HPV: warts and tumours

D12-g76-2361 CONDYLOMA ACUMINATA

Clinical data: The patient was a 41 year old woman.

Macroscopically: The specimen consists of a complex papilliferous (or cauliflower-like) tumour which was situated around the anus.

Microscopically: The histology of a wart shows acanthosis or epidermal hyperplasia, giving rise to multiple epithelial folds supported by fibrovascular stalks. The lesion is benign. 

Comments: Condyloma acuminata or genital warts may extensively involve the vulva, vagina, anus or penis. They are caused by papillomaviruses (HPV types 6 and 11), transmitted person to person by direct contact. Types 6 and 11 are non-oncogenic, but these strains frequently co-exist with oncogenic strains, which are a major risk factor for anal cancer. The incidence of anal cancer is increasing, especially in men who have sex with men.

Goldstone SE. Some straight talk about anal human papillomavirus infection. J Infect Dis. 2010; 201:1450-1452.

R2-n80-0641 JUVENILE PAPILLOMATOSIS OF THE LARYNX

Clinical data: The specimen is from a 2 year old child who had had symptoms of respiratory obstruction for about 18 months. He had spent virtually all of this time in hospital and required a permanent tracheostomy tube until his death from a respiratory infection.

Macroscopically: The specimen shows florid papillomatosis of the true and false vocal cords, the base of the epiglottis and aryepiglottic folds, the right pyriform fossa and on the tongue. Papillomata also extend down most of the length of the trachea. There is also prominent lymphoid hyperplasia, most marked at the base of the tongue, presumably a result of the viral infection.

Microscopically: These lesions are simple squamous papillomata with delicate connective tissue fronds supporting the bland squamous epithelium.

Comments: Laryngeal papillomatosis occurs in infancy as a result of papillomavirus infection transmitted during delivery from a mother with genital warts, through inhalation of infected secretions. Repeated surgical removal of the papillomata is often necessary.

Z1-z00-0069 SQUAMOUS CARCINOMA OF THE CERVIX

Clinical data: The patient was 30 years old, gravida 3 parity 3. Her presenting complaint was a foul smelling blood-stained vaginal discharge. She also reported inter-menstrual and post-coital bleeding for 3 months. The clinical diagnosis was stage IB carcinoma of cervix. A Wertheim’s hysterectomy and pelvic lymphadenectomy were done.

Macroscopically: The specimen is a uterus, without adnexae. A fungating tumour obliterates the cervix and is growing in a polypoid fashion. A cuff of vagina present. Not included in specimen is the lymph node dissection.

Microscopically: Histology showed a poorly differentiated squamous carcinoma of cervix. The resection line was free of tumour. The left internal iliac group of lymph nodes contained metastatic tumour, thus the actual stage of the cancer was more advanced than what could be clinically detected.

Comments: Carcinoma of the cervix is directly linked to oncogenic papillomaviruses, in particular HPV 16 & 18. Infection causes precursor lesions, cervical intraepithelial neoplasia (CIN), which if undetected and untreated may progress to frank carcinoma. [The progression is similar in other sites, beginning with vulvar intraepithelial neoplasia (VIN), penile intraepithelial neoplasia (PIN), or anal intraepithelial neoplasia (AIN).]

A new HPV vaccine given to pre-pubertal girls will hopefully reduce the very high incidence of carcinoma of the cervix in South Africa.

G7-n83-2408 CARCINOMA OF THE PENIS

Clinical data: No clinical details are available on this case.

Macroscopically: On the inner surface of the prepuce (foreskin) is a yellowish-white papillary growth. Macroscopically, the underlying tissue has not been invaded to any significant extent.

Microscopically: The features were those of a well differentiated squamous carcinoma of low grade malignancy.