Definition/General
Introduction:
Cervical condyloma (condyloma acuminatum) is a benign epithelial proliferation caused by low-risk human papillomavirus (HPV) types, primarily HPV 6 and 11
It represents a sexually transmitted viral infection of the cervical epithelium.
Origin:
Results from infection of basal epithelial cells by low-risk HPV types
Viral replication occurs in differentiating squamous epithelium, leading to characteristic morphological changes and epithelial proliferation.
Classification:
WHO Classification categorizes as benign HPV-related epithelial lesion
Distinguished from high-risk HPV lesions (CIN) by viral type and morphological features.
Epidemiology:
Common sexually transmitted infection
Peak incidence 15-30 years
More frequent in immunocompromised patients
Often coexists with genital condylomas.
Clinical Features
Presentation:
Visible warty lesions on cervix
Abnormal Pap smear showing HPV changes
May be asymptomatic
Can cause abnormal vaginal discharge or bleeding.
Symptoms:
Often asymptomatic
Abnormal vaginal discharge
Post-coital bleeding
Visible cervical lesions
Itching or irritation
May cause dyspareunia.
Risk Factors:
Sexual activity
Multiple sexual partners
Young age at first intercourse
Immunosuppression
Smoking
Other STIs
Poor genital hygiene.
Screening:
Pap smear shows koilocytic changes
HPV testing identifies low-risk types
Colposcopy reveals acetowhite lesions
Visual inspection shows warty appearance.
Master Cervical Condyloma Pathology with RxDx
Access 100+ pathology videos and expert guidance with the RxDx app
Gross Description
Appearance:
Warty, papillary, or flat lesions on cervical surface
White to pink coloration
Rough, irregular surface texture
May be single or multiple.
Characteristics:
Variable size (few mm to several cm)
Warty, cauliflower-like appearance
White to pink color
Rough surface texture
Soft consistency.
Size Location:
Can occur anywhere on cervix
Often involves transformation zone
May extend to vagina
Can be focal or multifocal.
Multifocality:
Often multiple lesions
May involve both ectocervix and endocervix
Can be associated with vaginal and vulvar condylomas.
Microscopic Description
Histological Features:
Acanthotic squamous epithelium with papillary architecture
Characteristic koilocytes (cells with perinuclear halos and nuclear irregularities)
Hyperkeratosis and parakeratosis.
Cellular Characteristics:
Koilocytes: enlarged cells with perinuclear clearing and wrinkled, hyperchromatic nuclei
Multinucleation common
Increased mitotic activity in basal layers.
Architectural Patterns:
Papillary epithelial proliferation
Acanthosis with regular maturation
Surface hyperkeratosis
Orderly progression from basal to surface layers.
Grading Criteria:
Benign lesion (no grading system)
Distinguished from CIN by preservation of epithelial maturation and absence of high-grade dysplastic changes.
Immunohistochemistry
Positive Markers:
p16 may show patchy positivity (unlike diffuse staining in high-risk HPV)
Ki-67 elevated in basal third
CK5/6 positive.
Negative Markers:
High-risk HPV typically negative
p53 shows wild-type pattern
Neuroendocrine markers negative.
Diagnostic Utility:
p16 staining pattern helps distinguish from high-risk HPV lesions
HPV in situ hybridization can identify specific viral types.
Molecular Subtypes:
Associated with low-risk HPV types (6, 11)
HPV 6 and 11 account for >90% of genital condylomas.
Molecular/Genetic
Genetic Mutations:
No significant cellular genetic alterations
Viral genome may be episomal or integrated
Low-risk HPV lacks E6/E7 transforming potential of high-risk types.
Molecular Markers:
Low-risk HPV DNA detectable by PCR or in situ hybridization
p16 shows patchy, not diffuse staining
Ki-67 elevated but confined to lower epithelial layers.
Prognostic Significance:
Excellent prognosis as benign lesion
No malignant potential
May resolve spontaneously with immune response
Can recur if incompletely treated.
Therapeutic Targets:
Topical therapies (imiquimod, podophyllin)
Cryotherapy
Laser ablation
Surgical excision
HPV vaccination for prevention.
Differential Diagnosis
Similar Entities:
Cervical intraepithelial neoplasia (CIN)
Squamous papilloma
Verrucous carcinoma
Seborrheic keratosis
Reactive squamous hyperplasia.
Distinguishing Features:
Condyloma: koilocytes, low-risk HPV
CIN: dysplastic changes, high-risk HPV, p16 diffuse positive
Verrucous carcinoma: invasion, no HPV.
Diagnostic Challenges:
Distinction from flat condyloma and CIN 1
Identification of koilocytic changes
Differentiation from reactive epithelial changes.
Rare Variants:
Flat condyloma
Giant condyloma (Buschke-Löwenstein tumor)
Condyloma with secondary bacterial infection.
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]