Definition/General
Introduction:
Cervical condyloma acuminatum is a benign squamous epithelial lesion caused by low-risk HPV types, characterized by koilocytotic changes, papillary architecture, and minimal dysplasia
It represents a low-grade squamous intraepithelial lesion (LSIL).
Origin:
Arises from cervical squamous epithelium infected with low-risk HPV types (particularly HPV 6 and 11)
Represents productive viral infection with viral replication and koilocyte formation.
Classification:
WHO Classification categorizes as benign squamous lesion
Part of LSIL spectrum
Low-risk HPV-associated lesion with minimal malignant potential.
Epidemiology:
Peak incidence 20-30 years
Associated with HPV 6 and 11 (>90% of cases)
Sexually transmitted
Low malignant potential
May regress spontaneously.
Clinical Features
Presentation:
Often asymptomatic
May present as visible genital warts
Abnormal Pap smear findings
Detected on routine gynecologic examination.
Symptoms:
Usually asymptomatic
Visible warty lesions
Pruritus possible
Bleeding with trauma
Psychological distress from visible lesions.
Risk Factors:
HPV 6/11 infection
Multiple sexual partners
Young age at first intercourse
Immunosuppression
Concurrent STIs.
Screening:
Pap smear may show LSIL
HPV testing shows low-risk types
Visual inspection identifies warty lesions
Colposcopy for assessment.
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Gross Description
Appearance:
Papillary, warty, or cauliflower-like lesions
Variable size from few millimeters to several centimeters
Pink to gray-white coloration.
Characteristics:
Exophytic papillary growths
Soft consistency
May be pedunculated or sessile
Multiple lesions possible
Friable surface.
Size Location:
Can occur anywhere on cervix, vagina, or vulva
Size variable (2mm to >5cm)
May be solitary or multiple.
Multifocality:
Often multifocal
May involve multiple genital sites
Field effect with extensive involvement possible.
Microscopic Description
Histological Features:
Papillary squamous epithelium with fibrovascular cores
Koilocytotic changes with perinuclear halos
Minimal nuclear atypia
Superficial hyperkeratosis.
Cellular Characteristics:
Koilocytes with perinuclear halos and nuclear enlargement
Binucleation common
Minimal nuclear atypia
Mature squamous epithelium.
Architectural Patterns:
Papillary architecture with fibrovascular cores
Acanthosis and hyperkeratosis
Normal maturation pattern
Minimal dysplasia.
Grading Criteria:
Low-grade lesion by definition
Minimal nuclear atypia
Koilocytotic changes prominent
No high-grade dysplasia.
Immunohistochemistry
Positive Markers:
p16 negative or patchy positive
Ki-67 low proliferation
HPV L1 capsid protein may be positive
Cytokeratins positive.
Negative Markers:
p16 typically negative (unlike high-grade lesions)
High-risk HPV markers negative
Neuroendocrine markers negative.
Diagnostic Utility:
p16 negativity helps distinguish from high-grade lesions
HPV L1 positivity may support productive infection
Low Ki-67 confirms low grade.
Molecular Subtypes:
Low-risk HPV-associated lesion
HPV 6 and 11 most common types.
Molecular/Genetic
Genetic Mutations:
Low-risk HPV infection (HPV 6, 11)
Episomal viral replication
No significant genomic instability
p53 and Rb pathways intact.
Molecular Markers:
Low-risk HPV DNA detection
HPV L1 capsid protein expression
Normal p53 and Rb function
Low proliferation indices.
Prognostic Significance:
Excellent prognosis with minimal malignant potential
May regress spontaneously
Recurrence possible but malignant transformation rare.
Therapeutic Targets:
HPV vaccines for prevention
Topical immune modulators (imiquimod)
Destructive therapies
Surgical excision.
Differential Diagnosis
Similar Entities:
Seborrheic keratosis
Fibroepithelial polyp
CIN 1 with koilocytosis
Squamous papilloma
Vulvar intraepithelial neoplasia.
Distinguishing Features:
Condyloma: HPV 6/11, p16-, minimal atypia
CIN 1: May have more atypia, p16 variable
Seborrheic keratosis: Different location, no HPV.
Diagnostic Challenges:
Distinction from CIN 1
Assessment of dysplasia grade
Recognition of koilocytic changes
Differential HPV typing.
Rare Variants:
Giant condyloma (Buschke-Löwenstein tumor)
Condyloma with CIN
Condyloma in immunocompromised patients.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]