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Vulvar Verrucous Carcinoma (VVC) is a rare lesion, with few described cases. It has low metastatic potential with high morbidity due to the necessity of extensive resections, although. Previously, VVC was considered a synonym to the Buschke-Lowenstein Tumor (BLT) or Giant Condyloma Acuminatum (GCA). Lichen Sclerosus (LS) is associated with Vulvar Intraepithelial Neoplasia (VIN) and Vulvar Squamous-cell carcinoma (SCC); association with VVC is also described. The case of a 60-year-old menopausal woman is reported; she had chronic itching and an extensive verrucous lesion in vulva, initially diagnosed and treated as condyloma acuminatum; there was recurrence as verrucous carcinoma associated to LS. Excision with margins was performed and clobetasol and imiquimod were used. Patient had complete remission with no further recurrences. Distinction between VVC and BLT can be difficult; current literature considers them different entities. Human papillomavirus (HPV) infection and the presence of LS play a controversial role in these injuries.

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.

This study aimed to document the dermatoses and their relationships with CD4+ T lymphocyte counts and clinical stages of disease among people living with HIV followed by our Clinical Department, to investigate the effect of antiretroviral therapy (ART) on findings and to compare with real-world data. Medical records of people living with HIV were analyzed retrospectively in our outpatient clinic from January 2005 to June 2017. A total of 500 patient files were examined. 179 patients with dermatoses were included in the study. Demographic data, clinical and laboratory findings, dermatological findings, type and distribution of lesions, serological and histopathological examinations, diagnosis, treatment, and follow-up of patients were transferred to data forms. 84.4% of the patients were male and the mean age was 38.65 ± 11.6 years. The median CD4+ T lymphocyte count was 253/mm3 (range:0–1067). At least one dermatosis was present in 69.3% of the patients. Compared with their median CD4+ T lymphocyte counts, the ratio of CD4+ T lymphocytes was significantly lower in the group with three or more dermatoses ( p = 0.019). Condyloma acuminatum (15.1%), drug eruption (13.4%), seborrheic dermatitis (11.7%), oral candidiasis (11.2%), dermatophytoses (11.2%), syphilis (8.4%), Kaposi’s sarcoma (8.4%), and telogen effluvium (8.4%) were the most common dermatoses. Kaposi sarcoma (KS), oral candidiasis, onychomycosis, and molluscum contagiosum were significantly higher in the CD4+ T lymphocyte + T lymphocyte threshold value was determined as 200/mm³. Compared with other TDF/FTC-containing regimens, a significantly higher proportion of alopecia was reported in patients receiving TDF/FTC/EVG/c ( p = 0.007). Dermatoses may be a good clinical marker for detecting clinical stage and diagnosing HIV infection; also, there may be a significant increase in the number of dermatoses in advanced stages. Although there are only a few studies in the literature, it should be kept in mind that ART-associated alopecia rates may increase nowadays when ART is targeted at everyone.

Condyloma acuminatum (CA) is a manifestation of Human Papillomavirus (HPV) infection which usually occurs in genital and perianal regions. We report a 46-year-old man with an ulcerative proctitis diagnosed four years earlier, asymptomatic for a long time under azathioprine but without any follow-up for three years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation and showed a circumferential “laterally spreading tumour” in the rectum. Surprisingly biopsies revealed a CA with a very focally high-grade intra-epithelial lesion. Azathioprine was stopped and a transanal surgical resection was performed. At guided anamnesis, patient confirmed to be a former active “men who have sex with men”. No recurrence of proctitis occurred despite azathioprine discontinuation. A retrospective review of the histological sections suggests that it was, in fact, an intestinal spirochetosis misdiagnosed as inflammatory bowel disease. Involvement of the rectal mucosa by HPV is a rare condition and this may have been promoted by inappropriate immunosuppressive treatment.

Two-step irradiance schedule (2-SIS) has been shown to significantly reduce pain during topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) on non-melanoma skin cancer (NMSC) and condyloma acuminatum (CA).1, 2 Few studies focused on 2-SIS pain control during PDT for acne.

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.

Background: Condyloma acuminatum (CA) is one of the most common sexually transmitted infections. Several therapeutic modalities that can be used are chemosurgery with trichloroacetic acid and cryosurgery with liquid nitrogen. Recurrence in CA often occurs, so selecting the right therapeutic modality and eliminating the lesion also prevents recurrence. This study aimed to compare the effectiveness of chemosurgery and cryosurgery therapy in patients with CA who are treated at Dr. Moewardi Hospital, Surakarta. Subjects and Method: A retrospective cross-sectional study was conducted at the Dermatology and Venereology Polyclinic, Dr. Moewardi Hospital, Surakarta, from January 1, 2018, to December 31, 2020. The study subjects were 78 patients diagnosed with CA based on ICD-10 criteria, while chemosurgery and cryosurgery procedures were based on ICD-9. The dependent variable was healing time in weeks. The independent variables were chemosurgery and cryosurgery therapy. The data came from the patient's medical record. Data were analyzed using an independent t-test. Results: Based on univariate analysis, most patients were male (67.9%), and the age group was 20-29 years (51.28%). Most of the CA patients work as private employees (46.15%). The most sexual orientation was heterosexual (53.8%), the most common site of lesions was genital (47.4%), and 52.6% were coinfected with HIV. Most CA patients received chemosurgery (70.5%). Bivariate analysis showed that chemosurgery therapy provided faster clinical improvement (Mean= 23.34; SD= 26.45) than cryosurgery therapy (Mean= 28.69; SD= 19.84), and the difference was statistically significant (p= 0.037). Conclusion: Treatment of CA using chemosurgery provides clinical improvement faster than cryosurgery, so that faster treatment time can reduce treatment costs and improve the patient's quality of life. Keywords: chemosurgery, cryosurgery, HPV, condyloma acuminatum Correspondence: Prasetyadi Mawardi. Department of Dermatology and Venereology, Faculty of Medicine of Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. Email: prasetyadimawardi@gmail.com/ prasetyadi_m@staff.uns.ac.id. Mobile: +6281229750211. Indonesian Journal of Medicine (2021), 06(03): 290-297 https://doi.­org/10.26911/the­ijmed.­2021.06.03.06

Giant Condyloma Acuminatum (GCA) or Buschke-Lowenstein Tumour (BLT) is a unique variant of condyloma acuminatum. The incidence of this disease tends to increase due to the increasing prevalence of Human Immunodeficiency Virus (HIV) infection. Until now, there is no therapeutic guideline for GCA, and many therapeutic options are not available for one in limited healthcare facilities. We present one case of GCA in HIV-positive women treated in health centers with limited facilities in a rural area. We treat the patient by doing a sitz bath with povidone-iodine 1%, simple excision with electrocautery for the tumour, adequate analgetics, regular wound care, and zinc supplementation acts as immunotherapy. Complications of wound infection by candida caused the lengthy hospitalization of the patient. After discharge, the patient came for control every week; no other lump arises again, and the wound was getting better. A combination of conservative and surgical treatment followed by regular wound care can lead to a good result in the GCA case, even with minimal healthcare facilities.

Background and Aim Human papilloma virus‐associated anal intraepithelial neoplasia (AIN) precedes most anal cancers and can be detected at colonoscopy. We aimed to quantify AIN detection rates in a general population undergoing colonoscopy. Methods A retrospective review of a community‐based practice for 2 years until December 2019 was conducted. Results A total of 2525 patients (1051 males and 1474 females; median age 59 years) had 2608 colonoscopies. Ten patients (two males and eight females; median age 57.5 years) had incidentally detected AIN (condyloma acuminatum or AIN1, n = 4; AIN2 or 3, n = 6). AIN was detected in 1 of 261 (95% CI 1/142–1/480) colonoscopies and 1 of 163 (95% CI 1/83–1/321) colonoscopies in women over 40 years old. Conclusions Opportunistically detecting AIN, especially in women over 40 years old, should be an important adjunct to colonoscopy‐based colorectal neoplasia detection., Human papilloma virus‐associated anal intraepithelial neoplasia (AIN) precedes most anal cancers and can be detected at colonoscopy. We aimed to quantify AIN detection rates in a general population undergoing colonoscopy. A retrospective review of a community‐based practice for 2 years until December 2019 was conducted. A total of 2525 patients (1051 males and 1474 females; median age 59 years) had 2608 colonoscopies. Ten patients (two males and eight females; median age 57.5 years) had incidentally detected AIN (condyloma acuminatum or AIN1, n = 4; AIN2 or 3, n = 6). AIN was detected in 1 of 261 (95% CI 1/142–1/480) colonoscopies and 1 of 163 (95% CI 1/83–1/321) colonoscopies in women over 40 years old. Opportunistically detecting AIN, especially in women over 40 years old, should be an important adjunct to colonoscopy‐based colorectal neoplasia detection.

Background: The aim of this study is to evaluate effectiveness and safety of the use of ablative Er:YAG laser for removal of external genital warts (EGW), also called condylomata acuminata (CA).Methods: This is a retrospective cohort study performed at Gynecology Clinic Juna in Ljubljana, Slovenia. All patients older than 18 years that were clinically diagnosed with EGW and were treated with ablative Er:YAG laser between January 2012 and December 2017 were included in the study.Results: A total of 133 female patients (mean age 39.6 ± 12.9 years, range: 19–80) with EGW were eligible to be included in this study. EGW have been present from one to seven months, with a mean presence of 2.1 ± 2.0 months. The majority of the warts were on the labia, major some also on the mons pubis. The size of the lesions was 2–8 mm. The majority of patients, who completed therapy (74 patients out of 116; 64 %) received only one treatment and 82 % of the patients (n = 95) showed complete clearance of the lesions, without recurrence observed to date of analysis. Complete clearance was achieved after an average of 1.33 treatment sessions. Recurrence was reported by 21 patients (18 %). Recorded adverse effects of laser treatment were mild and transient.Conclusion: Er:YAG laser removal of EGW is a simple, quick and safe procedure, particularly suitable for large volume EGW or those that are located in anatomical sites difficult to access by other techniques.

Introduction: An imbalance in type 1 (Th1) and type 2 (Th2) T helper cells is associated with the development and recurrence of condyloma acuminatum (CA); however, the mechanisms underlying this imbalance remain unknown. We investigated soluble fibrinogen-like protein 2 (sFGL2), which is an effector of regulatory T cells (Tregs), to determine its role in the Th1/Th2 imbalance of CA. Methodology: Lesion and blood samples were obtained from 30 CA patients, and these samples were compared with genital skin and blood samples from 20 control subjects. Serum sFGL2, mRNA, and protein levels were estimated using ELISA, quantitative real-time polymerase chain reaction, and western blot, respectively. Immunohistochemical analyses were also conducted. Results: Compared to controls, CA patients had decreased serum sFGL2 levels. However, sFGL2 mRNA and protein levels in the lesions of CA patients were significantly increased. Interleukin (IL)-4 and Foxp3 mRNA levels were upregulated, and interferon (IFN)-γ levels were downregulated in CA patients compared to those in controls. Additionally, the sFGL2 mRNA level positively correlated with Foxp3 and IL-4 levels and negatively correlated with IFN-γ and IL-17 levels. Conclusion: sFGL2 contributes to the underlying Th1/Th2 imbalance in CA pathogenesis.

Both HIV/AIDS and Sexually Transmitted Infection (STI) are transmitted through sexual activites making a parallel port of entry making the two condition increase the each other’s transmission which results as an impact to progression of HIV infection. This study aims to determine the characteristics of HIV/AIDS patients co-infected with sexually transmitted infections in H. Adam Malik General Hospital Medan between 2017 and 2018. This study is a descriptive observational study of 2422 HIV/AIDS patients attending H. Adam Malik General Hospital. Of those, 62 patients were diagnosed with STI coinfection. The majority of patients were male (85,5%) aged within the group of 25 – 49 years old (80,6%), had the level education of high school (88,7%), mostly were entrepreneurs (50%), and were single (59,7%). Most of the patients were already in their Stadium III (80,6%) clinical stage and had CD4+ count < 200/mm3 (51,6%). Condyloma acuminatum (35,5%) was found as the most common type of STI coinfection, and followed by Hepatitis B (33,9%).Based on anamnesis history, behavioral risk factors (66,1%) was the most frequent risk factor

Background Condyloma acuminatum (CA) is both highly infectious and frequently recurring and requires long-term, repeated treatments, which seriously affect the physical and psychological health of patients. The purpose of the present study was to investigate the effectiveness of a combination therapy of traditional Chinese medicine and CO2 laser on CA and the relationship between CA relapse and cellular immunity. Methods The study cohort consisted of 160 CA patients who underwent ambulatory treatment between January 2017 and January 2019 in the Department of Dermatology and Venerology of our hospital. The 160 patients were randomly divided into two groups: a combination therapy group (80 cases), who underwent CO2 -laser treatment followed by three courses of oral traditional Chinese medicine and a control group (80 cases), who were only treated with the CO2 laser to remove warts. The efficacy of the CO2 -laser treatment was evaluated on the first month after treatment and relapse was evaluated at monthly follow-ups for 6 months. Additionally, 20 normal volunteers were also recruited. Three months before and after treatment, the cellular immunity factors of peripheral blood T lymphocyte subsets, including CD4+, CD8+, CD4+/CD8+, and interleukin-2 (IL-2), were detected and compared between CA patients and normal volunteers, the combination therapy and control groups, and the relapse and cure groups to determine whether there were statistical differences. Results Compared with normal volunteers, CA patients exhibited lower CD4+, CD4+/CD8+, and IL-2 levels and higher CD8+ levels (P .05) before treatment. Three months after treatment, factors including CD4+ and CD4+/CD8+ were higher in the combination therapy group than in the control group (P .05); factors including CD4+, CD4+/CD8+, and IL-2 were higher and CD8+ was lower in the cure group than in the relapse group (P Conclusion The therapy combination of traditional Chinese medicine and CO2 -laser treatment can reduce the relapse rate of CA. It might be that traditional Chinese medicine combined with CO2-laser treatment regulate liver meridian, Qi and blood, and restore the balance between various subgroups.

Introduction: Condyloma acuminatum is caused by infection from Human Papilloma Virus (HPV), mostly found in the perineum and genital area. Therefore HPV infection is the most common sexually transmitted infection in the world. Infection often occurs in patients with a decreased immune system, such as Human Immunodeficiency Virus (HIV) infection.Case: A 62-year-old man was diagnosed with condyloma acuminatum in the penis and accompanied by stage IV HIV infection. CD4 + count is 23 cells/μL. Patients were given electric surgical therapy and 80% TCA. After receiving 8 treatments in 3 months, there was no significant improvement.Discussion: There are several therapeutic modalities in the management of condyloma acuminatum. Some considerations in the selection of condyloma acuminatum therapy include size, number, anatomic location of the lesion, patient comfort, side effects and the experience of the doctor in charge. The immune system plays an important role in the successful treatment of HPV infections. The risk of persistence, recurrence, and malignant transformation can increase with the decrease in the immune system by HIV infection as measured by CD4 + counts. In this case, more aggressive treatment will be needed and immunomodulators can be given to increase the success of the therapy.Conclusion: Host immune status has a significant impact on the course of HPV disease and response to treatment. HIV patients have an increased risk of HPV infection, with an increase in the duration and persistence of the disease and thus require aggressive therapy.

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.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.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).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.

Podophyllotoxin (PPT) is used to treat condylomata acuminata and works by destabilizing microtubules within epithelial cells, leading to mitotic arrest in metaphase. PPT-induced changes to the epidermis can cause histological findings mimicking dysplasia. Here, we present a case of vulvar condyloma acuminatum treated with PPT, showing ballooning degeneration, necrotic keratinocytes, and mitotic figures. PPT-treated skin may resemble dysplasia or squamous cell carcinoma in situ due to dyskeratosis and frequent mitoses; however, the synchronicity of mitotic figures in early phases of mitosis, as well as the absence of cellular pleomorphism and atypical mitotic figures, allows for distinction from malignancy. This case demonstrates the importance of understanding the histological changes caused by PPT to prevent misdiagnosis and potential overtreatment.

Condyloma acuminatum (CA) is a sexually transmitted disease caused by human papillomavirus (HPV) often with high recurrence rate after treatment. This study aimed to construct and evaluate a nomogram model containing three clinical parameters to predict the recurrence risk of CA after 5-aminolevulinic acid photodynamic therapy (ALA-PDT). A predictive model was established based on a training cohort of 346 CA patients treated with ALA-PDT between January 2013 and July 2018. A validation cohort of 123 CA patients was recruited from August 2018 to December 2019. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize the clinical feature selection. A nomogram predicting the recurrence of CA after ALA-PDT was constructed based on the predictors identified by LASSO regression. C-index and area under the curve (AUC) values were used to evaluate the discrimination. Calibration was evaluated with a calibration curve. The net benefit was performed via decision curve analysis (DCA). In the training cohort, 55 (15.89%) patients experienced recurrences after ALA-PDT. Predictors selected by LASSO regression were concomitant human immunodeficiency virus (HIV) infection [Hazard ratio (HR) = 4.4; 95% confidence interval (CI), 2.5-7.9; p

In this work, we used photodynamic therapy(ALA-PDT) to treat 2 patients with perianal hemorrhoids combined with condyloma acuminatum. After 4 photodynamic treatments, the condyloma acuminata skin lesions completely disappeared. At the same time, we unexpectedly found that the patient's hemorrhoids skin lesions had mostly faded, and did not reappear during the half-year follow-up. Photodynamic therapy is satisfactory in the treatment of hemorrhoids combined with condyloma acuminatum, and the recurrence rate is low. We also have found that photodynamic therapy is equally effective on hemorrhoid skin lesions. PDT may be adopted as a new strategy in the study and treatment of hemorrhoids. To the best of our knowledge, no such cases have been reported.

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.

BACKGROUND Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papillomaviruses. Five-aminolevulinic acid-photodynamic therapy (ALA-PDT) can promote the apoptosis of keratinocytes and inhibit proliferation; however, the effect of ALA-PDT on the immune mechanism of CA tissue is not well understood. In this study, we examined the changes in Toll-like receptor 4 (TRL4) and nuclear factor kappa B (NF-κB) expression in CA tissues before ALA-PDT treatment to determine its effects and possible immune mechanisms. METHODS Immunohistochemistry (streptavidin-peroxidase) was used to detect the expression of TLR4 and NF-κB in the keratinocytes of the patients with CA before and after ALA-PDT treatment. RESULTS Before treatment, the positive TLR4 and NF-κB expression rates in the keratinocytes of the patients with CA were 86.53% (45/52) and 94.23% (49/52), respectively, whereas after treatment, these rates were 44.230% (23/52) and 38.46% (20/52), respectively. Positive TLR4 and NF-κB expression in the keratinocytes of CA was mostly ++ to +++ in intensity before ALA-PDT and mostly ranged from - to + after treatment. The positive expression rate and intensity of TLR4 and NF-κB in the two groups before and after ALA-PDT were significantly different (P < 0.05). There was a positive correlation between the expression of TLR4 and NF-κB in the CA tissues after ALA-PDT (r = 0.486, P < 0.05). CONCLUSIONS ALA-PDT may relieve local immunosuppressive states by reducing TLR4 and NF-κB expression and jointly promoting CA regression, which is a potential molecular mechanism of ALA-PDT in CA treatment.

Background: Human Papilloma virus (HPV) infection is a high incidence entity in the world population. It is highly related to cervical carcinoma, as well as anogenital carcinoma, among others. The presences of bladder HPV lesions are infrequent and there is an association between it and the development of bladder cancer. Case presentation: We present a case of bladder HPV in a woman with a cervical carcinoma history that was presented clinically as a single episode of gross hematuria. We performed a cystoscopy and Holmium laser enucleation of the bladder tumors. Conclusion: We highlight the importance of consider HPV as a differential diagnosis of a bladder tumor, mainly in patients with history of pathologies related with the virus.

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.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.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%, P0.001). 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).Multiple-type HPV infection were closely associated with CA recurrence after photodynamic therapy.

S 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.

A cutaneous horn, cornu cutaneum, is a hard, conical projection composed of compacted keratin that resembles the horns of animals. They commonly occur on sun-exposed areas, including the head, ears, forearms and hands. Cutaneous horns are extremely rare. Although most are benign in nature, a significant portion may harbour a malignant or pre-malignant lesion, and histopathological analysis of the base of the lesion is imperative to categorise it as one of benign aetiology or one of a more sinister pathology. We present a case of a 46-year-old male who presented with a 2-month history of a painless, firm, rapidly growing conical projection arising from his scrotum. Clinically, a non-tender curved, yellow-brown, horn-like projection was observed arising from the median raphe of his scrotum. With informed consent, a full-thickness excision, with adequate excision of the base of the horn, was performed under local anaesthesia. Macroscopically, the exophytic keratinous lesion was 7.5 cm long and 1.8 cm wide, with the length of the horn far outweighing the width at its base. Histopathological analysis confirmed the presence of a cutaneous horn arising from a condyloma acuminatum as evidenced by a verruciform architecture with tiers of parakeratosis in association with hypergranulosis and koilocytes. No dysplastic or malignant changes were present in the epithelium. According to our knowledge, this is the first case in the English literature of a cutaneous horn arising from the scrotal skin.

The Treponema pallidum antibody immunohistochemical (IHC) stain has improved our ability to detect the organism histologically. We present a case of a man with genital condyloma acuminatum with a positive T. pallidum IHC stain but negative T. pallidum serologies and no syphilitic symptoms. It has been shown that the T. pallidum antibody IHC can cross-react, staining other spirochetes, including Borrelia burgdorferi and the Brachyspira family of intestinal spirochetes. Because of the proximity of our patient's lesions to the anus, and the persistently negative T. pallidum serologies, we believe nontreponemal spirochetes colonized the condyloma, giving a false-positive T. pallidum IHC. This cross-reactivity is a potential diagnostic pitfall and is important for the dermatopathologist to recognize, thereby avoiding false diagnosis of syphilis.

Background: Condylomata acuminata (CA) are a common sexually transmitted disease. The recurrence rate of condyloma acuminatum using traditional treatments is higher than that of applying ph...

Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.

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.

Background The aim of this study was to investigate whether macrophages can participate in the immunosuppression of condyloma acuminatum (CA) by expressing PD-1/PD-L1. Methods The infiltration of macrophages and expression of programmed death-1 (PD-1) and PD-1 ligand 1 (PD-L1) on wart lesions and in normal skin tissues were detected by immunohistochemistry assay. The amounts of M1- and M2-type macrophages derived from THP-1 cells were measured by flow cytometry. The expression of cytokines on macrophages was examined by using enzyme-linked immunosorbent assay (ELISA). The protein expression of PD-1 and PD-L1 on macrophages was detected by western blotting. Results The macrophages were significantly increased, while PD-1 and PD-L1 were highly expressed on wart lesions compared to normal controls. More M2-like macrophages than M1-type macrophages were present on wart lesions. The M2-like macrophages in the CA groups showed high expression of interleukin-10 (IL-10), transforming growth factor (TGF-β), PD-1, and PD-L1 compared to normal controls. Conclusion Macrophages participate in the immunosuppression of CA by expressing PD-1/PD-L1.

Cervical cancer is the third most common cancer after breast and colorectal cancers worldwide, and the second most common gynecological malignancy after endometrial cancer. Cervical cancer screening was first described by Papanicolaou in 1941 using the PAP smear test. The incidence of invasive cervical cancer clearly reduced with the common use of PAP smear in developed countries. The basic methods used for diagnosis of premalignant lesions of the cervix are determination with colposcopy, biopsy and HPV DNA typing. Cervical premalignant lesions cannot be observed with the naked eye, other than exophytic or papillary lesions of condyloma acuminatum. Condyloma acuminatum are simultaneously LSIL. LSIL and HSIL differentiation cannot be made with colposcopy. Due to better repeatability and interobserver compliance, the World Health Organization (WHO) recommends a 2-layer HSIL/LSIL system. In the 3-layer CIN system, CIN1 is equivalent to LSIL, while CIN3 equivalent is HSIL. The lesions are frequently encountered in routine biopsies, and in some cases, differential diagnosis may be difficult. Basal cell hyperplasia, atrophy, reactive and repair-induced atypia and immature squamous metaplasia may mimic precancerous lesions. Although histomorphology is gold standard, P16 and Ki-67 are beneficial immunohistochemical ancillary testes. However, it should be kept in mind that p16 can be positive in LSIL, and negative in HSIL.

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.

Background Human papilloma virus (HPV) infection and condyloma acuminatum (CA) in the genital area often exist in extensive and multi-point fashion. Laser ablation combined with topical photodynamic therapy (PDT) is a feasible approach for genital CA but its effectiveness and limitations need to be evaluated. Methods This single-arm prospective study consisted of 100 newly diagnosed CA cases of both sexes. All patients underwent laser ablation and then three times aminolaevulinic acid-based photodynamic therapy (ALA-PDT). The outcomes were evaluated and analyzed 3 months after the treatment. Results A total of 98 patients completed the study. Except for 6 patients (4 males and 2 females) showed some residual lesions other 92 patients (93.8%) showed complete cure. However, there were 18 patients (10 males and 8 females) showed new lesions near the treated areas. Although the HPV types of 18 patients before and after treatment were not completely consistent, 94.4% percent of patients (17/18) had the same HPV type as the primary lesion, which suggested that these late-onset CA might have latent infection or subclinical infection in the early stage of the disease but the length of the incubation period was longer. Conclusion Combination approach is effective in treating genital CA and preventing CA recurrence. But its limitations need to be recognized as the late-onset CA might occur near the treated area. The treatment plan needs to be optimized for multiple genital CA lesions.

BACKGROUND Despite its high contagiousness, high recurrence rate and potential for malignant transformation, effective treatments for condyloma acuminatum (CA) have not yet been developed. Accordingly, it is necessary to clarify the mechanisms underlying CA development. AIM To investigate the expression and significance of the proteins Wnt-1 and TSLC1 in patients with CA and in normal foreskin controls. METHODS Wnt-1 and TSLC1 were assessed by immunohistochemistry in 45 patients with CA. RESULTS Positive expression rates of Wnt-1 and TSLC1 were 82.22% (37/45) and 37.78% (17/45), respectively, in CA tissues, and 29.17% (7/24) and 91.67% (22/24), respectively, in normal foreskin controls. Wnt-1 expression intensity in CA was markedly higher (positive to strongly positive) than that in normal controls (negative to weakly positive), whereas TSLC1 expression intensity ranged from weakly positive to positive in CA, and nearly strongly positive in the normal control group. The differences in the positive expression rate and expression intensity of Wnt-1 and TSLC1 between the two groups were statistically significant (P

Patient: Male, 62 Final Diagnosis: Condyloma acuminatum Symptoms: Urinary retention Medication: — Clinical Procedure: Cystoscopy Specialty: Urology Objective: Unusual clinical course Background: A condyloma acuminatum is a sexually transmitted, human papillomavirus (HPV) associated, neoplasm. In men, it is predominantly found on external genitalia and rarely progresses more proximally than the distal penile urethra. Condyloma acuminata of the prostatic urethra are rare and are usually seen as an extension of, or in association with external lesions. Therefore, it is not typically considered in the differential diagnosis of isolated papillary lesions limited to the prostatic urethra. Case Report: A 62-year-old male with rheumatoid arthritis treated with abatacept presented to urology due to a history of intermittent bladder self-catheterization for urinary obstruction. He underwent a transurethral resection of the prostate and had incidental findings of papillary lesions restricted to the prostatic urethra that were presumed to be urothelial carcinoma. Microscopic examination established the diagnosis of condyloma acuminata, and low-risk HPV 6 and 11 were detected by in-situ hybridization. Subsequent cystoscopy showed marked growth and extension of condyloma acuminata to near the external meatus. After multiple treatments with intraurethral 5-fluorouracil, several small lesions remained in the bulbous urethra. With follow up for 2 years since diagnosis, the patient has not developed external condylomata. Conclusions: A condyloma acuminatum might present as an isolated papillary growth in the prostatic urethra without clinical or historical evidence of a visible lesion on external genitalia. Immunosuppression and/or urethral instrumentation might be a risk factor for such a presentation. Urologists and pathologists should be aware of this rare possibility in order to avoid misdiagnosis, and ensure that the patient receives appropriate therapy.

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.

Condyloma acuminata (CA) are benign anogenital warts caused by human papillomavirus (HPV) infection with a high recurrence rate. Despite its high contagiousness, high recurrence rate and potential for malignant transformation, effective treatments for CA have not yet been developed. Accordingly, it is necessary to clarify the mechanisms underlying CA development. Zinc (Zn) is stably maintained in the weight of human body. Skin is the third most Zn-abundant tissue in the body. Zn is present as a divalent ion (Zn2+) in cells and does not need a redox reaction upon crossing the cellular membrane. Zn transporters (ZnTs; SLC30A) and Irt-like proteins (ZIPs; SLC39A) are involved in Zn2+ efflux and uptake, respectively. ZnT1 is one of the ZnTs, which associates with the development of HPV. However, the role of ZnT1 regulation in the CA caused by HPV infection remains unknown. A multigroup case-control study was designed to investigate the expression and significance of the ZnT1 in patients with CA infected with HPV and in normal vulva controls. ZnT1 was assessed by immunohistochemistry in 44 patients with CA at Zhongnan Hospital of Wuhan University 2019-2020. Samples were analyzed by paraffin embedding and sectioning and hematoxylin-eosin and immunohistochemical staining. Immunohistochemical methods detected specific, dark brown, positive staining of ZnT1 in the keratinocytes of epidermis. We verified that the expression levels of ZnT1 that interact with HPV were upregulated in the CA groups independently of genotype compared with the control group. And then we found that the HPV risk grade in CA patients has a certain correlation with ZnT1 expression. These findings showed that HPV infection upregulated the expression of ZnT1 in CA. Additionally, there were obvious differences in the expression of ZnT1 between the different HPV risk grade infection groups. The higher the HPV risk grade, the stronger the ZNT1 protein expression. This study provided new insights into the sign pathway to HPV infection.

The giant condyloma acuminatum(GCA),also known as Buschke–Löwenstein tumor(BLT),is a type of human papilloma virus associated sexually transmitted infection. Various treatment options are available but best option amongst them is surgery. This case report present a GCA case in male with masses over lower abdomen and penile region where surgical resection is done, taking into account the high rate of recurrence and the significant potential of malignant transformation.

A 20-year-old young woman with cauliflower-shaped lesions on her vulva was misdiagnosed as condyloma acuminatum. Further evaluation revealed positive serological tests for syphilis. On histological examination, and numerous plasma cells were seen to infiltrate the dermis heavily. The cauliflower-shaped lesions on vulva completely disappeared after benzathine penicillin treatment. Cauliflower-shaped lesions are a rare manifestation of secondary syphilis.

A 23-year-old woman of low socioeconomic status presented to our obstetric department reporting pain in the perineal area, occasional bleeding during defecation and discomfort at the sitting position. The woman was nulliparous, at the 34thweek of gestation and had an unattended pregnancy, since she had never visited a healthcare provider the last three years. Physical examination revealed multiple, irregular vegetative lesions covering the perianal region. These cauliflower-like masses where hard and painless with maximum diameter 10cm, while vagina and vulva were free of warts. The patient was scheduled for elective caesarean section at the 38thweek of pregnancy, because large warts were blocking the natural birth canal. She was referred to a tertiary health care unit for further counselling and treatment after postpartum period.

Intra-anal warts are frequently recalcitrant to surgical removal, but imiquimod 5% cream is not formulated to use in clinical practice due to the risk of mucosal inflammation. In the present, prospective, open study examining the efficacy and safety of imiquimod 5% cream, the drug was applied to the entire inner surface of the anal canal with a cotton swab under anoscopy three times weekly for 16 weeks. If complete remission was not achieved, the treatment was continued until week 28. Electrocautery was applied once in a poorly responsive case. In total, 21 patients with intra-anal warts, of whom 16 were HIV-positive, were enrolled. Two patients withdrew before week 16, and nine more patients withdrew before week 28. The complete clearance rate was 36.8% (7/19) at week 16 and 70% (7/10) at week 28. Four patients achieved complete clearance at week 16 and maintained clearance at week 28 without further treatment. Three of four patients resistant to previous electrocautery achieved clearance with imiquimod 5% cream treatment. Adverse events occurred in 81% (17/21) of the patients mainly at the application site, but serious or previously unencountered adverse events were not observed. Imiquimod 5% cream applied to intra-anal warts was nearly as efficacious and safe as when applied to external anogenital warts. Since treatment modalities for intra-anal warts are very limited, application of imiquimod 5% cream alone with careful and frequent observation or in combination with electrocautery is a useful option for refractory cases of intra-anal wart.

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.