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Atypical morphology of anogenital warts is not a marker of atypical histology or of infection to the high‐risk human papillomavirus genotypes
Author(s) -
Kumar Pankaj,
Bhari Neetu,
Gupta Vishal,
Ramachandran V. G.,
Arava Sudheer,
Dar Lalit,
Sharma Vinod K.,
Verma Kaushal K.,
Dwivedi Sada N.,
Gupta Somesh
Publication year - 2017
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.13711
Subject(s) - medicine , condyloma acuminatum , pathology , histology , hpv infection , dysplasia , papillomaviridae , immunohistochemistry , dermatology , human papillomavirus , cervical cancer , cancer
Background The clinical morphology of anogenital warts may vary from flat, filiform, papular, or verrucous to giant condyloma acuminatum. Clinically atypical‐looking genital warts may alarm the clinician because of their suspected malignant potential, which may cause anxiety, often leading to aggressive interventions. Objective To study if clinically atypical‐looking anogenital warts are more likely to be premalignant or malignant as compared to typical warts. Method Data of 41 (37 males, 4 females) patients with anogenital warts was retrospectively analyzed. After a detailed literature review and in‐house discussions, criteria for anogenital warts with typical and atypical clinical morphology were defined. Clinical photographs were independently reviewed by three dermatologists, and human papillomavirus (HPV) genotyping results, histological evaluation, and immunohistochemical analysis for p53 expression were evaluated. Results Fifteen (36.6%) anogenital warts were classified as atypical by at least two of three blinded dermatologists. The histological examination showed mitotic figures in 31/41 (75.6%) specimens, dysplasia in 14/41 (44.1%) specimens, and p53 positivity in 34/41 (82.9%) specimens. There was no significant difference in the high‐risk HPV genotyping ( P = 0.67), frequency of dysplastic changes on histology ( P = 0.19), and immunohistochemistry with p53 ( P = 0.08) between clinically typical and atypical‐appearing anogenital warts. Similarly, no significant difference was found in the frequency of dysplastic changes ( P = 0.67) or p53 expressions ( P =0.41) based on the HPV genotypes. Conclusions The atypical clinical morphology of anogenital warts may not be a marker of increased malignant potential. High‐risk HPV genotypes do not have a statistically significant association with dysplasia or positive immunohistochemistry with p53.