Perianal condyloma acuminatum

Case contributed by Jose Antonio Habana
Diagnosis certain


Presented with tender and firm perianal mass. Concern for anorectal malignancy.

Patient Data

Age: 50 years
Gender: Male

Enhancing soft tissue mass in the anal notch measuring 2.0 x 2.0 x 2.3 cm. No invasion into the surrounding subcutaneous tissues or the anal canal. 

Several enlarged lymph nodes, some with calcifications, are in the left inguinal region. The largest measures 3.9 x 1.8 cm.

Case Discussion

Condyloma acuminata occur due to infection with human papillomavirus (HPV). The most common strains to affect the anogenital region are HPV 6 and 11. HPV is considered to be the most common sexually transmitted disease. Typically, they appear as skin-colored fleshy papules which may coalesce to form a larger lesion.

These may evolve into large destructive cauliflower-like masses, which are called Buschke-Lowenstein tumors.

The patient underwent excision biopsy, with the following histopathologic findings:

Histologic sections show tissues covered by thickened stratified squamous epithelium with foci of acanthosis, rounded and thickened rete ridges, koilocytic atypia, and parakeratosis. Scattered lymphocytic infiltrates, congested blood vessels, areas of hemorrhage, and cautery artifacts are also present.

Hyperplastic stratified squamous epithelium with foci of koilocytic atypia. Given the described morphologic findings, a Condyloma Acuminata is highly considered.

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