Oral condyloma acuminatum: a clinicopathologic study of 25 cases

Introduction

Condyloma acuminatum (CondA) is a benign proliferative lesion of the squamous epithelium caused by the human papillomavirus (HPV), most often HPV-6 and -11. It presents as single or multiple papular or papillary lesions commonly found on anogenital skin and mucosa. CondA of the oral cavity was reported to mostly occur in sexually active men in the third and fourth decades. The objective of this study is to characterize the clinical and histopathologic features of a series of oral CondA.

Materials and Methods

Cases were identified from the archives of StrataDx Inc. from March 2020 to September 2022. Clinical data and histopathologic features were evaluated.

Results

There were 25 biopsies from 24 patients with 19 males (79.2%) and M:F of 3.8:1. The median age was 59 years (range 27-84 years); 76.0% of patients were 50 years or older. The most frequently affected site was the lower lip mucosa (28.0%); the ventral tongue, dorsal tongue, floor of mouth, and palatal mucosa were involved in 12.0% of cases each. CondA showed subtle or obvious papillary squamous epithelial hyperplasia with mild parakeratosis and bulbous rete ridges, arising from a sessile base. All cases exhibited cytologic atypia and intra-epithelial and stromal inflammation were noted in 32.0% and 52.0% of cases respectively. Apoptotic cells, karyorrhectic cells, and koilocytes were present in all cases and the mitotic count varied from 1 to 18 mitoses/10 high-power fields (median = 9 mitoses). All cases tested positive for HPV-6 and -11 by in situ hybridization.

Conclusions

Oral CondA mostly occurred in males generally in the sixth decade and older. It should be distinguished from other histologic mimics, including squamous papilloma but especially bluntly invasive squamous cell carcinoma and verrucous carcinoma because epithelial hyperplasia may be marked and there is generally significant cytologic atypia.