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CASE REPORT  
Year : 2019  |  Volume : 62  |  Issue : 2  |  Page : 310-312
A pregnant woman with condyloma acuminatum on the vaginal orifice, areola, groin, and umbilicus


1 Infectious Disease Center, Peking University Ditan Teaching Hospital, Beijing, China
2 Department of Pathology, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing, China
3 Infectious Disease Center, Peking University Ditan Teaching Hospital; Department of Dermatology and Venereology, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing, China

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Date of Web Publication10-Apr-2019
 

   Abstract 


Condyloma acuminatum (CA) is a benign tumor primarily caused by infection with human papillomavirus (HPV) type-6 or type-11, lesions of which are most frequently found on the genital, perianal squamous mucosa, and skin. CA outside the anogenital region is not common. Here, we report a case showing simultaneous presence of CA on the vaginal orifice, areola, groin, and umbilicus in a 32-year-old pregnant woman. Histopathological examination and HPV detection are essential in making a definitive diagnosis of CA on multiple sites. The patient was treated with microwave and liquid nitrogen cryotherapy, but repeated relapse of the lesions were observed. Patients with CA during pregnancy represent a special risk group. These cases are usually characterized by fast-growing warts, multi-site or special site warts, a reduced tolerance, and poor response to treatment. Hence, we should pay more attention to CA in pregnant women in the process of diagnosis and treatment, especially cases outside the anogenital region.

Keywords: Condyloma acuminatum, human papillomavirus, multi-site, pregnancy

How to cite this article:
Song G, Zhou X, Wu Y. A pregnant woman with condyloma acuminatum on the vaginal orifice, areola, groin, and umbilicus. Indian J Pathol Microbiol 2019;62:310-2

How to cite this URL:
Song G, Zhou X, Wu Y. A pregnant woman with condyloma acuminatum on the vaginal orifice, areola, groin, and umbilicus. Indian J Pathol Microbiol [serial online] 2019 [cited 2019 Apr 23];62:310-2. Available from: http://www.ijpmonline.org/text.asp?2019/62/2/310/255829





   Introduction Top


Condyloma acuminatum (CA) is a benign tumor primarily caused by infection with human papillomavirus (HPV) type-6 or type-11. Although, 90% of HPV infections are manifested within 2 years of infection, it is possible for a latency period to occur, with the first occurrence or a recurrence happening months or even years later. Pregnant women with CA represent a special risk group. During pregnancy, there is a tendency for CA to proliferate and recurrence because of physiological changes to the external genitalia and immunological effects that promote HPV replication. Here, we report an uncommon case wherein a pregnant woman was diagnosed with CA on multiple sites.


   Case History Top


A 32-year-old primipara at 8 months of gestation presented with a 13-month history of multiple flat nodular lesions on different sites. HIV antibody screening and serological tests for syphilis were negative.

Thirteen months ago, approximately 5 months before pregnancy, the patient noticed some verrucous nodules on the vaginal orifice which she ignored because of its slow growth. During second month of pregnancy, these nodules began to grow rapidly and became wart like in appearance. She was diagnosed as a case of CA of vaginal orifice at the local hospital and treated with cryotherapy combined with microwave [Microwave therapy is a common method to treat CA in China. It applies ultra-high frequency electromagnetic waves with a wavelength of 1 m to 1 mm (300–30,000 MHz) to the human body, and can be used to remove warts through thermic effect and biological effect.] But the response to treatment was not satisfactory. Repeated relapse of the lesions and appearance of new warts were observed every following week. The shortest recurrence time was 2–3 days. HPV type-6 was identified from the scrapes of the lesion by flow hybridization and gene chip (Hybribio, Guangdong, China).

At around fifth month of pregnancy, the patient noted a flat wart on the left areola [Figure 1]a, which gradually became elevated. Half a month later a similar wart appeared on the right side [Figure 1]b. A excision biopsy [Figure 1]c and [Figure 1]d was carried out from the wart of areola. Histopathological examination revealed massive epidermal hyperplasia, hyperkeratosis, parakeratosis, and koilocytosis, which was consistent with the diagnosis of CA. HPV type-6 was also identified from the excised tissue. The patient was treated with microwave, but at the seventh month of pregnancy there were some recurrent warts on both the areolae.
Figure 1: (a) Condyloma acuminatum on the left areola. (b) Condyloma acuminatum on the right areola. (c) Histological examination from the wart of areola showed hyperkeratosis, parakeratosis, and papillomatosis (hematoxylin and eosin stain; original magnification × 200). (d) Some keratinocytes with vacuolated cytoplasm (koilocytes) were noted (H and E stain; ×400)

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During fifth month of pregnancy, there was a point-like neoplasm on the left groin [Figure 2]a, followed by a similar neoplasm on the right groin a month later [Figure 2]b. Histologic findings revealed koilocytosis [Figure 2]c and [Figure 2]d and HPV DNA testof the tissue revealed an infection with HPV type-11, which were consistent with the diagnosis of CA. No recurrence was found during the follow-up period.
Figure 2: (a) Condyloma acuminatum on the left groin. (b) Condyloma acuminatum on the right groin.(c) Histological examination of the groin revealed koilocytosis (H and E stain; ×200). (d) Histological examination of the groin revealed koilocytosis (H and E stain; ×400)

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During seventh month of pregnancy, a physical examination revealed a papillary lesion on the umbilicus [Figure 3]a. Histopathological examination of the excised lesion [Figure 3]b revealed massive epidermal hyperplasia, hyperkeratosis, and koilocytosis. HPV type-11 was identified from the lesion. There was no sign of recurrence until now.
Figure 3: (a) Condyloma acuminatum on the umbilicus. (b) Histological examination of the umbilicus revealed massive epidermal hyperplasia, hyperkeratosis, and koilocytosis (H and E stain; ×200). (c) Condyloma acuminatum on the neck. (d) Histological examination of the neck did not reveal koilocytosis (H and E stain; ×200)

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During pregnancy, the patient developed numerous filiform warts on the neck [Figure 3]c, but there had not been any such history before pregnancy. The biopsy [Figure 3]d did not reveal koilocytosis and the HPV test was negative for type-6 or 11.

About 15 months ago, her spouse first discovered the similar lesion on the prepuce and HPV DNA revealed an infection with HPV type-6. He was diagnosed with CA and treated with microwave. There was no sign of recurrence until now. What's more, her newborn was healthy and no infection with HPV was observed for half a year.


   Discussion Top


CA is one of the most common sexually transmitted diseases caused by infection with the HPV, in particular, HPV types 6 and 11. Patients who develop CA during pregnancy constitute a high risk group. The rate of HPV infection during pregnancy is high and the warts tend to enlarge and increase in number due to pregnancy hormones and partial suppression of the immune system.[1],[2] Lesions of CA are most frequently found on the genital, perianal squamous mucosa, and skin, but CA outside the anogenital region is uncommonly seen. A few cases of CA occuring at uncommon sites like the breast, tongue or groin have been reported.[3-5] However, the simultaneous presence of CA on the vaginal orifice, areola, groin, and umbilicus in a pregnant woman is an exceptional finding that, to the best of the authors' knowledge, has not been described previously. This case shows that we should diligently try to identify CA outside the anogenital region in the process of diagnosis and treatment, especially in pregnant women or those with low immunity.

Acknowledgements

We state that the manuscript has been read and approved by all the authors.

Financial support and sponsorship

Beijing Health System High-level Health Technology Talents Training Program (2014-3-094).

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Yavuzcan A, Caglar M, Turan H, Tekin A, Topuz S, Yavuzcan G, et al. The treatment of giant periurethral condyloma in pregnancy using an ultrasonic thermal scalpel: A case report and new single session treatment option. Case Rep Obstet Gynecol 2015;2015:792412.  Back to cited text no. 1
    
2.
Garozzo G, Nuciforo G, Rocchi CM, Bonanno NM, Sampugnaro EG, Piccione S, et al. Buschke-Lowenstein tumour in pregnancy. Eur J Obstet Gynecol Reprod Biol 2003;111:88-90.  Back to cited text no. 2
    
3.
Saeki Y, Sato S, Okajima K, Ando N, Saeki H, Kawase M, et al. Condyloma acuminatum of the nipple and areola. Int J Dermatol 2014;53:e171-2.  Back to cited text no. 3
    
4.
Percinoto AC, Danelon M, Crivelini MM, Cunha RF, Percinoto C. Condyloma acuminata in the tongue and palate of a sexually abused child: A case report. BMC Res Notes 2014;7:467.  Back to cited text no. 4
    
5.
Verma S. Bilateral linear location of condylomata acuminata in the groin: An uncommon presentation aggravated by topical steroids. Indian J Dermatol 2014;59:636.  Back to cited text no. 5
    

Top
Correspondence Address:
Yan Wu
Department of Dermatology and Venereology, Beijing Ditan Hospital Affiliated to Capital Medical University, No. 8 Jing Shun Dong Street, Chaoyang District - 100015, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_518_18

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