Condyloma Acuminatum

00:01 Our topic here is still vulvar pathology.

00:04 I’ll tell you at some point when we actually leave this behind, but this is going to be an infection of the vulvar region.

00:11 This, obviously, is referring to what's known as your HPV.

00:15 And these would be the low-risk strains since we’re talking about wart.

00:16 since we’re talking about wart.

00:19 Now, the warts here are going to be quite obvious when you actually see it.

00:24 And the type of histologic picture that you’d find with HPV, and specifically, condyloma acuminata, is accumulation of koilocytes if that helps you.

00:36 The reason that I’m emphasizing or exaggerating such a pronunciation is because you cannot afford to get acuminata confused with condylomata lata.

00:46 Condylomata lata is found with syphilis.

00:50 This is condyloma acuminata or acuminatum, and you’re accumulating koilocytes if that helps you, HPV.

00:58 Branching, tree-like proliferation of stratified squamous epithelium supported by fibrous stroma is what we’re seeing here on this histologic picture.

01:09 There’s branching, tree-like proliferation of stratified squamous, underlying fibrosis.

01:15 There will be thickened epithelium with koilocytes.

01:19 Koilocytes are these cells that are appearing as being blank or pale or empty.

01:27 And then you find a peripherally located hyper-eosinophilic nucleus.

01:32 Nuclear atypia in surface cells with perinuclear vacuolization.

01:37 So there’s going to be a clear halo in which then the nucleus has been pushed out to the side, which will then appear as being darkened.

01:45 You’ve seen this in microbiology.

01:47 I just wish to reinforce something that you’ve seen already.

01:51 These would be the low-risk strains of HPV for warts, 6 and 11.

01:55 Please do not forget about condyloma acuminata with warts.

02:00 Now what you’re seeing here on gross examination is exactly what you’d expect with warts on your left.

02:05 There’s absolutely no way that you can miss this.

02:08 On the right, the condyloma acuminata, accumulation of koilocytes.

02:12 And the cell that you see there in the middle there are those clear vacuolizations or clear halo.

02:18 And the nucleus will then appear as being hyper-eosinophilic or a little bit darker.

02:24 These are koilocytes.

02:26 We should point out to you there will be another Paget's -- Excuse me.

02:29 another vulvar disease we’ll take a look at known as Paget’s disease of the vulva, and those cells will be quite different.

02:36 They will not have clear vacuoles.

02:38 It is important that you know the histologic pictures of some of these conditions.