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Condyloma Acuminata of the Left Thigh- A Cytohistopathological curiosity.

Article · April 2013

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JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Nikumbh DB et al. Condyloma Acuminata of the left thigh- A cytohistopathological

curiosity. Journal of pharmaceutical and biomedical sciences (J Pharm Biomed Sci.) 2013, April;
29(29): 762-765. (Article no 08)

The online version of this article, along with updated information and services, is located on
the World Wide Web at: www.jpbms.info

Journal of Pharmaceutical and Biomedical Sciences (J Pharm Biomed Sci.), Member journal.
Committee of Publication ethics (COPE) and Journal donation project (JDP).
 ISSN NO- 2230 – 7885
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NLM Title: J Pharm Biomed Sci.

Nikumbh DB et al. J Pharm Biomed Sci. 2013, April; 29 (29): 762-765.

Available at jpbms.info

Case report
Condyloma Acuminata of the Left Thigh- A Cytohistopathological curiosity

Dhiraj B. Nikumbh1*, Nandkumar V. Dravid2, Priya S. Bagle3, Anjali M. Chitale4

& Chakor M. Rokade5
1Associate
Professor,2Professor & Head,3Assistant Professor, 5Assistant Lecturer,
Department of Pathology ,4 Professor, Department of Surgery, JMF’s ACPM medical
college and hospital, Dhule, Maharashtra, India.
Abstract:
Condyloma acuminata or genital wart is the anogenital expression of human papilloma virus (HPV)
infection and is the most common viral sexually transmitted disease in the western world. Isolated
condyloma acuminata of the thigh in absence of similar lesions on the genital areas are very uncommon.
After extensive review of literature, only limited case reports were available of this rare entity.

Herein, we present a case of condyloma acuminata of the left thigh in a 60 year old male in absence of any
similar lesions on genital areas. The diagnosis was offered on cytology and histopathologically; as a result
of curiosity due to its unusual appearance on gross features. We present this case due to its rarity and
uncommon findings.

Keywords: Condyloma acuminata, HPV, viral disease.

Introduction:

C
ondyloma acuminata or anogenital warts can occur on the Case report:
penis, female genitals and in the anal region[1]. Condyloma A 60 year old male came to
acuminata are transmitted sexually and HPV infection is one surgical OPD of our hospital with
of the most common viral sexually transmitted disease in the world, chief complaints of gradually
with an estimated 1% prevalence in the sexually active population increasing, large mass over the
in the United States[1]. postero-lateral aspect of left thigh
Condyloma acuminata are found on the penis and around the anus since 25 years. Past history of
in men. In women, frequent areas of infection include the vulva, treatment by local practitioner
vaginal introits, perianal and perineal area and cervix[1]. HPV was obtained. He applied some
infection in the male produces common and plantar warts[2]. ayurvedic local cream to the
Condyloma acuminata and subclinical condyloma is strongly mass, 2 years back. There was no
associated with penile and anal carcinomas and squamous history of fever, weight loss or
intraepithelial lesions in cervix[2]. Lesion of the skin consists of reduced appetite.
fairly soft, verrucous papules that
occasionally coalesce into cauliflower
like masses[2].

Condyloma acuminata of the thigh is

very uncommon findings. To the best
of our knowledge, only two cases are
reported in literature. This is the
third case report of condyloma
acuminata of the left thigh in 60 year
old male in absence of similar lesions
in the genital area. We are presenting
this case due to its rarity and
uncommon gross and
cytohistopathological findings.

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 ISSN NO- 2230 – 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

Nikumbh DB et al. J Pharm Biomed Sci. 2013, April; 29 (29): 762-765.

Available at jpbms.info

Rest of the systemic examination was within normal limit. Family keratinous debris (figure 2).
and personal history were not contributory. Local examination
revealed pedunculated,
cauliflower, fungating, and foul
smelling grey-black mass
measuring 6x5 cms over the
postero-lateral aspect of left thigh
with finger like projections on the
surface (figure 1). The patient mass
was clinically diagnosed as
papilloma and sent for cytological
examination. Fine needle
aspiration cytology (FNAC) of the
mass was performed, which
revealed numerous clusters of
anucleated squamous and

Few of the squamous epithelial cells show mild anisonucleosis. aspect of left thigh. The mass was
Background showed bacterial colony and keratinous material pedunculated, cauliflower like,
admixed with blood. Dyskaryotic and malignant cells were not fungating, foul smelling with
seen. Cytodiagnosis of keratin rich lesion was given with possibility grey-black areas of papillary
of verrucous carcinoma and biopsy was advised for further projection measuring 5 x 4 cm in
confirmation. Routine blood investigation and serology for HIV, diameter (figure 3). On cutting
VDRL, and HBsAg were negative. Wide excision of tumor mass with open showed whitish appearance
peduncle was carried out and specimens send for histopathological with surrounding grey-black
examination. areas of finger like projections on
Gross Findings: We received excised mass from postero-lateral the surface (figure 4).

Light microscopy:
Multiple sections studied through pedunculated mass revealed tumor with papillary projections. The skin
showed changes of condyloma acuminata. The changes of condyloma were as parakeratosis,
hyperkeratosis, hypergranulosis in stratum corneum with supraepidermal and intraepidermal vesicles.
Focal areas of papillomatosis and acanthosis noted with elongation of rete ridges (figure 5).
Epidermal cells show marked perinuclear vacuolization (koilocytic change) (figure 6) with large
hyperchromatic round nuclei. Dermis show fibrocollagenous tissue with focal dense lymphoplasmocytic

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CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

Nikumbh DB et al. J Pharm Biomed Sci. 2013, April; 29 (29): 762-765.

Available at jpbms.info

infiltrates. Large focal areas of skin

showed areas of ulceration with dense
diffuse mononuclear cells infiltration,
replaced by granulation tissue. Section
through stalk showed fibroconnective
tissue with mononuclear cell infiltration.
Final histopathological diagnosis of
condyloma acuminata was given and
patient is on regular follow up.

Discussion:
Condyloma acuminata was a well known
disease in ancient Roman and Hellenic
ages. Condyloma comes from the Greek
“round tumor” and acuminata is from the
Latin for “sharp points”. Both the term use
for description as condyloma looks like a
round skin tumor, but up close the surface
of most is irregular and multiple
projections of wart tissue[2] .Celsus was
probably the first to derive that both
common and plantar warts shared an
etiology with genital warts[3] .The
infectious cause of condyloma acuminata
was demonstrated in 1917 by the
experimental transmission of the disease
from penile condyloma tissue4.Topical
podophyllin was first reported to be
effective in 1942 by Kaplan[5].

observed in our case. The main

differential diagnosis of the
The wart is an epidermal tumor caused by HPV, one of the condyloma acuminata are
papavovirus family. The lower genital tract tends to be infected squamous papilloma and verruca
with types 6,11,16,18 and 32; and the external anogenital skin is vulagaris[6].Condyloma acuminata
usually infected with types 6 and 11[2]. HPV is readily transmitted presents as a benign proliferation
during genital-genital contact, and moisture and abrasion of the of acanthotic stratified squamous
epithelial surface probably enhance transmission[2]. Transmission epithelium with mildly keratotic
by fomites such as towels or toilet seats is believed to be possible papular or nodular surface
but extremely infrequent because it is rarely seen in nonsexually projections. Thin connective
active people and children[2]. tissue core support the papillary
epithelial projections. These
In our case, 60 year old male presented with large, cauliflower papillary projections are more
grey-black finger like projection warty mass over thigh since long blunted and broad than those of
duration; in the absence of genital lesions. Our patient belongs to squamous papilloma and verruca
lower socio-economic group and farmer with lack of standard of vulagaris[6]. The appearance of
living. Transmission by fomites may be possible in such instances. keratin filled crypts between
prominences, koilocytic change
Classic condyloma acuminata are the most frequent form of genital (superficial keratocytes
warts2.They are soft, flesh colored with irregular surface and are 2- containing pyknotic nuclei and
5mm in diameter. Papular warts are multiple and condyloma on clear zones), are the classical
skin give rise to cauliflower like mass due to coalesce of fairly soft, microscopic features of HPV
verrucous papule as per Xu Xiaowei et al.[1] Such features were infection or condyloma

764
 ISSN NO- 2230 – 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

Nikumbh DB et al. J Pharm Biomed Sci. 2013, April; 29 (29): 762-765.

Available at jpbms.info

acuminata. Condyloma is treated with conservative surgical

excision, topical application of podophyllin 5-flurouracil or
Submit your next
cryosurgery with liquid nitrogen[2]. Condyloma acuminata occur
manuscript to:-
other than anogenital regions is a rare clinical entity. Only oral
cavity[6], breast[7] and skin were the site reported by authors.

To the best of our knowledge, Condyloma acuminata of the thigh Journal of

was reported only by Sardesai VR et al.[8] and Bedi TR[9] in 2009 Pharmaceutical and
and 1975 respectively. We report this third case of condyloma Biomedical Sciences
acuminata of the thigh in a 60 year male in absence of genital (JPBMS)
lesions. We are presenting this case due to its rarity, unusual gross
and cytohistopathological features.
An international
References: member journal of
1.Xu Xiaowei, Erickson LA, Elder DE. Diseases caused by viruses. In: Elder EV, Elenitsas COPE, World Health
R, Johnson BL, Mhrphy GF(ed). Lever’s Histopathology of skin. Indian ed, Lippincot organization (WHO)-
Willims and Wilkins Pub. 2005:667-8. HINARI Access and JDP
2.Dyment PG .Human Papilloma infection. Reprint from Adolescent Medicine ; state of and take benefit of:
heart review.1996;7(1):Philadelphia.
3.Bafverstedt B: Condyloma acuminata-Past and present. Acta Derm Venerol.
1967;47:376-81.
4.Oriel JD: Natural history of Genital warts. Br J Vener Dis. 1971; 47; 1-3. • Convenient online
5.Kaplan I: Condyloma acuminata. New Orleans Med Surg J. 1942; 94; 388-90. submission with
6.Zent S, Tomich CE, Oral condyloma acuminata. J Dermotol Surg Oncol.b 1989;15;591- persistent Authors
4.
7.Zhao L, Fang F, Carey F, Wary QQ. A case of condyloma acuminata with giantand support
multiple lesions on the vulva and breast: successfully treated with surgical operation. • Thorough peer
Int J STD AIDS.2004;15(3):194-201. review.
8.Sardesai VR, Agarwal V, Manvatkar PP, Ghorphade MB. Giant condyloma acuminate
with sprigocystoadenoma papilliform. Indian J Dermatol Venerol leprol.2009;75:330.
9.Bedi TR, Pandhi RK, Bhutani LK. Condyloma acuminata of the thigh. Indian Jr of • High visibility and
Dermatology Venerology and leprosy.1975;41(4):144-5. citation of article
with readers
/authors across the
Conflict of interest: - Author has not declared any conflict of interest. boundaries.

• Immediate
Source of funding: - None publication on
acceptance.
• Inclusion in
*Correspondence address:
COPE,HINARI Access
Dr DHIRAJ B. NIKUMBH MD., (WHO) JDP, CAS,
Associate Professor, DOAJ, NLM catalog,
Department of Pathology, JMF’s ACPM MEDICAL COLLEGE, Google Scholar and
Dhule, Maharashtra, India.
many more

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