Condyloma Acuminatum: Biopsy vs. HPV DNA Test Results

Is it a case of false cauliflower?

Hello, Doctor! Three weeks ago, I visited a urology clinic to examine several white raised lesions on my scrotum.
During the initial examination, the doctor was unsure of the nature of these lesions and performed a skin biopsy.
Ten days later, I returned for a follow-up, and the biopsy report indicated the following: the specimen consists of one tiny piece of grey soft tissue measuring from the scrotum, with the excisional biopsy consistent with condyloma acuminatum.
The sections show a picture consistent with condyloma acuminatum, demonstrating acanthosis and papillomatosis of the overlying squamous epithelium supported by delicate, well-vascularized connective tissue stalks.
Parakeratosis with mild koilocytic changes is scattered throughout the superficial portion of the epithelium.
Limited submucosal tissue is included, and there is no evidence of malignancy in the examined specimen.

The nurse scheduled a laser surgery for removal at a cost of 7,000, and recommended an additional 8,000 for health supplements to boost immunity.
Subsequently, I visited another non-insured urology and sexually transmitted disease clinic, where I was again diagnosed with condyloma.
The growth areas included several lesions around the anal region and on the scrotum.
I immediately underwent electrosurgical treatment costing 7,000, along with injections and medications (including oral and topical treatments) without a prescription.
When I inquired about the purpose of the medications, I was told they were antiviral.
Each follow-up visit incurs a medication cost of 3,000.
At that clinic, I also underwent HPV DNA testing, which returned a negative result.
When I asked the doctor about this, they were unsure of the reason.
1.
Should I seek a third hospital for a second opinion?
2.
Should I trust the pathology biopsy report or the HPV DNA test results?

felix, 40~49 year old female. Ask Date: 2016/09/07

Dr. Wu Yuxin reply Dermatology

The pathology report indicates cauliflower, so there is no issue of pseudocauliflower (in fact, there is no diagnosis of pseudocauliflower).

Reply Date: 2016/09/07

More Info

Understanding the relationship between biopsy results for Condyloma Acuminatum (genital warts) and HPV DNA test results can be quite complex. Let's break down the findings and address your questions systematically.

Biopsy Results
Your biopsy report indicates that the tissue examined is consistent with Condyloma Acuminatum. This condition is caused by certain strains of the Human Papillomavirus (HPV), particularly the low-risk types, which are not typically associated with cancer. The report describes features such as acanthosis (thickening of the skin), papillomatosis (nipple-like projections), and koilocytic changes, which are characteristic of HPV infection. Importantly, the report states that there is no evidence of malignancy, which is a positive finding.

HPV DNA Test Results
On the other hand, your HPV DNA test results came back negative. This can be puzzling, especially since the biopsy confirmed the presence of Condyloma Acuminatum. Here are a few points to consider regarding this discrepancy:
1. Timing of Infection: HPV infections can be transient. It is possible that the HPV virus was present at one time but was cleared by your immune system by the time the DNA test was conducted. This is particularly common with low-risk HPV types that cause genital warts.

2. Detection Limits: The HPV DNA test is designed to detect the presence of viral DNA in the sample. If the viral load is very low or if the infection has resolved, the test may return a negative result even if there was a previous infection.

3. Biopsy vs. HPV Testing: The biopsy provides a direct examination of the tissue and can confirm the presence of changes associated with HPV infection, while the HPV DNA test assesses whether the virus is currently detectable in the body. In your case, the biopsy confirms the presence of the effects of HPV, while the DNA test indicates that the virus may no longer be present.

Recommendations
1. Seek a Third Opinion: If you are uncertain about the diagnosis or the treatment plan, it is reasonable to seek a second or even third opinion from another healthcare provider. This can provide you with more clarity and confidence in your treatment options.

2. Trust the Biopsy: Given that the biopsy provides histological evidence of Condyloma Acuminatum, it is a reliable indicator of the condition. The HPV DNA test, while useful, may not always correlate with the presence of the disease, especially in cases where the virus has been cleared.

3. Treatment Options: Since you have been diagnosed with Condyloma Acuminatum, treatment options typically include topical therapies, cryotherapy, laser treatment, or surgical excision. It is essential to discuss these options with your healthcare provider to determine the best course of action based on your specific situation.

4. Follow-Up Care: Regular follow-up appointments are crucial to monitor any recurrence of warts and to manage any potential complications. Your healthcare provider can guide you on the appropriate schedule for follow-ups.

5. Education on HPV: Understanding HPV and its implications is vital. While low-risk HPV types can cause warts, they are not associated with cancer. However, high-risk HPV types can lead to cervical and other genital cancers, so it is essential to stay informed and engage in preventive measures, such as regular screenings.

Conclusion
In summary, the biopsy results indicating Condyloma Acuminatum are significant and should guide your treatment decisions. The negative HPV DNA test may reflect a transient infection or the resolution of the virus. Seeking further medical advice and understanding your treatment options will empower you to manage your health effectively. Always feel free to ask your healthcare provider any questions you may have regarding your diagnosis and treatment plan.

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