The imiquimod cream was found to be efficacious in 20 cases after 8 weeks' treatment. Before treatment, the expressions of HLA-DR, CD1a, CD16 and ICAM-1 in the lesions of responders were significantly higher than those in the lesions of nonresponders (P<0.05). CONCLUSION: Higher expressions of HLA-DR, CD1a, CD16 and ICAM-1 suggested that immunotherapy might have efficacy in treating condyloma acuminatum.

Administration, Topical↗

[Study on the frequency of human papillomavirus type 6 and type 11 infection and L1 gene expression of the virus in biopsy samples of pointed condyloma patients].

OBJECTIVE: To determine the different rates of human papillomavirus types 6 (HPV-6) and 11 (HPV-11) infection in biopsy samples from pointed condyloma patients, and to construct prokaryotic expression system of the major capsid protein L1 of the virus so as to establish an ELISA for detecting the expression of L1 gene in the biopsy samples. METHODS: Using a double PCR based on the L1 gene of HPV-6 and HPV-11, the infection rates of HPV-6 and HPV-11 in the biopsy samples were determined. The whole length of HPV-6 L1 gene was amplified using PCR and the target amplification fragment was sequenced after T-A cloning. The prokaryotic expression system pET32a-L1-E. coli BL21 (DE3) was constructed and SDS-PAGE was used to measure the expression of the target recombinant protein rL1. Rabbit anti-rL1 serum was prepared and immuno-diffusion assay was applied to examine the antiserum titer. ELISA was established to detect the expression of L1 gene in the biopsy samples. RESULTS: In the biopsy samples from 116 pointed condyloma patients, 92.2% (107/116) were detectable for HPV-6 and/or HPV-11. Of the 107 positive samples, 70.1% (75/107) and 23.4% (25/107) were positive for HPV-6 or HPV-11 alone and 6.5% (7/107) were coinfected with both HPV-6 and HPV-11 respectively. When compared with the reported corresponding sequences, the homology of nucleotide and sequence of the cloned HPV-6 L1 gene was from 99.20% - 99.93% while its putative amino acid sequence homology was from 99.80% - 100%, suggesting IPTG could induce the expression of rL1. The immuno-diffusion titer of the rabbit anti-rL1 serum was 1:4. 88.8% (103/116) of the biopsy samples were the major capsid protein L1 detectable. CONCLUSION: A prokaryotic expression system of HPV-6 L1 gene, a double PCR assay for HPV-6 and HPV-11 genotyping, and an ELISA assay for detecting the major capsid protein L1 were successfully established in this study. The pointed condyloma patients in Zhejiang area mainly infected with HPV-6. The HPV in the focus frequently expressed major capsid protein L1.

Animals↗

[Giant condyloma with malignant degeneration: a case report].

We report a case of giant condyloma with malignant degeneration. A 56-year-old male was referred to our hospital due to a penile infection that was resistant to antibiotic therapy for more than a year. The swelling appeared to be a penile cancer. We suspected malignancy and performed penile biopsies twice; however, the histopathological diagnosis was condyloma acuminatum and malignant findings were absent. We continued the antibiotic therapy for 3 months; however, no improvement was achieved. Therefore, total penectomy and urinary diversion were performed. The pathological diagnosis of the resected tissues was not only condyloma but also squamous cell carcinoma, and cancer cells appeared on the cut surface of the specimens. We added radiation therapy. There was no evidence of recurrence or metastasis at 18 months after surgery.

Carcinoma, Squamous Cell↗

Sensitivity and specificity of various morphological features of cervical condylomas. An in situ hybridization study.

Fifty-seven cervical biopsy specimens or endocervical curettings showing condyloma, changes suggestive of condyloma, or no changes of condyloma were analyzed for presence of nuclear atypia (nuclear enlargement and irregularity in superficial epithelium), presence of multinucleated cells, and presence of perinuclear cytoplasmic clearing in superficial squamous epithelium. The findings were correlated with results of in situ hybridization with biotin-labeled human papillomavirus DNA probes. Moderate nuclear atypia was significantly more specific than perinuclear cytoplasmic clearing and 100% sensitive for predicting cases positive for human papillomavirus. Of the various morphological features analyzed, perinuclear cytoplasmic clearing had the lowest specificity for predicting positive results on in situ hybridization.

Blotting, Southern↗

Cytology of condyloma of the uterine cervix.

The presence of the koilocyte as well as other dyskeratotic cells in the routine gynecologic smear is often the earliest indication of an abnormality in an otherwise asymptomatic patient. These cells have now been shown to be infected by the human papillomavirus and for many women represent a transient event. The term condyloma has become associated with them and, by inference, a benign clinical course. But these cells should not be regarded solely as a manifestation of a viral infection, for nearly half are associated with a significant precancerous lesion and, in a few, invasive carcinoma. The behavior of the so-called condyloma of the cervix is unlike that of condyloma acuminatum of the external anogenital area.

Adolescent↗