Flat Condyloma Research Articles

Histopathological characteristics and HPV status in cervical biopsy specimens diagnosed as flat condyloma.

HPV infections cause a wide spectrum of pathological changes in lower anogenital epithelium. The aim of this study was to investigate the HPV DNA status and histological findings in cervical biopsy specimens diagnosed as flat condyloma. This study included 20 cervical biopsy specimens diagnosed as flat condyloma. The histopathological criteria and presence of HPV DNA were evaluated. HPV genotyping was determined in HPV-positive specimens using BioEdit software and the results were analyzed in SPSS software. HPV DNA was not found in 30% of specimens and relative frequency of HPV genotypes was: 15% HPV6, 15% HPV11, 5% HPV16, 5% HPV18, 5% HPV53, 5% HPV68, 5% HPV84, 10% HPV45. Relative frequency of histopathological criteria was as below: 100% of specimens had koilocytosis, 100% acanthosis, 15% nuclear immaturity, 100% atypia, 15% mitotic activity, 50% dyskeratosis, 35% parakeratosis and 10% hyperkeratosis. There were significant differences between HPV positivity and two pathologic criteria; multinucleation and hyperkeratosis (P Value: 0.02). Nuclear immaturity was significantly more prevalent in high risk HPV-positive specimens (P Value: 0.03).

Cervical Pre-cancers: Biopsy and Immunohistochemistry.

The existence of precursor lesions for invasive cervical cancer has been recognized for more than 50 years. Our understanding of the pathobiology and behavior of cervical cancer precursors has evolved considerably over the past five decades. Furthermore, the terminology used to classify pre-invasive lesions of the cervix has frequently changed. The realization that human papillomavirus (HPV) infections constitute a morphologic continuum has prompted efforts to include them within a single classification system, specifically the squamous intraepithelial lesions (SILs) which have now been embraced by the surgical pathologists. The reduced number of specific pathological categories has made clinical decision-making more straightforward. The generic criteria for SIL have two important histological parameters: Alterations in the density of superficial epithelial cells and superficial squamous atypia. The flat condyloma or cervical intraepithelial neoplasia (CIN) I is generally associated with intermediate and high-risk HPV types as against the low-risk viruses that cause exophytic/papillary growth patterns of condylomas. The diagnosis of low-grade SIL (LSIL) (flat and exophytic condylomas) requires first excluding benign mimics of LSIL and second to confirm the characteristic cytologic atypia. For high-grade SILs (HSILs), the extent and degree of atypia generally exceed the limits of that described in flat or exophytic condylomas (LSILs). Less maturation, abnormal cell differentiation, loss of cell polarity, and increased mitotic index with abnormal mitotic figures occupying increasing thickness of the epithelium define a lesion as CIN II or CIN III. Atypical immature metaplasia associated with inflammation and atrophy is a challenge in cervical biopsy interpretation. Careful attention to the growth pattern of the epithelium, the distribution of the atypia, nuclear spacing, and the degree of anisokaryosis and the presence of enlarged hyperchromatic nuclei help in differentiating a non-neoplastic from a neoplastic process. This chapter describes in depth the diagnostic difficulties in the interpretation of cervical biopsies. It also provides useful criteria in distinguishing benign mimics from true precancerous lesions and the role of biomarkers such as the p16ink4 and Ki-67 in the differential diagnosis of precursor lesions and the reactive and metaplastic epithelium.

Flat Condyloma and High-grade Lesion Following Cryotherapy for Low-grade Lesion Cervix Uteri

Flat Condyloma and High-grade Lesion Following Cryotherapy for Low-grade Lesion Cervix Uteri

Digital analysis of colposcopic images with acetowhite epithelium in "real-time" mode

Digital analysis is a method of assessing qualitative data by converting them into quantitative data using a personal computer’s graphics processing unit (GPU). Visual changes on the cervical surface in human papillomavirus (HPV)-associated pathology can be evaluated by extended colposcopy with a 3–5% acetic acid test and Schiller’s test. Acetowhite epithelium (appears after a test with acetic acid) in the form of flat condyloma is one of the main clinical manifestations of HPV infection (excluding manifestations on the metaplastic epithelium). The intensity of acetowhite epithelium (AWE) is a subjective parameter during gynecological examination, and to exclude the malignant process, a histology or liquid-based cytology should be performed. Objective assessment of the AWE intensity is introduced by digital image analysis using specialized software. The aim. To improve the assessment of visual changes of acetowhite epithelium on the cervical surface using a digital approach as an additional tool when performing extended colposcopy. Materials and methods. Colposcopy images of 359 patients were estimated by digital approach. Colposcopy images were made with a screenshot function after performing extended colposcopy. Screenshots of the cervix were converted to 8-bit type. This allowed us to estimate the intensity of AWE by software ImageJ. Index grey value (IndGV) was calculated to estimate the intensity of AWE. The IndGV data were assessed by MS office 365 (Excel v16.46) and RStudio v1.2.5042 statistical packages. Results and conclusion. The quantification approach detects the severity of AWE on the cervical surface. IndGV correlates with the grades of cervical intraepithelial neoplasia (CIN) and clinical manifestations of HPV. The clinical manifestations of HPV infection in CIN have a direct dependence on digital measurement as grey value (GV). These indicators give the opportunity to evaluate clinical manifestations in digital analysis in real-time mode, which does not require a significant financial investment. IndGV can be used as a prognostic factor of the severity of HPV infection and its clinical forms (CIN I–III and cervical cancer). Key words: digital medicine, quantitative approach, acetowhite epithelium, HPV infection

Colposcopic features of cervical oncotropic papilloma-virus infection in patients with various pathology of uterine cervix

In order to estimate the colposcopic manifestations of cervical oncotropic human papilloma-virus (HPV)-infection, a total of 693 patients were examimed. Among them, there were 298 patients with benign tumors pathology, 57 patients with 1-3 Grade cervical dysplasia of mucosa, 50 patients with uterine cervix cancer, 288 healthy women.
 All patients underwent bimanual examination, taking of cervical smears for cytological examination and uterine cervix colposcopy. Diagnosis for HPV16/18 infection was made by the method of polimerase chain reaction.
 А large variety in colposcopic manifestations of HPV-infection was found, namely: areas of atypical vessels, leukoplakia sites,fields of atypical epithelium, iodine-negative sites. It was related to the influence of oncogenic types of HPV infection. In these patients,fields of atypical epithelium, atypical vessels, iodinenegative areas were observed 1.2, 2.5, 10.5 times more frequently, respectively.
 It was found that all varieties of papillomas occurred among patients with pathology, whereas flat condylomas presenting the most difficulties of or diagnosis prevailed in patients with cervical neoplasms and uterine cervix cancer The most pronounced colposcopic evidences of uterine cervix epithelium malignancy were observed in patients with virus-positive uterine cervix cancer.

Secondary syphilis: a woman with flat condyloma.

Secondary syphilis: a woman with flat condyloma.

Screening for Cervical Cancer by Visual Inspection with Acetic Acid (VIA) in Nabil Choucair Health Center—Dakar (Senegal)

OBJECTIVES: 1) To draw up the epidemiological profile of patients who have benefited from cervical cancer screening by visual inspection after application of acetic acid (VIA) and then describe the results of the test, the colposcopy, histological and therapeutic aspects in case of dysplasia. 2) To evaluate the performance of IVA in cervical cancer screening and its feasibility in low-resource countries. MATERIALS AND METHODS: This was a prospective and descriptive study carried out from 06 June 2015 to 31 January 2016 (7 months) at the Maternity Center at Nabil Choucair health center in Dakar. The patients had been screened for cervical cancer by visual inspection, which consisted of applying 3% acetic acid after setting up a vaginal speculum. The test was considered positive if there were intense white areas in the cervix. Colposcopy was performed in case of a positive VIA result. This colposcopy included an unprepared examination, an examination after application of 3% acetic acid and an examination after application of Lugol solution. The colposcopic report is made according to the terminology of the French Society of Colposcopy and Cervico-Vaginal Pathology. Patients with major changes or unsatisfactory colposcopy had undergone diathermic loop resection. Surgical specimens were sent to pathologic anatomy and follow-up was performed according to the results of the histology. The studied parameters concerned the socio-demographic aspects, the results of the VIA test, the results of the colposcopy after a positive test, the therapeutic aspects in case atypical transformation zone grade 2 or of unsatisfactory colposcopy, the results of the histology after the conization and the followed. The collection of data was done thanks to a file and the statistical analysis thanks to the software Epi-info version 7. RESULTS: 899 patients were involved in the study. The epidemiologic profile of our patient was a multipara in a period of genital activity, aged 42.2 years with a mean gestational weight of 4.5, and a parity of 4. In our series, the patients had their first sexual intercourse with 20.8 years old. In our study, 84 patients (10.2%) had positive results after visual inspection after acetic acid applications. All patients with positive results after application of 3% acetic acid had colposcopy. In our study, 27 patients had major changes and/or unsatisfactory colposcopy and underwent diathermic loop resection for diagnostic and therapeutic purposes. Anatomo-pathological examination of the cone room revealed cervicitis in 22.2% of cases, flat condyloma in 7.4% of cases, CIN2 in 22.2% of cases, and CIN3 in 18.5% of cases. All the conizations were in sano. The postoperative course was simple. CONCLUSION: Cervical cancer is a real public health problem in developing countries. To do to human resources, developing countries like Senegal must put in place simple, inexpensive, effective strategies that must globally respond to “screen and treat”.

Syphilis Diagnosis From Multiple Flat Condyloma of the Mouth: a Case Report

Syphilis Diagnosis From Multiple Flat Condyloma of the Mouth: a Case Report

P16 Expression and Biological Behavior of Flat Vulvar Low-grade Squamous Intraepithelial Lesions (LSIL).

Flat low-grade squamous intraepithelial lesion (LSIL) of the vulva [vulvar intraepithelial neoplasia (VIN) 1, flat condyloma] is an uncommon entity with poorly understood biological behavior. We aimed to determine the risk of subsequent vulvar high-grade squamous intraepithelial lesion (HSIL) or carcinoma following a diagnosis of vulvar LSIL/VIN 1, as well as the frequency and predictive value of p16 immunohistochemical expression in this setting. Of the 51 included cases, p16 positivity (diffuse block staining) was identified in 2 (4%). Follow-up data were available in 34 cases, of which 2 (5.9%) developed subsequent vulvar HSIL, including 1/2 p16-positive cases and 1/32 p16-negative cases. The difference in HSIL frequency between p16-positive and p16-negative cases was not statistically significant (P=0.116 for VIN 2+, P=0.061 for VIN 3). For the 18 patients with treatment information available, 10 (56%) received medical or surgical treatment after biopsy. Our results indicate that flat vulvar LSIL is infrequently p16 positive, and that few patients with vulvar LSIL develop subsequent vulvar HSIL. Despite the use of destructive treatment in some cases, the data provide support for the nonpreneoplastic nature of the entity. Immunohistochemical expression of p16 may not be a predictor of HSIL risk in vulvar LSIL, although this result may also be related to the very low rates of both p16 positivity and subsequent vulvar HSIL in our sample. It is clear that vulvar LSIL is distinct from LSIL in other lower anogenital sites in terms of its behavior and p16 expression frequency.

A case of syphilis manifesting as flat condylomata in the perianal, umbilical and interdigital regions complicated by roseola and hard chancre

A case of syphilis manifesting as flat condylomata in the perianal, umbilical and interdigital regions complicated by roseola and hard chancre

A case of secondary syphilis with flat condyloma at the angle of the mouth and mucous patches on the lips as initial symptoms

A case of secondary syphilis with flat condyloma at the angle of the mouth and mucous patches on the lips as initial symptoms

The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions.

The impact of terminology for vulvar intraepithelial lesions has been significant over the years, because it has affected diagnosis, treatment, and research. The introduction of the Lower Anogenital Squamous Terminology (LAST) in 2012 raised 2 concerns in relation to vulvar lesions: firstly, the absence of reference to "differentiated vulvar intraepithelial neoplasia" (differentiated VIN) could lead to its being overlooked by health care providers, despite its malignant potential. Secondly, including the term "low-grade squamous intraepithelial lesion" (LSIL) in LAST recreated the potential for overdiagnosis and overtreatment for benign, self-limiting lesions. The International Society for the Study of Vulvovaginal Disease (ISSVD) assigned the terminology committee the task of developing a terminology to take these issues into consideration. The committee reviewed the development of terminology for vulvar SILs with the previous 2 concerns in mind and reviewed several new terminology options. The final version accepted by the ISSVD contains the following: 1) Low-grade SIL of the vulva or vulvar LSIL, encompassing flat condyloma or human papillomavirus effect. 2) High-grade SIL or vulvar HSIL (which was termed "vulvar intraepithelial neoplasia usual type" in the 2004 ISSVD terminology). 3) Vulvar intraepithelial neoplasia, differentiated type. The advantage of the new terminology is that it includes all types of vulvar SILs, it provides a solution to the concerns in relation to the application of LAST to vulvar lesion, and it is in accordance with the World Health Organization classification as well as the LAST, creating unity among clinicians and pathologists.

The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions.

The impact of terminology for vulvar intraepithelial lesions has been significant over the years, because it has affected diagnosis, treatment, and research. The introduction of the Lower Anogenital Squamous Terminology (LAST) in 2012 raised 2 concerns in relation to vulvar lesions: firstly, the absence of reference to "differentiated vulvar intraepithelial neoplasia" (differentiated VIN) could lead to its being overlooked by health care providers, despite its malignant potential. Secondly, including the term "low-grade squamous intraepithelial lesion" (LSIL) in LAST recreated the potential for overdiagnosis and overtreatment for benign, self-limiting lesions. The International Society for the Study of Vulvovaginal Disease (ISSVD) assigned the terminology committee the task of developing a terminology to take these issues into consideration. The committee reviewed the development of terminology for vulvar SILs with the previous 2 concerns in mind and reviewed several new terminology options. The final version accepted by the ISSVD contains the following:•Low-grade SIL of the vulva or vulvar LSIL, encompassing flat condyloma or human papillomavirus effect.•High-grade SIL or vulvar HSIL (which was termed "vulvar intraepithelial neoplasia usual type" in the 2004 ISSVD terminology).•Vulvar intraepithelial neoplasia, differentiated type. The advantage of the new terminology is that it includes all types of vulvar SILs, it provides a solution to the concerns in relation to the application of LAST to vulvar lesion, and it is in accordance with the World Health Organization classification as well as the LAST, creating unity among clinicians and pathologists.

Оценка эффективности и безопасности применения имихимода в лечении субклинических и клинических проявлений персистирующей папилломавирусной инфекции шейки матки у пациенток раннего репродуктивного возраста

Objectives. HPV infection is a major risk factor for cervix cancer. This study evaluated cervical application of imiquimodfortreatment of subclinical (flat condyloma) and clinical (CIN I, LSIL) manifestations of human papillomavirus infection. Methods. An open controlled study (n=28) efficacy and safety of imiquimod (5% cream Aldara) in 1-2 months. Results. All patients treated had complete clinical responses. Clinical efficacy of treatment at 1 month was 96,4%, in 2 months - 100%. Microbiological efficacy (full HPV-clearance) achieved in 60,7% of cases, in other cases there was a decrease in viral load. Elimination of the 16 types of virus was achieved in 80% of cases. Immunocytochemical study showed higher levels of expression of Toll-like receptor 4 and 9 type in the endo - and ectocervix after treatment. Undesirable effects were not grounds for termination of treatment.Conclusions. The trial does support the feasibility and acceptability of the use of imiquimod on the cervix in treatment of manifestations of human papillomavirus infection.

Cervical pathology. What tasks have a gynecologist?

Cervical pathological processes occupy a significant place in the structure of the reproductive system pathology and are found in 15-20% of women of reproductive age and in 5-9% of menopausal women. Cervical background diseases are cervical ectopia (pseudo erosion), cervical true erosion, ectropion, simple leukoplakia, cervical polyp, warts and flat condylomas. Early detection and treatment of cervical background diseases and precancerous cervical diseases can prevent cervical cancer, which ranks third in frequency among malignant tumors of the genital organs and the sixth in the structure of total cancer incidence. The article describes approaches to the classification, diagnostics, and treatment of pathological conditions of the cervix.

P16INK4a Immunoprofiles of Squamous Lesions of the Uterine Cervix–Implications for the Reclassification of Atypical Immature Squamous Metaplasia

p16(INK4a) immunoprofiles of non-precancerous and dysplastic squamous cervical lesions were defined and applied to the reclassification of atypical immature squamous metaplasia (AIM). The immunoexpression of cytokeratin 17 (CK 17) in AIM was also evaluated. Totally, 295 cervical cone biopsies representing squamous metaplasia, reactive changes, koilocytosis, flat condyloma, CIN I, CIN II, CIN III and AIM were subjected to p16(INK4a) immunohistochemistry. AIM cases were analyzed using CK 17 antibody. Typical p16(INK4a) immunoprofiles for the metaplastic, LSIL/HPV and HSIL phenotypes were recorded and used for the categorization of AIM into particular phenotype groups. Results were correlated with CK 17 immunoexpression. All CIN II and CIN III lesions, all but one case of CIN I and all flat condylomas overexpressed p16(INK4a). Other non-precancerous lesions, including koilocytosis, were predominantly negative. Contrary to the sporadic and focal immunostaining, diffuse positivity was associated with the dysplastic features of the lesion. CIN II and CIN III were characterized by a diffuse, strong/weak, full-thickness staining, whereas CIN I showed a heterogeneous diffuse/focal, weak/strong, lower half positivity. One third of AIM lesions may be reclassified as HSIL, one third as LSIL/HPV and one third shows metaplastic phenotype. All AIM cases with metaplastic and LSIL/HPV phenotypes expressed CK 17 diffusely, whereas focal positivity slightly prevailed in AIM with HSIL phenotype. We conclude that p16(INK4a) immunohistochemistry is a supporting method for the differential diagnosis of cervical lesions, which may be especially useful for the reclassification of AIM. The efficacy of CK 17 immunohistochemistry seems to be controversial for these purposes.

Prevalence of low-risk HPV types and genital warts in women born 1988/89 or 1983/84 -results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany

BackgroundWolfsburg HPV Epidemiological Study (WOLVES) is a population-based cohort study on HPV infections and associated diseases in the pre-vaccination era in young women in Wolfsburg, Germany.MethodsWomen born 1983/84 or 1988/89 were invited to participate. Participants were recruited in gynecology practices, and completed a questionnaire with socioeconomic, sexual and medical data including vaccination status. Pelvic examination with Pap smear and HPV testing (HC2 = Hybrid Capture 2) was obligatory. HC2-positive and 10% of HC2-negative samples were tested for specific HPV types with SPF-10-PCR, and in inconclusive cases with DNA sequencing. Women with genital warts (GW) and those with atypical Pap smears were transferred for colposcopy. GWs were classified as typical condylomata acuminata (TCA), flat condyloma (FC) and seborrheic wart-like (SWL).ResultsIn total, 1258 subjects were recruited from the target population of 2850 (44.1%). Overall the prevalence of HC2 low-risk (LR) types was 8.5%. HPV6 was the most frequent LR type (2.1%), followed by HPV42 (1.1%), HPV11 and HPV44 (each 0.4%). LiPA showed a low sensitivity for HPV types 42, 90 and 91, which were detected only by HC2 and HPV sequencing. Nine women (0.7%) were transferred with incident GW: five TCA, two FC and two SWL. All TCA were associated with HPV6 in corresponding cervical swabs and warts. Tissues of SWL contained HPV6 (n = 1) and HPV16 (n = 1). The cumulative life-risk for GW was 1.4% in the 1988/89 and 4.8% in the 1983/84 cohort. Eight of 107 HC2-LR + and five of nine cases of GW had concomitant abnormal Pap smears. All CIN lesions could be linked to high-risk HPV types but borderline and low-grade abnormal smears were explained by vaginal and cervical TCA in four cases.ConclusionsHC2 was a specific test for the detection of established and potential LR types. In this first WOLVES analysis, HPV6 was the most frequent HPV type and the single LR type linked to disease. The observed GW incidence of 715 per 100,000 fits well with estimates of healthcare providers. Although life risks for GW were lower than in Scandinavian analyses, the societal burden within the WOLVES populations was considerable.

Cutaneous and VisCeral syphilis: unusual presentation

The most reported secondary syphilis general symptoms are the following: uneasiness (23-46%), headache (9-46%), fever (5-39%), pruritus (42%), hyporexia (25%). Other symptoms, less common, are: eye pain, bone pain, arthralgia, meningism, iritis and hoarseness. More specific signs occur in the following frequencies: skin rash (88100%), lymphadenopathy (85-89%), primary cancer (25-43%), flat condyloma (9-44%), hepatosplenomegaly (23%), mucous plaques (7-12%) and alopecia (3-11%). Rare manifestations include: acute meningitis, that occurs in approximately 2% of patients, hepatitis, renal disease, cardiac disease, gastritis, proctitis, ulcerative colitis,

Cervical, vaginal and vulvar intraepithelial neoplasms

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Genotype distribution of cervical human papillomavirus DNA in women with cervical lesions in Bioko, Equatorial Guinea

BackgroundThe HVP vaccine is a useful tool for preventing cervical cancer. The purpose of this study is to determine the most frequent HPV genotypes in Equatorial Guinea in order to develop future vaccination strategies to apply in this country.MethodsA campaign against cervical cancer was carried out in the area on a total of 1,680 women. 26 of the women, following cytological screening, were treated surgically with a loop electrosurgical excision procedure (LEEP). Cases were studied histologically and were genotyped from paraffin blocks by applying a commercial kit that recognized 35 HPV types.ResultsCytological diagnoses included 17 HSIL, 1 LSIL, 5 ASC-H and 3 AGUS. Histological diagnosis resulted in 3 cases of microinvasive squamous cell carcinoma stage IA of FIGO, 9 CIN-3, 8 CIN-2, 2 CIN-1, 3 flat condylomas and mild dysplasia of the endocervical epithelium. Fifteen of twenty-five cases genotyped were positive for HPV (60%). HPV 16 and 33 were identified in four cases each, HPV 58 in two other cases, and HPV 18, 31, 52, and 82 in one case, with one HPV 16 and 58 coinfection.ConclusionThe frequency of HPV types in the African area varies in comparison to other regions, particularly in Europe and USA. Vaccination against the five most common HPV types (16, 33, 58, 18, and 31) should be considered in the geographic region of West Africa and specifically in Equatorial Guinea.