Track: Clinical Studies

Abstract:

Background: Condyloma acuminatum (CA), a benign squamous proliferation induced by human papillomavirus (HPV), is classically encountered in the anogenital region and associated with low-risk (LR) HPV types 6 and 11. However, its occurrence in extragenital cutaneous sites remains rare and may present a diagnostic challenge, particularly in the absence of classical histomorphologic features.

Methods: We reviewed seven cases of cutaneous CA involving non-mucosal, extragenital regions, including the areola, chest, hip, central abdomen, upper back, and umbilicus. All patients were male, with ages ranging from 30 to 75 years. In situ hybridization (ISH) was performed to detect HPV subtypes, including LR (6/11) and high-risk (HR) (16/18, 31/33) types.

Results: All lesions demonstrated acanthotic epidermal proliferations with viral cytopathic changes. HPV ISH confirmed the presence of LR HPV subtypes 6/11 in five of seven cases, with focal or diffuse staining. Notably, none of the cases demonstrated hybridization signals for HR HPV subtypes 16/18 or 31/33. These findings were consistent across multiple anatomic locations. The absence of HR HPV in these cutaneous sites suggests a distinct biological behavior and reinforces the importance of accurate molecular subtyping, especially in cases with atypical clinical or histologic presentation.

Conclusion: Our findings emphasize the diagnostic value of HPV ISH in confirming the viral etiology of morphologically ambiguous lesions in unusual locations. Recognition of cutaneous CA in extragenital sites and its consistent association with LR HPV has implications for both pathologic diagnosis and clinical management, particularly in differentiating these lesions from verrucous carcinoma, bowenoid papulosis, or HPV-related dysplasias.

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Avi Bitterman