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The preparation and administration of autogenous vaccine and the possible mechanism(s) of its action in the immunotherapeutic treatment of Condyloma acuminata are presented as an alternative means of treatment to or as an adjunct to conventional means of therapy.

Three recently observed cases of verrucous carcinoma involving the squamous epithelium of the female reproductive tract are the basis for this report. These are rare, locally invasive, radioresistant cancers. Both gynecologists and pathologists should be alert to the fact that precise initial diagnosis may be difficult because of the close gross and microscopic similarity to benign squamous papillomas and condyloma acuminata. The pertinent literature is reviewed and treatment discussed.

A review of 21 papillary squamous tumors of the uterine cervix encountered over an 8-year period is presented. The lesions were grouped into three categories: Group A, condyloma acuminatum, 15 cases; Group B, true squamous papilloma, four cases; Group C, verrucous squamous-cell carcinoma, two cases. The clinical and pathologic features of these three groups of lesions are described. In 14 of the 15 cases the condylomas were typical. One, because of extensive involvement of the cervix, was clinically suggestive of carcinoma, but histologically on cone biopsy showed the usual features of condyloma acuminatum. All four squamous papillomas showed histologic features of severe squamous dysplasia and carcinoma in situ involving the papillomatous as well as the adjacent nonpapillomatous epithelium, indicating a high risk of malignant transformation in this group of tumors. Two of the cases represented the rare verrucous squamous-cell carcinoma. The literature on the subject of squamous-cell papillomas of the cervix is reviewed. Including the present series, there are approximately 254 reported cases of squamous papillary tumors of the uterine cervix. Of this total, only 13 are regarded as malignant, and none has had distant or lymph nodal metastases.

The authors successfully have used an autogenous vaccine in two dozen treatment-resistant cases of this disease. Though such treatment had been described some decades ago, it had fallen into disuse.

Summary: A case is reported in which elective Caesarean section was necessitated by extensive vulval and vaginal condylomata acuminata. The problems of treatment in pregnancy, particularly during the latter part of the third trimester, are discussed.

Treatment of a recurrence of oral condyloma acuminatum is presented as a follow-up of the case originally reported by Knapp and Uohara. 8 The need for aggressive surgical intervention to ensure complete removal of the papillomatous tumor and a border of normal tissues in treating this unusual type of epithelial lesion is stressed.

1. 1. Thirty-nine cases of condylomata acuminata of the cervix were studied. 2. 2. Microscopic criteria for the diagnosis of this lesion and differences between condyloma and squamous papilloma are suggested. 3. 3. Malignant change is a rare finding in condylomata, although confusing pictures are seen.

A study of 13 patients with laryngeal papillomas is presented, with an analysis of epidemiologic factors, electron microscopic study of the lesion, and therapeutic trial of frequent microlaryngoscopic surgery and application of idoxuridine. Five of the nine children in this group were delivered by mothers who had condyloma accuminatum at time of delivery. These five children developed symptoms and required surgery much earlier than the other four. This correlation is shown to be statistically significant. The electron microscopic study of tissue specimens from all our patients failed to find any actual virus particles. The comparison study with skin and genital warts, however, showed ultrastructural details linking the three lesions. Results of the therapeutic program showed an overall improvement in frequency of recurrence, but no complete cures. This improvement is felt to be related to frequent complete surgical excision, and not to application of idoxuridine.

Zusammenfassung Es wird über elektronenmikroskopische Untersuchungen an spitzen Condylomen im Bereich des weiblichen Genitale berichtet, in denen der Nachweis von Viruspartikeln im Cytoplasma der Epithelzellen erbracht werden konnte. Größe, Lokalisation und Mikromorphologie der gefundenen Elementarkörperchen machen wahrscheinlich, daß der Erreger der spitzen Condylome nicht mit dem der Verrucae vulgares identisch ist.

Urethral meatal condyloma acuminata are not usually seen in children. 1–3 Two recent cases of condyloma acuminata involving the urethral meatus in children are the basis for this report.

Hanson, Albert W. (Communicable Disease Center, Atlanta, Ga.), and George R. Cannefax . Isolation of Borrelia refringens in pure culture from patients with condylomata acuminata. J. Bacteriol. 88: 111–113. 1964.— Borrelia refringens was isolated from five of ten clinical specimens by use of a modification of the Noguchi technique. An enriched anaerobic medium is described for the cultivation of B. refringens with retention of morphological characteristics.

SUMMARY.— A patient is described who had anal warts (condylomata acuminata) in which papillomavirus particles were demonstrated in the electron microscope. One of these warts showed an area of carcinoma in situ.

A case of verrucous tuberculosis of the anal canal is reported. The pathogenesis, clinical features and management of the condition are discussed.

Human wart virus was isolated from plantar warts. After extraction of its DNA, component I was transcribed into radioactive complementary RNA (cRNA) with the aid of Escherichia coli RNA polymerase. The resulting cRNA annealed specifically to wart viral DNA and was used as a probe for the detection of wart viral DNA in human warts, condylomata acuminata, laryngeal papillomas and some malignant human tumors. High concentrations of hybridizing DNA were found in plantar warts. Verrucae vulgares annealed to a considerably lower extent only, indicating that very few genome equivalents were present in those papilloma cells. Some verrucae vulgares were found to be completely negative in this test. Condylomata acuminata, as well as laryngeal papillomas and all malignant tumors tested, did not hybridize with wart viral cRNA.

A case of multiple lesions of the “fibromatous” type occurring intraorally concurrent with large perianal lesions is reported. Histologically, the lesions were similar in appearance and a diagnosis of condyloma acuminatum was based the clinical and histologic findings.

Three cases of condyloma acuminatum with malignant transformation, and ultrastructural details of one, are reported. Carcinoma developed wim unusual rapidity in the sessile papillomas. Aggregates of uniform, spherical, 45–50-millimicron particles, suggestive of papova viruses, were detected in the nuclei of a few cells in one benign condyloma. Similar particles were not found in the condyloma showing malignant transformation from the same patient. In the neoplastic epithelium there were peculiar multinucleated, syncytial giant cells. Ultrastructurally, the nuclei of the giant cells often manifested ring-shaped nucleoli, characteristic of resting cells, which may not contribute to the further growth of the neoplasm.