Quick Review for Patients
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Yet another papilloma look-alike lesion is the HPV-induced condyloma acuminatum (condyloma = "knuckle or knob"), an epithelial proliferation considered to be a sexually transmitted disease (STD). The condyloma develops at a site of sexual contact or trauma and is, therefore, much more common in the anogenital region, where it represents approximately 20% of all STDs. Not surprising, the virus involved with oral condyloma acuminatum is HPV, especially subtypes HPV-6, HPV-11, HPV-16, and HPV-18. The later two subtypes are among those associated with carcinoma and epithelial dysplasia of genital mucosa, perhaps explaining why the condyloma is considered a premalignant lesion by many. For reasons unknown, this precancerous character does not seem to be a part of condylomas arising from oral and oropharyngeal mucosa.
It is not unusual for a patient with a condyloma to have multiple STDs and so caution is advised relative to infection control procedures in the dental office. This multi-disease feature is so strong, in fact, that the genital condyloma was once thought to be a characteristic feature of syphilis rather than a separate entity. The condyloma is very contagious and may spread by auto-inoculation to other sites of trauma.
Pathology and Differential Diagnosis
The covering epithelium is mature and differentiated, but superficial keratinocytes commonly contain pyknotic nuclei surrounded by clear zones (koilocytes), a classical microscopic feature of HPV infections. Ultrastructural examination will reveal virions within the cytoplasm and/or nuclei of koilocytes and the virus also can be demonstrated by immunohistochemistry, in situ hybridization and polymerase chain reaction techniques. The diagnosis, however, seldom requires the use of special methods. The reader is referred to the pathology section of the discussion of the squamous papilloma for a review of the differential diagnosis of oral papillary lesions with similarities to condyloma.
Treatment and Prognosis
In the anogenital area, this lesion may demonstrate a premalignant character, especially when infected with HPV subtypes 16 and 18, but this has not been demonstrated in oral lesions. It should be remembered that condyloma may be an oral manifestation of a greater problem, such as child sexual abuse or HIV infection.
References (Chronologic Order)
Note: Click on underlined author's names for additional detail.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. Philadelphia, W. B. Saunders; 1995.
Elder D, Elenitsas R, Jaworsky C, Johnson B Jr. Lever's Histopathology of the skin, 8th edition. Philadelphia; Lippincott-Raven, 1997.
Sapp JP, Eversole LR, Wysocki GP. Contemporary oral and maxillofacial pathology. Mosby; St. Louis, 1997.
Odell EW, Morgan PR. Biopsy pathology of the oral tissues. London; Chapman & hall Medical, 1998.
Silverman S Jr, Migliorata CA, Lazada-Nur F, et al. Oral findings in people with or at high-risk for AIDS: a study of 375 homosexual males. J Am Dent Assoc 1986; 112: 187-192.
Zunt S, Tomich CE. Oral condyloma acuminatum. J Dermatol Surg Oncol 1989; 15: 591-594.
Barone R, Ficarra G, Gaglioti D, et al. Prevalence of oral lesions among HIV-infected intravenous drug abusers and other risk groups. Oral Surg Oral Med Oral Pathol 1990; 69: 169-173.
Sykes NL. Condyloma acuminatum. Int J Dermatol 1995; 34:297-302.
Suskind DL, et al. Condyloma acuminatum presenting as a base-of-tongue mass. Otolaryngol Head Neck Surg 1996; 114:487-490.
Simon PA. Oral condyloma acuminatum as an indicator of sexual abuse: dentistry's role. Quintessence Int 1998; 29:455-458.
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