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Condylomatous Tumours Ofvulva, Vagina, and Penis

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Condylomatous Tumours Ofvulva, Vagina, and Penis J Clin Pathol: first published as 10.1136/jcp.33.11.1039 on 1 November 1980. Downloaded from J Clin Pathol 1980;33:1039-1046 Condylomatous tumours of vulva, vagina, and penis Relation between histological appearance and age R SCHMAUZ AND R OWOR From the Institute ofPathology, Medizinische Hochschule Luibeck, Ratzeburger Allee 160, D-2400 Luibeck, Federal Republic of German), and Pathology Department, Makerere University, POB 7072, Kampala, Uganda SUMMARY Among 237 cases of condyloma diagnosed in Uganda between 1964 and 1975 seven types of lesions were defined. Three of these were found within a wide age range in both young and elderly people, namely, the common (49-4A ) and the flat (2-0 %) condyloma acuminatum, and condyloma acuminatum of irregular outline (135 %). Four variants, on the other hand, fell into different age groups. Condyloma acuminatum, showing marked cell death (5 1 %) and observed exclusively among girls in the first decade of life, displayed numerous acidophil bodies, presumably reflecting single cell necroses. Condylomata acuminata showing marked acanthosis (I6-9 %) were found in patients between 12 and 30 years, dysplastic condylomata acuminata (5.9%) between 20 and 62 years, and proliferative (giant) condylomata acuminata (7 2%) between 31 and 80 years of age. In the latter two groups of lesions, the inflammatory stromal infiltrate was more prominent, copyright. but cytoplasmic vacuolation, often believed to be a sign of viral infection, was seen less frequently than in the remaining types. In young people, the features seen resemble, therefore, a cytocidal and/or vacuolating viral infection, whereas the dysplastic and proliferative changes observed in older patients are compatible with malignant transformation being under way. The terminology and classification of papillary introduced, embracing all these kinds of tumours,6 http://jcp.bmj.com/ squamous tumours occurring on the genitalia are at or referring only to giant condylomata acuminata variance. According to the macroscopic appearance, showing malignant change in the form of true early reports distinguish the common, the flat, and invasion.7 However, another proposition is to retain the giant condylomata acuminata, and these terms the term verrucous carcinoma only for cases that are still in use today.' 2 Later subdivisions distinguish show invasion by large epithelial islands conforming condylomata acuminata of young people showing to a solid growth pattern8 and to describe in full cytoplasmic vacuolation in the upper epithelial detail whatever combinations are seen within a single on September 27, 2021 by guest. Protected layers from squamous cell papillomas of the elderly, tumour.9 in which precancerous changes are seen but only little When analysing their age distribution in biopsy vacuolation.34 By contrast, according to a recent series ofcases, two groups ofcondyloma acuminatum authoritative recommendation, the only difference were found which occurred mainly in young and less between a squamous cell papilloma and a condyloma often in elderly persons and thus preceded the cases acuminatum is that the former is a solitary and the of carcinoma by decades and years, respectively, latter a multiple lesion.5 suggesting perhaps that these lesions are pre- Many examples of papillary squamous tumours cancerous. They showed a low risk and long time have been observed which were neither benign nor interval to subsequent carcinoma in young patients fully malignant. For such lesions, the terms giant and a high risk and short time interval in older condyloma acuminatum, carcinoma-like condyloma, patients.10-'2 It seemed likely that there were and condyloma-like carcinoma were suggested.' variations not only in age distribution but also in Furthermore, the term verrucous carcinoma was histological appearance, and it was decided, there- fore, to reassess the cases from Uganda where most Received for publication 10 March 1980 material had been collected. 1039 J Clin Pathol: first published as 10.1136/jcp.33.11.1039 on 1 November 1980. Downloaded from 1040 Schmauz and Owor Material and methods when of negligible degree. The cases of carcinoma were taken from the Kampala Cancer Registry Slides of all cases diagnosed in the Pathology which uses the biopsy service for case finding Department of Makerere University in Kampala (Table 2). between 1964 and 1975 were taken out from the files. This department harbours the only histo- Results pathology service for all of Uganda, a country with approximately 12 million inhabitants and a high Seven variants of condylomatous tumours could be incidence of cancer of the penis.13 A case was defined distinguished histologically and were divided into as a lesion reported as condyloma acuminatum, the following two groups (Tables 1 and 2). venereal or genital warts, or squamous cell papilloma. The tumours had occurred mainly on the vulva, WITHIN A WIDE AGE RANGE vagina, and penis, but a few examples in which the Commoncondylomataacuminata, themostfrequently origin was the orifice of the urethra were also seen type of lesion, were encountered mainly in included because it was felt that other such cases patients between 10 and 30 years old and less often could have been reported simply as arising from in the 0-9 and 30-50 year age groups (Fig. 1). These a genital site. Slides could not be obtained in 20-9 % cases showed elongated, acanthotically enlarged rete and 7-6% of female and male cases respectively. ridges, together with increased formation of fibro- Histological examination was done without vascular papillae, and resembled closely the less knowledge of the sex or age of the patient or the site frequently observed irregular condyloma acumi- of the lesion. A number of features were assessed, natum (Fig. 2). The distinguishing features were namely, the degree of cytoplasmic vacuolation of the that these latter lesions seem to occur in slightly epithelium, the density of stromal inflammatory older age groups among men (Table 2) and have an infiltration, dysplastic changes, and the portion of outline of rete ridges showing notched and less epithelial and fibrovascular tissue seen in the broad epithelial processes. The few cases of flat condylomatous tumour. Nine cases which fell out- condylomata acuminata were characterised by acopyright. side the histological range ofcondylomata acuminata broad base and formation of fibrovascular cores were excluded from the analyses. These showed towards the surface; they occurred in patients aged borderline changes either to malignancy or to hyper- 19-40 years (Fig. 3). plastic lesions. Cytoplasmic vacuolation is con- sidered to be a normal occurrence on all mucosal IN VARYING AGE GROUPS surfaces, but a distinction from vacuolation seen in A remarkable, though rarely encountered type of condylomata acuminata was not attempted; the condyloma acuminatum showing marked cell death changes were difficult to distinguish, particularly was found among girls within the first decade of http://jcp.bmj.com/ Table 1 Histological type and age distribution ofcondylomatous tumours of vulva, vagina, andpenis seen in the biopsy service for all Uganda, 1964-75 Sitelage group Type of condyloma acuminatum (yr) Common Irregular Flat With cell death With marked acanthosis Dysplastic Total on September 27, 2021 by guest. Protected Vulva and vagina 0-9 3 2 - 11 - - 16 10-19 14 19 1 1 12 - 37 20-29 8 4 2 - 3 1 18 30-39 2 -- - 1 2 5 40+ 1 - - - - - 1 Total* 30 16 3 12 19 3 83 Common Irregular Flat Proliferative With marked acanthosis Dysplastic Total (giant) Penis 0-9 7 1 - - - - 8 10-19 27 5 - - 9 - 41 20-29 36 6 1 - 10 1 54 30-39 4 2 - 1 - - 7 40-49 3 1 1 3 - 2 10 50-59 3 1 - 4 - 5 13 60+ - -- 7 - 1 8 Total* 87 16 2 17 21 11 154 *Includes cases in which the age was not known or stated as 'adult' only. J Clin Pathol: first published as 10.1136/jcp.33.11.1039 on 1 November 1980. Downloaded from Condylomatous tumours of vulva, vagina, and penis 1041 Table 2 Histological type, frequency, mean and median age, and age range of condylomatous tumours of vulva, vagina, and penis compared to squamous cell carcinoma. All cases were collected through a biopsy service for all Uganda, 1964-75 Type of tumour Vulva and vagina Penis No. % Age distribution (yr) No. % Age distribution (yr) of of cases* Mean Median Range cases* Mean Median Range Common CA 30 36-1 19-3 19 3-50 87 56.5 21-7 20 4-50 Flat CA 3 3-6 20-7 21 19-22 2 1-3 - - 20, 30 Irregular CA 16 19.3 18-8 17 4-44 16 10-4 32-6 25 4-55 CA with cell death 12 14-5 5 7 5 2-5-10 - - - - - CA with marked acanthosis 19 22 9 18.2 17 15-30 21 13-6 19-1 20 12-28 CA with dysplasia 3 3-6 28-3 30 20-35 11 7-2 47-1 46 22-62 Proliferative (giant) CA - -- - - 17 11-0 55-4 55 31-80 Squamous cell carcinoma 185 45.6 45 7-78 1237 55.4 60 24-108 *Includes cases in which the age was unknown or stated as 'adult' only. CA condyloma acuminatum. MJ~~~~~~~~~~ copyright. http://jcp.bmj.com/ on September 27, 2021 by guest. Protected Fig. 1 Common condyloma acuminatum from a 5-year-old boy showing negligible vacuolation in other Fig. 2 Condyloma acuminatum ofirregular outline areas of tumour and little inflammatory stromal occurring in a 27-year-old man. H and E x 125. infiltration. Haematoxylin and eosin x 50. life. Fibrovascular cores were seen superficially, but chromatic. Acidophil bodies, usually termed dys- in deeper portions there was only a delicate stroma keratoses or cells undergoing monocellular keratin- between the epithelial processes. Compared to the isation, were noted frequently in contrast to the common condylomata acuminata the squamous remaining variants in which such changes were cells were smaller and their nuclei more hyper- rarely seen.
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