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. 1989 Aug;65(4):216–224. doi: 10.1136/sti.65.4.216

Anal condylomas in men. 1. Histopathological and virological assessment.

S M Syrjänen 1, G von Krogh 1, K J Syrjänen 1
PMCID: PMC1194355  PMID: 2553581

Abstract

A series of 128 biopsy specimens from anal condylomas in 73 homosexual or bisexual and 38 heterosexual men (mean (SD) age 31.8 (9.6) years) were subjected to histological assessment and human papillomavirus (HPV) typing by in situ DNA hybridisation with 35S-labelled HPV 6, 11, 16, 18, 31, and 33 probes. Most patients were also tested serologically for antibodies to human immunodeficiency virus (HIV). As evaluated on light microscopy, most (74%, 95/128) of the lesions were exophytic (papillary) acuminate warts, 15% (19) were flat, and 11% (14) were pigmented papulous lesions. No signs of anal intraepithelial neoplasia (AIN) were seen in 70% (90) of the 128 biopsy specimens (NAIN), 27% (35) were classified as showing AIN I, and another 2% (three) as AIN II. AIN was significantly (p less than 0.05) more often associated with papulous lesions, only 43% (6/14) of which showed NAIN compared with 72% (68/98) of acuminate condylomas. The duration of disease was directly related to the presence and severity of AIN in the lesions; thus in 47 lesions that had been present for more than 12 months, NAIN was found in 31 (66%), AIN I in 14 (30%), and AIN II in two (4%). HPV DNA of at least one of the six types tested for was detected in 109/125 (87%) lesions. HPV 6 and HPV 11 were the two most common types, comprising 57% (62) and 37% (40), respectively, of the 109 HPV DNA positive cases. Only seven (6%) biopsy specimens were associated with any of HPV types 16, 18, 31, or 33, which carry a high risk of potential malignant transformation. No association was found between sexual preferences of patients and the incidence of any of the various HPV types. Neither did the distribution of the various HPV types differ between men with antibody to HIV and those without antibody. All the men with antibody to HIV were homosexual or bisexual. On microscopy, 93% (38) of 41 lesions containing HPV 11 and 75% (48/64) of HPV 6 lesions were of the acuminate wart type; in comparison, the remaining 16 HPV 6 lesions were equally either flat or papulous (eight, 13% each). Of the 64 HPV 6 and 41 HPV 11 associated lesions, 73% (47) and 63% (26), respectively, were classified as NAIN. Only two lesions were associated with HPV 16, and both showed mild dysplasia. On the other hand, two HPV 6 induced lesions were associated with AIN II. No differences were found between HPV 6 and HPV 11 in duration of disease; (39%, and 27% respectively, had been present for more than 12 months). The results showed that overt anal wart disease was associated with HPV types 6 and 11 in most cases. Although HPV types considered as being of higher oncogenic potential were detected relatively rarely, the associated AIN in a relatively high proportion (31% 32/105) of HPV 6 or 11 induced lesions indicated that a malignant potential, even for HPV 11 associated anal warts, cannot be excluded.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Carr G., William D. C. Anal warts in a population of gay men in New York City. Sex Transm Dis. 1977 Apr-Jun;4(2):56–57. doi: 10.1097/00007435-197704000-00006. [DOI] [PubMed] [Google Scholar]
  2. Choo Y. C., Morley G. W. Multiple primary neoplasms of the anogenital region. Obstet Gynecol. 1980 Sep;56(3):365–369. [PubMed] [Google Scholar]
  3. Croxson T., Chabon A. B., Rorat E., Barash I. M. Intraepithelial carcinoma of the anus in homosexual men. Dis Colon Rectum. 1984 May;27(5):325–330. doi: 10.1007/BF02555647. [DOI] [PubMed] [Google Scholar]
  4. Dürst M., Gissmann L., Ikenberg H., zur Hausen H. A papillomavirus DNA from a cervical carcinoma and its prevalence in cancer biopsy samples from different geographic regions. Proc Natl Acad Sci U S A. 1983 Jun;80(12):3812–3815. doi: 10.1073/pnas.80.12.3812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ejeckam G. C., Idikio H. A., Nayak V., Gardiner J. P. Malignant transformation in an anal condyloma acuminatum. Can J Surg. 1983 Mar;26(2):170–173. [PubMed] [Google Scholar]
  6. Fenger C., Nielsen V. T. Intraepithelial neoplasia in the anal canal. The appearance and relation to genital neoplasia. Acta Pathol Microbiol Immunol Scand A. 1986 Sep;94(5):343–349. doi: 10.1111/j.1699-0463.1986.tb03003.x. [DOI] [PubMed] [Google Scholar]
  7. Fiumara N. J., Wagner R. F. Perianal Bowen's disease associated with anorectal warts: a case report. Sex Transm Dis. 1987 Jan-Mar;14(1):58–60. doi: 10.1097/00007435-198701000-00014. [DOI] [PubMed] [Google Scholar]
  8. Fleming K. A., Venning V., Evans M. DNA typing of genital warts and diagnosis of sexual abuse of children. Lancet. 1987 Aug 22;2(8556):454–454. doi: 10.1016/s0140-6736(87)90987-1. [DOI] [PubMed] [Google Scholar]
  9. Gal A. A., Meyer P. R., Taylor C. R. Papillomavirus antigens in anorectal condyloma and carcinoma in homosexual men. JAMA. 1987 Jan 16;257(3):337–340. [PubMed] [Google Scholar]
  10. Gross G., Gissmann L. Urogenitale und anale Papillomvirusinfektionen. Hautarzt. 1986 Nov;37(11):587–596. [PubMed] [Google Scholar]
  11. Gross G., Hagedorn M., Ikenberg H., Rufli T., Dahlet C., Grosshans E., Gissmann L. Bowenoid papulosis. Presence of human papillomavirus (HPV) structural antigens and of HPV 16-related DNA sequences. Arch Dermatol. 1985 Jul;121(7):858–863. doi: 10.1001/archderm.121.7.858. [DOI] [PubMed] [Google Scholar]
  12. Gross G., Ikenberg H., Gissmann L., Hagedorn M. Papillomavirus infection of the anogenital region: correlation between histology, clinical picture, and virus type. Proposal of a new nomenclature. J Invest Dermatol. 1985 Aug;85(2):147–152. doi: 10.1111/1523-1747.ep12276576. [DOI] [PubMed] [Google Scholar]
  13. Henderson B. R., Thompson C. H., Rose B. R., Cossart Y. E., Morris B. J. Detection of specific types of human papillomavirus in cervical scrapes, anal scrapes, and anogenital biopsies by DNA hybridization. J Med Virol. 1987 Apr;21(4):381–393. doi: 10.1002/jmv.1890210410. [DOI] [PubMed] [Google Scholar]
  14. Hill S. A., Coghill S. B. Human papillomavirus in squamous carcinoma of anus. Lancet. 1986 Dec 6;2(8519):1333–1333. doi: 10.1016/s0140-6736(86)91458-3. [DOI] [PubMed] [Google Scholar]
  15. Hills E., Laverty C. R. Electron microscopic detection of papilloma virus particles in selected koilocytotic cells in a routine cervical smear. Acta Cytol. 1979 Jan-Feb;23(1):53–56. [PubMed] [Google Scholar]
  16. Ikenberg H., Gissmann L., Gross G., Grussendorf-Conen E. I., zur Hausen H. Human papillomavirus type-16-related DNA in genital Bowen's disease and in Bowenoid papulosis. Int J Cancer. 1983 Nov 15;32(5):563–565. doi: 10.1002/ijc.2910320507. [DOI] [PubMed] [Google Scholar]
  17. Lee S. H., McGregor D. H., Kuziez M. N. Malignant transformation of perianal condyloma acuminatum: a case report with review of the literature. Dis Colon Rectum. 1981 Sep;24(6):462–467. doi: 10.1007/BF02626784. [DOI] [PubMed] [Google Scholar]
  18. Moore G. E., Norton L. W., Meiselbaugh D. M. Condyloma. A new epidemic. Arch Surg. 1978 May;113(5):630–631. doi: 10.1001/archsurg.1978.01370170092018. [DOI] [PubMed] [Google Scholar]
  19. Oriel J. D. Anal warts and anal coitus. Br J Vener Dis. 1971 Oct;47(5):373–376. doi: 10.1136/sti.47.5.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Oriel J. D. Genital warts. Sex Transm Dis. 1981 Oct-Dec;8(4 Suppl):326–329. [PubMed] [Google Scholar]
  21. Oriel J. D., Whimster I. W. Carcinoma in situ associated with virus-containing anal warts. Br J Dermatol. 1971 Jan;84(1):71–73. doi: 10.1111/j.1365-2133.1971.tb14199.x. [DOI] [PubMed] [Google Scholar]
  22. Palmer J. G., Shepherd N. A., Jass J. R., Crawford L. V., Northover J. M. Human papillomavirus type 16 DNA in anal squamous cell carcinoma. Lancet. 1987 Jul 4;2(8549):42–42. doi: 10.1016/s0140-6736(87)93075-3. [DOI] [PubMed] [Google Scholar]
  23. Patterson J. W., Kao G. F., Graham J. H., Helwig E. B. Bowenoid papulosis. A clinicopathologic study with ultrastructural observations. Cancer. 1986 Feb 15;57(4):823–836. doi: 10.1002/1097-0142(19860215)57:4<823::aid-cncr2820570424>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  24. Penn I. Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases. Cancer. 1986 Aug 1;58(3):611–616. doi: 10.1002/1097-0142(19860801)58:3<611::aid-cncr2820580303>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  25. Prasad M. L., Abcarian H. Malignant potential of perianal condyloma acuminatum. Dis Colon Rectum. 1980 Apr;23(3):191–197. doi: 10.1007/BF02587626. [DOI] [PubMed] [Google Scholar]
  26. Rathjen F. G., Schachner M. Immunocytological and biochemical characterization of a new neuronal cell surface component (L1 antigen) which is involved in cell adhesion. EMBO J. 1984 Jan;3(1):1–10. doi: 10.1002/j.1460-2075.1984.tb01753.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Syrjänen K. J. Biology of human papillomavirus (HPV) infections and their role in squamous cell carcinogenesis. Med Biol. 1987;65(1):21–39. [PubMed] [Google Scholar]
  28. Syrjänen K. J. Human papillomavirus lesions in association with cervical dysplasias and neoplasias. Obstet Gynecol. 1983 Nov;62(5):617–624. [PubMed] [Google Scholar]
  29. Syrjänen S. M., von Krogh G., Syrjänen K. J. Detection of human papillomavirus DNA in anogenital condylomata in men using in situ DNA hybridisation applied to paraffin sections. Genitourin Med. 1987 Feb;63(1):32–39. doi: 10.1136/sti.63.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Syrjänen S., Partanen P., Mäntyjärvi R., Syrjänen K. Sensitivity of in situ hybridization techniques using biotin- and 35S-labeled human papillomavirus (HPV) DNA probes. J Virol Methods. 1988 Mar-Apr;19(3-4):225–238. doi: 10.1016/0166-0934(88)90017-1. [DOI] [PubMed] [Google Scholar]
  31. Syrjänen S., Syrjänen K. An improved in situ DNA hybridization protocol for detection of human papillomavirus (HPV) DNA sequences in paraffin-embedded biopsies. J Virol Methods. 1986 Nov;14(3-4):293–304. doi: 10.1016/0166-0934(86)90031-5. [DOI] [PubMed] [Google Scholar]
  32. Syrjänen S., Syrjänen K., Mäntyjärvi R., Parkkinen S., Väyrynen M., Saarikoski S., Castren O. Human papillomavirus (HPV) DNA sequences demonstrated by in situ DNA hybridization in serial paraffin-embedded cervical biopsies. Arch Gynecol. 1986;239(1):39–48. doi: 10.1007/BF02134287. [DOI] [PubMed] [Google Scholar]
  33. Vallejos H., Del Mistro A., Kleinhaus S., Braunstein J. D., Halwer M., Koss L. G. Characterization of human papilloma virus types in condylomata acuminata in children by in situ hybridization. Lab Invest. 1987 Jun;56(6):611–615. [PubMed] [Google Scholar]
  34. Van Cutsem J., Janssen P. A. Experimental systemic dermatophytosis. J Invest Dermatol. 1984 Jul;83(1):26–31. doi: 10.1111/1523-1747.ep12261652. [DOI] [PubMed] [Google Scholar]
  35. Wells M., Griffiths S., Lewis F., Bird C. C. Demonstration of human papillomavirus types in paraffin processed tissue from human ano-genital lesions by in-situ DNA hybridisation. J Pathol. 1987 Jun;152(2):77–82. doi: 10.1002/path.1711520203. [DOI] [PubMed] [Google Scholar]
  36. Wells M., Robertson S., Lewis F., Dixon M. F. Squamous carcinoma arising in a giant peri-anal condyloma associated with human papillomavirus types 6 and 11. Histopathology. 1988 Mar;12(3):319–323. doi: 10.1111/j.1365-2559.1988.tb01946.x. [DOI] [PubMed] [Google Scholar]

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