Rowell's syndrome with Condyloma acuminatum: A case report

Rowell's syndrome is an autoimmune disease characterized by lupus erythematosus, erythema multiforme skin lesions, and speckled antinuclear antibody. We report the case of a woman who presented with erythema multiforme with target-type skin lesions and vulvar vegetation who fulfilled the criteria for Rowell's syndrome and condyloma acuminatum. The simultaneous occurrence of both conditions has rarely been reported in the literature.

Effect of topical 5-aminolevulinic acid-mediated photodynamic therapy combined with CO2 laser pretreatment for vaginal condyloma acuminate

BACKGROUND

Condyloma acuminatum (CA) of the vagina is a sexually transmitted disease due to infection by human papilloma virus (HPV). The treatment efficacy of the conventional methods for vaginal CA is often unsatisfactory with a high recurrence rate. Topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) combined with CO2 laser pretreatment is a feasible approach for vaginal CA, but the effectiveness and safety need further evaluation.

METHODS

This study enrolled 15 patients with vaginal CA. All patients underwent CO2 laser ablation and then ALA-PDT for two or three cycles. The clinical efficacy and side effects were evaluated and analyzed during the treatment and 6 months after the treatment.

RESULTS

The wart lesions in 4 cases (26.7 %) disappeared after the first treatment. The wart lesions in 5 cases (33.3 %) disappeared after the second treatment. And 6 cases (40 %) needed three treatment cycles before the lesions disappeared completely. The complete response (CR) rate was 93.3 % (14/15) at 2 weeks after three treatment cycles. There were 5 cases (83.3 %) which have complete remission after 2 treatments in warts diameter <1 cm group. There were only 4 cases (44.4 %) which have complete remission after 2 treatments in diameter>1 cm group. All patients had CR without reoccurrence at 6 months after treatment. The side effects mainly included a mild or moderate burning or stinging sensation (26.7 %). There were no infection, ulcers and scars after treatment.

CONCLUSION

Topical 5-aminolevulinic acid-mediated photodynamic therapy combined with CO2 laser pretreatment is a safe and effective treatment for vaginal CA.

Successful application of aminolevulinic acid/photodynamic therapy in the treatment of giant condyloma acuminatum in an 87-year-old patient

Condyloma acuminatum is a common sexually transmitted disease caused by human papillomavirus infection and is a benign hyperplastic lesion of the genital and perianal areas. The principle of its treatment is to remove the visible warts as much as possible and to prevent recurrence. Traditional treatment methods of condyloma acuminatum, such as CO2 laser, liquid nitrogen freezing, surgery, and topical medications, can remove warts. However, these methods have disadvantages such as pain, high recurrence rates, long treatment cycles, and scarring. Aminolevulinic acid/photodynamic therapy (ALA-PDT), a safe and effective method, has been widely used to treat condyloma acuminatum in recent years. Condyloma acuminatum occurs relatively rarely in elderly patients, in whom treatment is difficult owing to poorer physiological function. We successfully treated an 87-year-old patient with a giant condyloma acuminatum of the glans penis using six sessions of ALA-PDT at 7-day intervals and obtained satisfactory results. No recurrence was observed during a 6-month follow-up. Therefore, ALA-PDT is worth popularizing in clinical practice.

Ultrasonic scalpel associated with photodynamic therapy in the treatment of refractory vulvar condyloma acuminatum

This is a case report of a patient with vulvar condyloma acuminatum associated with hyperkeratosis and folliculitis, which had been refractory to two previous therapies. The patient had been successfully treated using a combination of promising techniques: the ultrasonic scalpel and MAL photodynamic therapy.

Efficacy and safety of Chinese patent medicine paiteling in condyloma acuminatum: A systematic review and meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Condyloma acuminatum (CA) is a common sexually transmitted disease. Previous studies using randomized controlled trials (RCTs) have revealed that Paiteling (PTL), a Chinese patent medicine formula, can effectively relieve CA symptoms. However, the evidence needs to be more cohesive and there is a need for a clear summary of the existing RCTs to assess the overall efficacy and safety profile of PTL.

AIMS OF THE STUDY

This study aimed to conduct a comprehensive review and meta-analysis of RCTs, to examine the efficacy of PTL and physical therapies in CA.

MATERIAL AND METHODS

A literature search was conducted in multiple databases, including PubMed, MEDLINE, Cochrane Library, etc. up to December 1, 2022. Revman 5.4 and Stata 15.0 was used for data statistics and sensitivity analyses.

RESULTS

31 trials with a total of 2868 patients were included in this review. The results showed that PTL plus physical therapies were significantly more effective than physical therapies used alone (RR = 1.60, 95% CI [1.38, 1.86]; P < 0.00001). Subgroup analysis showed that the type of physical therapies, gender, and wart location might be the primary sources of heterogeneity. Additionally, PTL can reduce recurrence rates (RR = 0.27, 95% CI [0.19, 0.39]; P < 0.00001), improve the negative conversion rate of HPV (RR = 1.15, 95% CI [1.02, 1.30]; P = 0.02), and improve immune function. No severe adverse reactions or physical injuries were observed, making it a better choice for women planning to become pregnant.

CONCLUSION

Compared with physical therapies, PTL can effectively eliminate CA symptoms and reduce the recurrence rates with safety ensured. However, due to the heterogeneity and methodological shortcomings, large sample sizes and high-quality rigorous RTCs are still needed to strengthen this clinical evidence.

The expression and significance of PD-L1 in condyloma acuminatum

BACKGROUND

It has been reported that programmed death-ligand 1 (PD-L1) is highly expressed in cells during viral infection, which helps the virus escape host immunity. However, the relationship between human papillomavirus (HPV) and PD-L1 in condyloma acuminatum and whether they participate in immunosuppression have not been reported. In this paper, we aimed to explore the expression and significance of PD-L1 in condyloma acuminatum.

METHODS

The expression of PD-L1 in the wart of condyloma acuminatum patients and the foreskin of healthy individuals was evaluated. Lentivirus transfection was used to introduce the HPV11-E7 gene into HaCaT cells to investigate whether HPV infection could affect the expression of PD-L1. The successfully constructed HPV11-E7 HaCaT cells were cocultured with Jurkat cells, and Jurkat cell apoptosis and proliferation as well as the Jurkat cell cycle were evaluated by flow cytometry and cell counting kit-8 (CCK-8) assays.

RESULTS

PD-L1 was highly expressed in keratinocytes of genital warts. Through the construction of a cell model, we found that HPV11-E7 could upregulate the expression of PD-L1 in HaCaT cells. Furthermore, HPV11-E7 HaCaT cells can promote the apoptosis of Jurkat cells, inhibit the proliferation of Jurkat cells and mediate the cell cycle arrest of Jurkat cells through the PD-1/PD-L1 signalling pathway.

CONCLUSIONS

HPV infection may upregulate PD-L1 expression in the keratinocytes of genital warts and participate in the inhibition of local T-cell function.

Epidemiology of human papillomavirus on condyloma acuminatum in Shandong Province，China

Condyloma acuminatum (CA) is a sexually transmitted disease (STD) caused by human papillomavirus (HPV) infection. It is important to study the prevalence and distribution of HPV genotypes before implementing the HPV vaccination program. Therefore, the aim of this study was to evaluate the epidemiological characteristics of CA cases and the distribution of HPV genotypes in Shandong Province, China. One-to-one questionnaire surveys were conducted on all patients diagnosed with CA in sentinel hospitals from Shandong Province, China. HPV genotypes were determined using the polymerase chain reaction (PCR)-reverse dot blot hybridization method. The study enrolled 1185 patients (870 males and 315 females) and found that CA patients are mainly males and sexually active people between the ages of 20 and 40. Recurrence occurred in 34.7% patients. Among the 880 CA patients who underwent HPV typing, the HPV test positivity rate was 91.4%. In these cases, low-risk (LR) HPV infection was predominant, with an infection rate of 91.3%, while high-risk (HR) HPV genotypes were found in 53.5% patients. The most frequent HPV genotypes encountered were HPV6 (57.8%), HPV11 (37.2%), HPV16 (13.7%), and HPV42 (10.3%). HPV6 and/or HPV11 are the main infections in all patients, and more than half of the patients are coinfected with HR-HPV. However, unlike other regions, HPV42 has a higher prevalence rate among CA patients in Shandong Province and is a nonvaccine HPV genotype. Therefore, regular HPV typing helps to understand the characteristics of specific genotypes and the choice of the best type for vaccine coverage.

Mechanisms of action of Fu Fang Gang Liu liquid in treating condyloma acuminatum by network pharmacology and experimental validation

BACKGROUND

Condyloma acuminatum (CA) is a sexually transmitted disease characterized by the anomalous proliferation of keratinocytes caused by human papillomavirus (HPV) infection. Fu Fang Gang Liu liquid (FFGL) is an effective externally administered prescription used to treat CA; however, its molecular mechanism remains unclear. This study aimed to identify and experimentally validate the major active ingredients and prospective targets of FFGL.

METHODS

Network pharmacology, transcriptomics, and enrichment analysis were used to identify the active ingredients and prospective targets of FFGL, which were confirmed through subsequent experimental validation using mass spectrometry, molecular docking, western blotting, and in vitro assays.

RESULTS

The network pharmacology analysis revealed that FFGL contains a total of 78 active compounds, which led to the screening of 610 compound-related targets. Among them, 59 overlapped with CA targets and were considered to be targets with potential therapeutic effects. The protein-protein interaction network analysis revealed that protein kinase B (Akt) serine/threonine kinase 1 was a potential therapeutic target. To further confirm this result, we performed ribonucleic acid sequencing (RNA-seq) assays on HPV 18⁺ cells after FFGL exposure and conducted enrichment analyses on the differentially expressed genes that were screened. The enrichment analysis results indicated that the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) pathway may be a key pathway through which FFGL exerts its effects. Further in vitro experiments revealed that FFGL significantly inhibited the activity of HPV 18⁺ cells and reduced PI3K and Akt protein levels. A rescue experiment indicated that the reduction in cell viability induced by FFGL was partially restored after the administration of activators of the PI3K/Akt pathway. We further screened two active components of FFCL that may be efficacious in the treatment of CA: periplogenin and periplocymarin. The molecular docking experiments showed that these two compounds exhibited good binding activity to Akt1.

CONCLUSION

FFGL reduced HPV 18⁺ cell viability by inhibiting key proteins in the PI3K/Akt pathway; this pathway may represent an essential mechanism through which FFGL treats CA. Periplogenin and periplocymarin may play a significant role in this process.

ALA-PDT combined with oral acitretin in the treatment of refractory condyloma acuminatum in anal canal

BACKGROUND

Condyloma acuminatum (CA) of the anal canal is difficult to treat and subject to relapse.. We investigated the effects of aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with oral acitretin during therapy of refractory CA in the anal canal. We also conducted a clinical retrospective study for the treatment of intra-anal CA.

METHODS

A total of 101 patients diagnosed with intra-anal CA were enrolled. All patients underwent liquid nitrogen cryotherapy as a basic treatment until visible wart clearance. Patients were divided into two groups depending on the treatment modality after cryotherapy. ALA-PDT group with 51 patients was given ALA-PDT treatment, and ALA-PDT plus acitretin group with 50 patients was given ALA-PDT treatment combined with oral acitretin. The cure rate, recurrence rate, and adverse reactions of the two groups were analyzed and recorded.

RESULTS

The cure rate in the ALA-PDT plus acitretin group was 94% (47/50), which was significantly higher than 80.4% (41/51) in ALA-PDT group. The recurrence rate in the ALA-PDT plus acitretin group was 6% (3/50), which was lower than 19.6% (10/51) in ALA-PDT group (P<0.05).

CONCLUSION

ALA-PDT combined with oral acitretin is effective and safe in the treatment of refractory CA in anal canal, and with further study may become an option for these patients.

Squamous Cell Carcinoma Arising from Perianal Buschke-Lowenstein Tumor (Giant Condyloma Acuminatum): Comprehensive Literature Review

PURPOSE

This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum.

METHODS

We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020.

RESULTS

A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2).

CONCLUSION

Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.

Condyloma acuminatum of the urinary bladder with underlying squamous cell carcinoma: a case report

BACKGROUND

Condyloma acuminatum is a rare finding of the urinary bladder. There are many morphological variants that exist. It has been previously reported that some of these variants were found to be associated with subsequent or concurrent squamous cell carcinoma. However, there are limited cases that describe this underlying malignancy found in patients with bladder condyloma.

CASE PRESENTATION

A 38-year-old African American female presented with condyloma acuminatum of the urinary bladder and underlying squamous cell carcinoma, which also invaded the neighboring uterus, urethra, and anterior vagina. Initial attempts at treatment began with cystoscopic resection of the condyloma; however, due to diffuse transformation, we pursued radical cystectomy with adjuvant chemotherapy and radiation.

CONCLUSION

As such a finding is rare in the urinary bladder, with few reports discussing its association with ensuing squamous cell carcinoma, we hope that this continues to generate awareness and consideration in the treatment of affected individuals.

Condyloma acuminatum of the urinary tract demonstrates atypical squamous cells in urine cytology

Urine cytology of urinary tract condylomas has not been systematically studied. We analyzed cytologic features of urinary tract condylomas and evaluated potential diagnostic challenges and pitfalls. We retrospectively reviewed urine cytology of urinary tract condylomas from 2 academic institutions (2015-2022). Among 20 patients with urinary tract condylomas, 6 had urine cytology (2 samples in 1 patient), including 3 men and 3 women (mean age, 74.3 years; range, 65-86 years). Original interpretations were negative for high-grade urothelial carcinoma (NHGUC; n = 4), atypical urothelial cells (n = 1), reactive urothelial cells (n = 1), and negative for malignancy (n = 1). Squamous cells were noted in 3 cases, atypical squamous cells (ASC) consistent with low-grade squamous intraepithelial lesion (LSIL) were noted in 1 case, and in 3 cases, the presence of squamous cells was not mentioned. All urines were reclassified according to The Paris System as NHGUC. Specimens were composed of benign urothelial cells and groups or isolated ASC consistent with LSIL (n = 4), atypical keratinized squamous cells (n = 2), and ASC that did not meet LSIL criteria (n = 1). The LSIL cells showed nuclear enlargement (n = 4), hyperchromasia (n = 4), perinuclear halo (n = 3), nuclear membrane irregularity (n = 4), orangeophilic cytoplasm (n = 3), and binucleation (n = 4). The atypical keratinized squamous cells showed hyperchromasia (n = 2), nuclear membrane irregularity (n = 2), keratin pearls (n = 2), and binucleation (n = 1). The ASC that did not meet LSIL criteria showed nuclear enlargement and orangeophilic cytoplasm. Many urinary tract condylomas (57%) demonstrate classic LSIL features in urine cytology. Less frequent cases can mimic keratinizing squamous cell carcinoma (28%) or demonstrate ASC not diagnostic of LSIL (15%).

Human papillomavirus vaccines effectiveness to prevent genital warts: A population-based study using health system integrated databases, 2009-2017

OBJECTIVES

To assess the effectiveness of the HPV vaccines in preventing genital warts (GW) in women aged 14-23 years and to estimate the incidence of GW in the whole population aged from 14 to 65.

DESIGN

Population-based retrospective cohort study using real-world data from the Valencia health system Integrated Databases (VID).

STUDY POPULATION

All subjects aged 14-65 years residing in the Valencia Region during 2009-2017 (n = 4,492,724), including a cohort of 563,240 females aged 14-23 years followed-up for the vaccine effectiveness (VE) estimations.

MAIN OUTCOME MEASURES

Incident cases of GW defined as the first activation of GW-related codes (ICD-9-CM 078.11 or ICD-10-CM A63.0) in hospital, primary and specialized care during the study period. Adjusted VE was estimated as (1-Relative Risk (RR)) × 100 by a negative binomial Bayesian model.

RESULTS

There were 23,049 cases of GW in the overall population and 2,565 in the females' cohort 14-23 years old. The incidence rate (IR) (in 100,000 persons-year) was 69.1 (95% CI 68.21-69.99) in the population overall, being higher in men (72.73; 95% CI 71.45-74.04). The IR of GW was 104.08 (95% CI 100.79-108.94) in the cohort of young women. The RR of GW increased with age from 14 to 21 years, reaching a plateau from 21 to 23. The VE of a complete schedule was 74% (95% CrI 68-79) for quadrivalent HPV vaccine (HPV4v). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine (HPV2v) in girls up to 21 years old. GW IR tends to be higher in unvaccinated cohorts covered by HPV4v vaccine than in unvaccinated cohorts not covered by HPV4v vaccine.

CONCLUSIONS

A complete HPV4v vaccination schedule was 74% effective in reducing GW in our population. Our results also suggest an indirect protection to unvaccinated and HPV2v vaccinated girls.

Healthcare resource utilization and costs associated with anogenital warts in Morocco

Background

Human papillomavirus (HPV), primarily genotypes 6 and 11, cause the majority of cases of anogenital warts (AGW). Although benign, AGW are associated with a substantial economic and psychosocial burden. Several vaccines have been developed to prevent HPV. The objective of this study was to describe the epidemiology and healthcare resource utilization of AGW in Morocco, as well as the associated costs of treatment from the public healthcare perspective.

Methods

This was a descriptive analysis of questionnaire data obtained via a Delphi panel. The panel consisted of 9 physicians practicing in public hospitals in Morocco (4 dermatologists and 5 obstetricians/gynecologists). The questionnaire collected data on physician and practice characteristics, diagnostic tests and procedures, treatments, and follow-up (including recurrence) of patients with AGW. Questionnaire items on which ≥ 70% of respondents agreed were considered as having consensus. Costs associated with diagnosis, treatment, and follow-up were calculated in Moroccan dirham (MAD) and converted to euros (€) based on official national price lists for public hospitals and the HCRU estimates from the questionnaire.

Results

The physician-estimated prevalence of AGW in Morocco was 1.6%-2.6% in women and 2.0%-5.3% in men. A mean (median) of 6.4 (4) patients per month per physician sought medical attention for AGW. Simple observation was the most common diagnostic method for AGW in both men and women, and excision was the most prescribed therapy (75%), requiring a mean of 2 visits. Recurrence occurred in approximately 27% of patients. The cost per case of managing AGW, including recurrence, was estimated at 2182–2872 MAD (€207–272) for women and 2170–2450 MAD (€206–233) for men. The total annual cost of medical consultations for AGW in Morocco ranged from 3,271,877 MAD to 4,253,703 MAD (€310,828–404,102).

Conclusions

Expert consensus indicates that AGW represent a significant burden to the Moroccan public healthcare system. These data can inform policy makers regarding this vaccine-preventable disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13027-021-00403-1.

Utility of GATA-3 and Cytokeratin 5/6 Immunostains in Separating Condyloma Acuminatum Arising in the Urinary Tract From Non-Invasive Papillary Urothelial Carcinoma

Background Condyloma acuminatum is a squamous epithelial lesion which uncommonly involves the urinary tract. In this location, non-invasive papillary urothelial carcinoma constitutes one of the main differential diagnoses with significant prognostic and therapeutic implications. To date, no ancillary immunohistochemical stain has been described to differentiate these two entities. We assess the utility of cytokeratin 5/6 (CK5/6) and GATA-3 immunohistochemistry in distinguishing condyloma acuminatum from non-invasive papillary urothelial carcinoma. Design We reviewed 9 condylomata acuminata involving the urinary tract, 12 low-grade and 8 high-grade non-invasive papillary urothelial carcinomas. CK5/6 immunostaining was performed in all cases. GATA-3 immunostaining and low-risk human papilloma virus (HPV) chromogenic in situ hybridization was performed in all condyloma cases and 2 urothelial carcinomas with squamous differentiation. Results 8/9 condylomata acuminata were positive for low-risk HPV. All condylomata acuminata exhibited strong full-thickness cytoplasmic staining for CK5/6. In 10 of 12 low-grade non-invasive papillary urothelial carcinomas, CK5/6 expression was continuous and limited to the basal cell layer, while it was patchy and limited to the basal cell layer in all 8 high-grade non-invasive papillary urothelial carcinomas. Two low-grade non-invasive papillary urothelial carcinomas showed focal full-thickness CK5/6 expression in the areas of squamous differentiation. These 2 cases were negative for low-risk HPV. GATA-3 immunostaining was positive in all condylomata acuminata. Conclusions CK5/6 immunostaining is a useful and simple tool that can help separate low-grade and high-grade non-invasive papillary urothelial carcinomas from condyloma acuminatum involving the urothelium-lined organs. GATA-3 has no discriminatory role between condyloma acuminatum and papillary urothelial carcinomas.

Multiple-type HPV infection predicting condyloma acuminatum recurrence after aminolevulinic acid photodynamic therapy

BACKGROUND

Aminolevulinic acid photodynamic therapy (ALA-PDT) has been widely used in the treatment of condyloma acuminatum (CA), but there is a lack of reports on clinical factors related to CA relapse after photodynamic therapy.

METHODS

The clinical data of patients with CA treated with ALA-PDT from April 2018 to December 2019 were retrospectively analyzed, including HPV type, follow-up time and recurrence within 6 months after treatment. The patients were classified into single-type HPV infection and multiple-type HPV infection groups. Besides, the patients were also classified into high-risk HPV infection, low-risk HPV infection, and low + high-risk HPV infection groups. Univariate and multivariate COX regression was performed to analyze whether HPV type was related with CA relapse after photodynamic therapy.

RESULTS

A total of 161 CA patients who underwent ALA-PDT were analyzed in this study. CA recurred in 20 patients within 6 months after treatment, with a recurrence rate of 12.4%. Of them, the patients with multiple-type HPV infection made up 85%. Multivariate COX regression analysis revealed that multiple-type HPV infection was associated with CA recurrence (HR:5.0; 95% CI: 1.1-21.4; P = 0.032). Of the patients with CA recurrence, 70% developed low + high-risk infections, a proportion significantly higher than that in patients without CA relapse (16.3%, P < 0.001). Using low-risk infection as a reference, low + high-risk infection was positively correlated with postoperative recurrence (HR: 6.7; 95% CI: 1.6-26.2; P = 0.006).

CONCLUSION

Multiple-type HPV infection were closely associated with CA recurrence after photodynamic therapy.

Dermoscopic findings of genital keratotic lesions: Bowenoid papulosis, seborrheic keratosis, and condyloma acuminatum

Dermatologists often encounter keratotic or warty lesions in the genital area. Establishing a clear diagnosis may seem challenging, particularly when the differential diagnosis includes bowenoid papulosis, seborrheic keratosis, and condyloma acuminatum. This study aimed to compare the dermoscopic features of bowenoid papulosis (BP), seborrheic keratosis, and condyloma acuminatum in the genital area. All lesions histopathologically confirmed underwent clinical assessment and dermoscopic observation. Dermoscopically, glomerular vessels were predominant in bowenoid papulosis, whereas seborrheic keratosis was the least vascular-patterned disease. Most cases of bowenoid papulosis presented mucosal pigmentation and classified as "flat". Seborrheic keratosis had a pigmented, cerebriform appearance. Condyloma acuminatum was characterised by a finger-like appearance, highly vascular-patterned features surrounded by whitish halos. Dermoscopic findings can be useful for differentiating the entity of genital keratotic lesions ahead of an invasive method. When dermoscopic features favor BP, different from genital warts, it should be removed completely but conservatively.

Oral condyloma acuminatum with changes in excretory duct of minor salivary gland: An unusual case report and review of literature

Condyloma acuminatum (CA) is human papilloma virus-induced disease, rarely involving oral cavity, usually sexually transmitted and frequently occurs in anogenital areas. Oral lesions are being present predominantly on the tongue, lip mucosa, buccal mucosa, palate and floor of the mouth. The disease is more common in teenagers and appears as solitary or multiple, sessile or pedunculated masses. Here, we report the unique case of CA on the lower lip in a 45-year-old man, showing changes in the excretory duct of the minor salivary gland, which is relatively unusual.

Long-term relapse-free treatment with endoscopic submucosal dissection combined with magnifying narrow-band imaging for a pregnant patient with flat-type condyloma acuminatum: a case report

Condyloma acuminatum, in the form of genital warts, usually results from an infection by human papillomavirus, one of the most common causes of sexually transmitted diseases. It develops after an incubation period of 3 weeks to 8 months after infection; flat lesions are significantly rare. Condyloma acuminatum is prevalent in the genitals, particularly in the anus of immunodeficient patients. This also occurs in women during menstrual period and pregnancy. Although a common treatment option for rectal and anal lesions, surgical resection is highly invasive and results in a high rate of recurrence. Recently, endoscopic submucosal dissection has been performed for anorectal lesions, but data on its long-term follow-up are not available. We report the case of an immunocompromised patient due to pregnancy who remained recurrence-free 27 months after en-bloc resection by endoscopic submucosal dissection, with adequate visualisation of the flat lesion's safety margin, combined with magnifying narrow-band imaging.

Successful treatment with ALA-PDT of Refractory condyloma acuminatum of the whole anterior urethra

Condyloma acuminatum is a sexually transmitted disease caused by human papillomavirus infection, which mostly occurs in the external genitalia, vulva, perianal, and the Intraurethral condyloma acuminatum is relatively rare. Treatment of urethral warts present a challenge especially if the proximal urethra is involved. Here, we report a case of intractable urethral condyloma acuminatum involving the urethral meatus and mid penile urethra with scar. This case suggested that local Photodynamic therapy in condyloma of the whole anterior urethra appears to be not only safe and effective, but also might be able to improve existing scars.

Pan-urethral condylomata acuminata - A primary treatment recommendation based on our experience

We present a case of a 28 year old man presenting with obstructive urinary tract symptoms and cystoscopic findings of pan-urethral, occlusive condylomata acuminata (urethral genital warts). We describe the in rooms administration process of 5-fluorouracil over an 8 week period with follow up cystoscopy results. Urine flow rates improved early in the treatment course from a maximum flow of 7ml/s to 19ml/s and a post void residual improvement from 311ml to 160ml. Significant volume reduction of the warts was achieved allowing for limited treatment with cold excision to minimise urethral stricture risk in a young man.

Lymphoid Papillary Hyperplasia Arising from the Upper Portion of the Left Palatine Tonsil: A Case Report and Literature Review

Lymphoid papillary hyperplasia of the tonsils is a rare, benign lesion and is characterized by a papillomatous appearance with reactive follicular hyperplasia. Our case was unique because the lesion involved the unilateral and focal palatine tonsil, as the lesion usually involves the bilateral and entire palatine tonsils.

Correlation of interleukin-18 gene polymorphism with the susceptibility of condyloma acuminatum in Chinese population

Host immunogenetic setting is involved in the regulation of human papillomavirus (HPV) infection and development of condyloma acuminatum (CA). We investigated the correlation of two common single nucleotide polymorphisms (SNPs) (−607C/A and −137G/C) of IL-18 with the susceptibility of CA in a large Chinese cohort. Out of 408 CA patients analyzed, 300 had HPV infection transmitted through sexual contact (SC) and 108 through non-sexual contact (NSC). In addition, 360 healthy volunteers were enrolled as controls. SNPs at positions −607C/A and −137G/C in IL-18 promoter were analyzed. Comparing CA patients to healthy controls, no dominant relevance was found between the IL-18 promoter −607 C/A or −137G/C polymorphisms and the CA disease either identified genotypically (p > 0.05) or by allelically (p > 0.05). However, the IL-18 promoter −137G/C polymorphism genotype and allele frequencies in the NSC CA group, but not between in the SC group, were significantly higher than in the controls. There was no dominant relevance between IL-18-607C/A polymorphism genotype and allele frequencies among SC, NSC CA patients, and controls. Our study demonstrates that polymorphism −137G/C in IL-18 promoter is significantly correlated with risk of CA in NSC patients.

HPV infection in urology practice

Human papillomavirus (HPV) is the most common pathogen of sexually transmitted disease worldwide. While HPV is responsible for low-grade benign lesions in the anogenital area such as condyloma acuminatum, it is also strongly associated with cervical, anal, vulvar/vaginal, and penile carcinomas. In addition to being an oncogenic virus, HPV causes a substantial socioeconomic burden due to the recurrence of benign lesions, the lack of a definitive treatment option that provides a complete cure, and the high cost of treatment. The global incidence of HPV infection is rising, especially among young and sexually active individuals; as a result, in recent years these infections have also become increasingly conspicuous in urology practice, both as incidental findings and primary complaints. The aim of this review is to evaluate the pathogenesis, diagnosis, and treatment modalities of HPV infections in light of the current literature from the urologist's perspective.

Yes-Associated Protein Promotes the Development of Condyloma Acuminatum through EGFR Pathway Activation

OBJECTIVE

Investigate the role of Yes-associated protein (YAP1) in the development of condyloma acuminatum (CA).

METHODS

We enrolled 30 male patients with CA and 20 healthy individuals as a control group, to compare the YAP1 expression in their tissue samples. Following this, we overexpressed and downregulated YAP1 expression in HaCaT cells to examine the migratory, proliferative, and apoptotic potential of HaCaT cells expressing different levels of YAP1.

RESULTS

In the CA patient tissue samples, an increase in YAP1 expression can be observed. In vitro,the overexpression of YAP1 was shown to promote the growth and migration of HaCaT cells and to activate epidermal growth factor receptor (EGFR) pathway-associated proteins, while the downregulation of YAP1 inhibited cell growth and migration of these cells.

CONCLUSIONS

YAP1 promotes the growth of keratinocytes in CA through the activation of the EGFR pathway, and it may mediate the development of human papilloma virus-associated diseases.

A pregnant woman with condyloma acuminatum on the vaginal orifice, areola, groin, and umbilicus

Condyloma acuminatum (CA) is a benign tumor primarily caused by infection with human papillomavirus (HPV) type-6 or type-11, lesions of which are most frequently found on the genital, perianal squamous mucosa, and skin. CA outside the anogenital region is not common. Here, we report a case showing simultaneous presence of CA on the vaginal orifice, areola, groin, and umbilicus in a 32-year-old pregnant woman. Histopathological examination and HPV detection are essential in making a definitive diagnosis of CA on multiple sites. The patient was treated with microwave and liquid nitrogen cryotherapy, but repeated relapse of the lesions were observed. Patients with CA during pregnancy represent a special risk group. These cases are usually characterized by fast-growing warts, multi-site or special site warts, a reduced tolerance, and poor response to treatment. Hence, we should pay more attention to CA in pregnant women in the process of diagnosis and treatment, especially cases outside the anogenital region.

Effect of 5-aminolevulinic acid photodynamic therapy on the expression of apoptosis inhibitors Bcl-2 and Survivin in keratinocytes of condyloma acuminatum

BACKGROUND

Condyloma acuminatum is a highly infectious disease caused by the human papillomavirus. Previous studies have shown that 5-aminolevulinic acid photodynamic therapy can inhibit proliferation of condyloma acuminatum keratinocytes. However, the effect of 5-aminolevulinic acid photodynamic therapy on condyloma acuminatum tissues has not been systematically studied. Here, we investigated possible molecular mechanisms of 5-aminolevulinic acid photodynamic therapy in the treatment of condyloma acuminatum and its effect on the expression of apoptosis inhibitors Bcl-2 and Survivin.

METHODS

Immunohistochemistry streptavidin-peroxidase was used to detect the expression of apoptosis inhibitors Bcl-2 and Survivin in condyloma acuminatum keratinocytes before and after the therapy.

RESULTS

The positive expression rates of Bcl-2 and Survivin in condyloma acuminatum keratinocytes before treatment were 87.50% (42/48) and 79.16% (38/48), respectively. The positive expression rates of Bcl-2 and Survivin in condyloma acuminatum keratinocytes after treatment were 37.50% (18/48) and 41.67% (20/48), respectively. The positive expression intensity of Bcl-2 and Survivin in condyloma acuminatum keratinocytes before 5-aminolevulinic acid photodynamic therapy was mostly ++ to +++, and that after treatment was mostly - to +. There were statistically significant differences in the positive expression rate and the expression intensity of Bcl-2 and Survivin in the two groups before and after 5-aminolevulinic acid photodynamic therapy (P <  0.001). There was a positive correlation between the expression of Bcl-2 and Survivin in condyloma acuminatum tissues after 5-aminolevulinic acid photodynamic therapy (r = 0.480, P <  0.05).

CONCLUSION

5-aminolevulinic acid photodynamic therapy may promote apoptosis of condyloma acuminatum cells by reducing the expression of Bcl-2 and Survivin, suggesting that this is potentially one of the molecular mechanisms of 5-aminolevulinic acid photodynamic therapy in the treatment of condyloma acuminatum.

Comparative analysis of human papillomavirus type 6 complete genomes originated from head and neck and anogenital disorders

It is increasingly recognized that fundamental differences exist between high-risk and low-risk human papillomavirus (HPV) genotypes regarding interactions with the host. This study aims to join the recently emerging efforts to uncover these differences at the complete genome level and to study how they may influence the disease caused. Sixteen samples of thirteen patients with various HPV6-mediated benign mucosal disorders (nine recurrent respiratory papillomatoses with 2-8 recurrences, one condyloma acuminatum and three premalignant lesions of the genital mucosa) were sampled to determine the complete virus genomes. We collected the 197 HPV6 complete genomes deposited in the GenBank for cluster analysis to determine (sub)lineages. Genome polymorphisms were determined against the reference sequences of the (sub)lineages. Genome polymorphisms of the long control region (LCR) were tested for putative transcription factor binding sites; their functional analysis was performed by transient transfection of cloned whole LCRs into HEp-2 cells using a luciferase reporter system. Genomes from the same patients were always identical. Three, nine and one patients carried HPV6 lineage A, sublineage B1 and B2 variants, respectively. The three lineage A sequences were highly similar to each other, but distinct from the reference genome. A unique non-synonymous single nucleotide polymorphism (SNP) was found in the E5a open reading frame (ORF). Sublineage B1 genomes were more diverse, exhibited unique non-synonymous SNPs in the LCR and the E2/E4, L1, L2 ORFs. LCR activity of lineage A and sublineage B1 differed significantly; activity of one sublineage B1 LCR exhibiting two unique SNPs was significantly higher than that of other B1 LCR variants, close to the mean of LCR activities of lineage A variants. Different HPV6 lineages showed marked differences in variability patterns of the different genome regions. This may be involved in the differences in their distribution in different diseases or patient populations.

Treatment of multi-position condyloma acuminatum using topical CO2 laser combined with photodynamic therapy - Report of 6 cases

BACKGROUND

Condyloma acuminatum(CA) is a venereal disease associated with a high rate of recurrence due to the rapid replication and subtle immune escape mechanism of Human Papillomavirus(HPV). Topical CO₂ laser can remove verruca accurately. Photodynamic therapy with 5-aminolevulinic acid(PDT-ALA) is also an effective therapy which targets on HPV infected sites. Some studies demonstrate that when combined with use of CO₂ lasers, photodynamic therapy can become more effective.

METHODS

We attempted to clinically cure a series of CA grown on cervix, urethra, urinary meatus, vulva, crissum and anal canal with treatment of topical CO₂ laser combined with ALA photodynamic therapy and report herein 6 cases.

RESULTS

Topical CO₂ laser combined photodynamic therapy for CA achieved a complete response after 3 courses of treatment. No recurrence was found after 6-month follow-up in 6 cases, and the HPV PCR detection for all was changed from positive to negative.

CONCLUSION

When it comes to CA treatment, the combination of photodynamic therapy and CO₂ laser usage can give full play to their own respective superiority, and the curative effect is more significant.

Squamous cell carcinoma of the anal canal

Anal squamous cell carcinoma (SCC) is a rare cancer and accounts for approximately 4% of all cancers of the lower alimentary tract. The dominant etiology is infection with human papilloma virus (HPV), which is the most common sexually transmitted disease in the United States. Integration of HPV DNA into the host genome seems to be the driving mechanism behind carcinogenesis. Vaccines directed against oncogenic HPV serotypes exist, and their utility for preventing anal neoplasia is under investigation. Additional risk factors for developing SCC include HIV infection, anal receptive intercourse, smoking, and immunosuppression. Patients with known anal intraepithelial neoplasia (AIN) must be carefully screened with periodic digital rectal exam and anoscopy. The most common presenting symptom is bleeding, with up to one third of patients presenting asymptomatic. Once tissue diagnosis is made, staging of primary tumor is accomplished with either MRI or transanal ultrasound. Distant disease is evaluated with CT of chest abdomen and pelvis vs whole body PET/CT. The gold standard treatment for stage I-III disease remains the Nigro protocol, first described in 1974. Stage I disease not involving sphincter may be treated with local excision. Distant disease is treated with systemic chemotherapy with radiation reserved for locoregional symptoms. Careful surveillance is mandatory after completion of chemoradiation. Salvage abdominoperineal resection can achieve locoregional control in up to 77% of patients with persistent or recurrent disease. Morbidity is high, mostly owing to wound complications, and as such a flap reconstruction of the perineum is warranted.

The role of regulatory T cells in pathogenesis and therapy of human papillomavirus-related diseases, especially in cancer

Human papillomavirus (HPV) is the most common sexually transmitted agent in the world. It can cause condyloma acuminatum, anogenital malignancies, and head and neck cancers. The host immune responses to HPV involve multiple cell types that have regulatory functions, and HPV-mediated changes to regulatory T cells (Tregs) in both the local lesion tissues and the circulatory system of patients have received considerable attention. The role of Tregs in HPV infections ranges from suppression of effector T cell (Teff) responses to protection of tissues from immune-mediated injury in different anatomic subsites. In this review, we explore the influence of Tregs in the immunopathology of HPV-related diseases and therapies targeting Tregs as novel approaches against HPV.

Development of a human papillomavirus type 6/11 vaccine candidate for the prevention of condyloma acuminatum

Condyloma acuminatum (CA) represents a significant human papillomavirus (HPV) disease burden worldwide, resulting in substantial healthcare costs and loss of life quality in both genders. To address this problem, we tried to develop a bivalent HPV6/11 virus-like particle (VLP) vaccine targeting CA. HPV6/11 VLPs were generated in Hansenula polymorpha, and a disassembly and reassembly (D/R) treatment was further conducted to improve the stability and monodispersity of the VLPs. The HPV6/11 VLPs were identified by transmission electron microscopy (TEM), high performance liquid chromatography (HPLC), mass spectrum (MS) and dynamic light scattering (DLS), and were evaluated for their immunogenicity in both mice and cynomolgus monkeys. The results showed that the HPV6/11 L1 proteins were correctly expressed and assembled into HPV6/11 VLPs, and the HPV6/11 VLPs formulated with aluminum phosphate induced vigorous production of specific neutralizing antibodies against HPV6/11 VLPs in mice and cynomolgus monkeys. These data indicated that the Hansenula polymorpha-derived HPV6/11 VLPs could be formulated into a bivalent vaccine used in prevention of CA.

NF-κB inhibition rescues Toll-like receptor 9 expression in human papillomavirus type 11 infected HaCaT cells

OBJECTIVES

Toll-like receptors (TLRs) are related to human papillomavirus (HPV) infections including condyloma acuminatum (CA). This study was designed to investigate the mechanism of TLR9 and nuclear factor κB (NF-κB) in CA.

METHODS

Expression of TLR9 protein in CA patients was detected and compared with those in CA relapse-free (CaRF) patients and normal control. HaCaT cells were transfected with HPV11 genome and NF-κB p65 siRNA or IκB kinase inhibitor BMS345541. Expression of NF-κB and TLR9 were detected using both PCR and Western blot methods.

RESULTS

TLR9 was downregulated in CA specimens as compared to CaRF and normal controls. HPV11 transfection into HaCaT (HPV11.HaCaT) cells reduced TLR9 expression and activated NF-κB p65 expression. However, administration of NF-κB p65 siRNA or IκB kinase inhibitor BMS345541 significantly inhibited NF-κB p65 expression and rescued the expression of TLR9.

CONCLUSION

Inhibition of NF-κB activation could rescue TLR9 expression in HPV11.HaCaT cells. TLR9/NF-κB mechanism may provide new target for clinical treatment of CA.

Effectiveness of HPV vaccines against genital warts in women from Valencia, Spain

OBJECTIVES

To assess the effectiveness of the HPV vaccines in preventing genital warts in young women.

DESIGN

Population-based study using health databases.

SETTING

Valencian Community (Spain).

PARTICIPANTS

All girls and women aged 14-19years who were registered in the Valencian Community between January 2009 and December 2014 (n=279,787).

MAIN OUTCOME MEASURES

Incident cases of genital warts were defined as the first activation of diagnosis code ICD-9-CM 078.11 (Condyloma acuminatum) in primary care and outpatient clinics during the study period.

RESULTS

There were 612 cases of genital warts. The overall incidence rate was 75.8/100,000 person-years (95% CrI 69.7-81.8). There was a decrease in genital warts when female candidates to be vaccinated with quadrivalent HPV vaccine reached the age of 18 (in 2012), compared to previous years. Incidence of genital warts in unvaccinated women and those who received the bivalent vaccine was higher than in girls and women who received the quadrivalent HPV vaccine. The effectiveness of a three-dose regimen of the quadrivalent HPV vaccine was 77% (95 CrI: 66-85%), whereas that of a single dose was 61% (95 CrI: 20-87%). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine.

CONCLUSIONS

Three doses of the quadrivalent HPV vaccine were effective against genital warts in our population. Moreover, with low vaccine coverage the incidence of genital warts decreased only in the vaccinated.

Innumerable Condyloma Acuminatum Tumors of the Bladder

Condylomata acuminata caused by human papillomavirus (HPV), a sexually transmitted virus, are rarely seen beyond the external genitalia and anal region. Here, a patient with innumerable condyloma acuminatum of the bladder is presented. Attempted surgical resection was performed and intraoperative photographs are presented.

Effect of 5-aminolevulinic acid photodynamic therapy on keratinocyte proliferation and apoptosis in condyloma acuminatum

BACKGROUND

The effect of 5-aminolevulinic acid photodynamic therapy on keratinocyte proliferation and apoptosis in condyloma acuminatum tissues was evaluated.

METHODS

An immunohistochemical method and TdT-mediated dUTP nick end labeling were performed to detect the positive expression of the keratinocyte proliferation-related gene Ki-67 and apoptosis, respectively, in condyloma acuminatum tissues.

RESULTS

Of 52 cases, 44 showed positive expression of Ki-67 in condyloma acuminatum keratinocytes before the treatment, with a positive expression rate of 84.62% (44/52), an expression strength of mostly ++ - +++, and a Ki-67 proliferation index of 80.26±5.07%. After treatment, 22 cases showed positive expression of Ki-67 in condyloma acuminatum keratinocytes, with a positive expression rate of 42.31% (22/52), an expression strength of mostly - - ++, and a proliferation index of 42.67±3.06%. The differences in the positive expression rate, expression strength, and proliferation index in the before- and after-treatment groups were statistically significant (χ²=20.070, P<0.001). For visible apoptotic cells in condyloma acuminatum keratinocytes before the 5-aminolevulinic acid photodynamic treatment, the expression strength was mostly + - ++, and the average apoptotic index was 13.94±2.35%; after treatment, the expression strength was mostly ++ - +++, and the average apoptotic index was 73.88±7.65%; the difference in the apoptotic index between the before and after treatment groups was statistically significant (P<0.001).

CONCLUSION

5-Aminolevulinic acid photodynamic therapy can inhibit the proliferation and promote the apoptosis of keratinocytes, and represents an effective mechanism for treating condyloma acuminatum.

Giant perianal condyloma acuminatum: Reconstruction with bilateral gluteal fasciocutaneous V-Y advancement flap

Condyloma acuminatum caused by human papilloma virus is the most common sexually transmitted infection in the anogenital region. On the other hand, giant condyloma acuminatum that is also known as Buschke-Lowenstein tumor is a rare disease. Its primary treatment is surgical excision. The purpose of this report is to present a case that reached immense dimensions in the perianal region, and to emphasize the importance of wide surgical excision. A 17-year-old woman presented with a giant mass in the perianal region for 2 years, which progressively increased in size. Local examination revealed a large vegetative lesion in the perianal area. Wide surgical excision of the involved skin and lesion was undertaken. The wound was reconstructed by bilateral gluteal fasciocutaneous V-Y advancement flap. Response to various treatments is often poor, with a high recurrence rate. In conclusion, surgical treatment with wide excision and plastic reconstruction is an effective therapy for giant anal condylomas.

miR-99b suppresses IGF-1R expression and contributes to inhibition of cell proliferation in human epidermal keratinocytes

Condyloma acuminatum (CA) is a condition caused by the highly contagious human papillomavirus (HPV), characterized by warts that undergo abnormal cell proliferation. One of the important regulators of cell proliferation is microRNAs (miRNAs). In this study, we aimed to investigate the expression profile of miR-99b in HPV positive CA samples and normal skin. We found significantly lower miR-99b levels in CA samples than in normal skin. Therefore, we investigated the role of miR-99b in regulating the proliferation of primary cultured human epidermal keratinocytes, and found that forced expression of miR-99b inhibited proliferation and induced G1-phase arrest. Based on conserved sequences in 3'UTR for miR-99b binding, we identified the insulin-like growth factor-1 receptor (IGF-1R) gene as a direct target for miR-99b. Further, we confirmed the binding site for miR-99b in the IGF-1R 3'UTR by mutation using a luciferase reporter assay that showed decrease in luciferase activity in the presence of miR-99b in the construct with the wild-type 3'UTR, but not in the construct with the mutant 3'UTR. Moreover, miR-99b over-expression could down-regulate IGF-1R expression, and could repress the PI3K-AKT signaling pathway. Lastly, over-expression of IGF-1R reversed the inhibitory effect of miR-99b on keratinocyte proliferation. Taken together, our results suggest that IGF-1R levels may be modulated by miR-99b in CA: downregulation of miR-99b with concomitant upregulation of its target gene IGF-1R may over-induce the PI3K-AKT signaling pathway, leading to deregulated cell proliferation in CA.

Woman with rectal condyloma acuminatum: a case report

Condyloma acuminatum (CA) is caused by human papilloma virus (HPV) infection, and it often occurs in the genital and perianal regions. The subtypes of HPV mainly include HPV-6, -11, -16, and -18. This case report presents a 37-year-old woman admitted to hospital because of lower abdominal pain and increased stool frequency for > 1 year. Colonoscopy found a neoplasm with a diameter ~5 mm in the rectum, ~5 cm from the anal margin. The pathological diagnosis of the excised specimen was CA. HPV DNA analysis indicated HPV-6. After asking the history closely, the patient admitted that her husband had CA, and they once had anal intercourse. The patient was discharged on the third day after the operation, and she was referred to a dermatology and venereal disease specialist for further treatment.

An unusual, giant and benign condyloma acuminatum lesion on the genital area for more than a decade

Condyloma acuminatum, is a rare sexually transmitted disease. The virus responsible for condyloma is human papillomavirus.HPV-6 and HPV-11 are the most commonly detected HPV genotypes, but at least 20 other HPV genotypes have occasionally been found in genital wart tissue specimens. In fact genital HPV infection is common among sexually active populations. This disease may occur at any age after puberty and always seen in the mucosal area. It is characterized by slow growth. We reported here a case of a 42-year-old female patient with a 12 year history of a condyloma acuminatum lesion in her genitalia area without any medical treatment.

The role of human papillomavirus in oral disease

A wide range of human papillomavirus (HPV) genotypes have been detected in oral mucosa. Clinical infections with low-risk genotypes manifest as squamous papilloma, condyloma acuminatum, verruca vulgaris, or multifocal epithelial hyperplasia. Clinical infections with high-risk genotypes have been associated with malignant lesions. The most common genotype isolated from subclinical infection is HPV-16. A causal role for HPV in carcinogenesis of oral squamous carcinoma is minimal. Ongoing vaccination against HPV types 6, 11, 16, and 18 is expected to decrease the spread of infection and decrease the carcinogenic potential of HPV-16 in the oropharynx and oral cavity.

Downregulation of pigment epithelium-derived factor in condyloma acuminatum

OBJECTIVES

To investigate pigment epithelium-derived factor (PEDF) mRNA and protein levels in condyloma acuminatum, and their relationship with angiogenesis and keratinocyte proliferation.

METHODS

Lesions from male patients with condyloma acuminatum and skin from healthy male (control) subjects were collected. Levels of PEDF protein and its corresponding mRNA (SERPINF1) were determined via Western blotting and reverse transcription-polymerase chain reaction, respectively. Immunohistochemical staining for Ki-67 and CD34 was performed to calculate keratinocyte proliferation index (PI) and microvessel density (MVD), respectively.

RESULTS

Levels of both PEDF protein and SERPINF1 mRNA were significantly lower in lesions from patients with condyloma acuminatum (n = 30) than in skin from healthy control subjects (n = 30). There were significant negative correlations between PEDF levels and both PI and MVD.

CONCLUSIONS

The reduction in PEDF levels in condyloma acuminatum was associated with an increase in angiogenesis and cell proliferation. PEDF may be involved in the pathogenesis of condyloma acuminatum.

Condyloma acuminatum associated with odontogenic myxoma: a case report

Condylomata acuminatum is a sexually transmitted infectious disease caused by human papiloma virus on the skin. The transmission is mainly by close contact with infected person and autoinoculation. In oral cavity the condition manifests as soft pink nodules which proliferate and coalesce rapidly to form diffuse papillomatous clusters of varying size. Odontogenic myxoma is a rare tumor of jaws which occurs in the tooth-bearing areas of the mandible and maxilla. It is an uncommon, benign, but locally aggressive neoplasm. This case report highlights a 17-year-old girl with two lesions in oral cavity with soft tissue growth on the palate which has been diagnosed as Condyloma Acuminatum, treated by surgical excision and a large swelling on the right side of the mandible in the same patient diagnosed as odontogenic myxoma where marginal resection was performed.

Total excision and V-Y plasty technique in the anal area condyloma acuminatum

Condyloma acuminatum is located in the perianal region, anal canal, vagina and the perineum. It is caused by human papillomavirus types 6 and 11. A 18 year-old man was admitted to the clinic because of a perianal mass. On examination of the patient's perianal area and inside the anal canal, a mass was found, which was nearly 8 × 8 cm in size. We could not obtain any information about venereal transmission. The mass was totally excised and the defect was reconstructed with a bilateral V-Y advancement flap. This technique has been used for sacrococcygeal, ischial and other defects but rarely used for condyloma acuminatum. We think that total excision and the use of the V-Y advancement flap technique is safe and has low morbidity in the treatment of condyloma acuminatum.