Anus and Perianus: Condyloma Acuminatum
Differential Diagnosis
- Nonspecific hyperplasia
- Fibroepithelial polyp / skin tag
- Verrucous carcinoma
- Podophylin effect vs carcinoma in situ
- Issues related to HSIL
| Condyloma Acuminatum | Non-specific Squamous Hyperplasia |
| Koilocytes at least focally present | No koilocytes |
| Prominent parakeratosis | Parakeratosis unusual |
| Condyloma Acuminatum | Fibroepithelial Polyp |
| Koilocytes at least focally present | No Koilocytes |
| Prominent parakeratosis | Parakeratosis unusual |
| Lacks central stromal component | Central stromal component, frequently with atypical stromal cells |
| Verrucous Carcinoma of the Anus | Condyloma Acuminatum |
| Usually large | Usually small |
| Blunt destructive downward growth | Superficial lesion, no destructive growth |
| May develop fistulas and sinuses | Does not produce fistulas or sinuses |
- Condyloma with podophyllin effect should be distinguished from HSIL
- Podophyllin does not produce:
- Cytologic dysplasia
- Disturbance of maturation
- Dyskeratosis
- Early podophyllin effects (≤48 hours post application)
- Intra- and intercellular edema
- Necrotic keratinocytes in lower half of epithelium
- Numerous mitotic figures in lower half of epithelium
- Changes resolving by 72 hours
- Necrotic keratinocytes now in upper half of epithelium
- Fewer mitotic figures
- Changes entirely resolved by one week
Differential diagnosis related to the presence of HSIL in a condyloma is covered under Anal Dysplasia
