Pathology Reports: Differing Diagnoses in Urology

Interpretation of pathology reports varies?

Hello Doctor, eight years ago I had warts on my foreskin, which were surgically removed.
Since then, I occasionally notice one or two small bumps.
I have consulted one or two doctors, and they only performed cryotherapy.
Recently, I discovered many small bumps around my anal area.
The initial evaluations by dermatology and colorectal specialists both diagnosed them as warts.
After a biopsy, the pathology report indicated squamous papilloma, but they have recurred every two to three days.
Both doctors I consulted said they are not warts; one suggested I could ignore them, while the other advised to seek treatment only if I experience discomfort.
I then visited another hospital's colorectal department, where the doctor also identified them as a type of wart and prescribed a topical treatment (a wart removal solution).
However, after just one application, it caused bleeding, so I stopped the medication.
Once the wound healed, I switched to a wart gel, which took about a month to flatten the bumps.
I am now very worried because I have never had anal sexual contact.
During my initial consultation, the doctor emphasized that this is an infection from intimate contact.
Is it possible that my pathology report is incorrect, or can it still be interpreted as warts? The interpretations from the two hospitals differ, and I am quite troubled.
Could you help clarify this for me? Thank you.

Qiang, 30~39 year old female. Ask Date: 2015/10/22

Dr. Xu Weikai reply Urology

Hello, based on what you said, I cannot make a judgment.
Generally, the pathological report is considered the standard.
When combined with the clinical physician's diagnosis and treatment, a definitive diagnosis can usually be achieved.
However, after treatment, skin lesions may sometimes undergo changes, presenting differently from typical lesions, which can complicate the clinical physician's assessment.
Therefore, the pathological report becomes the most critical and accurate basis.
Note: The error rate of pathological reports is nearly nonexistent, unless in very rare cases.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Responses on the internet should only serve as a reference; if necessary, it is still important to seek medical care at a healthcare facility.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/10/22

More Info

When dealing with pathology reports, especially in the context of urology and dermatology, it is crucial to understand the nuances of the diagnoses and the implications they carry. In your case, the pathology report indicating "squamous papilloma" raises several important points for consideration.

Firstly, squamous papilloma is a benign epithelial tumor that can appear in various locations, including the genital and anal regions. It is often associated with human papillomavirus (HPV) infection, which is known to cause warts (condylomata acuminata) or "cauliflower-like" growths. The fact that you have a history of similar lesions and have undergone treatment for them suggests a recurring issue, which is not uncommon with HPV-related conditions.

The differing opinions from various healthcare providers can be attributed to the complexity of diagnosing lesions based on visual examination versus histopathological analysis. While some doctors may visually identify the growths as warts, the pathology report provides a more definitive diagnosis based on microscopic examination of the tissue. It is essential to recognize that while squamous papilloma can be a benign finding, it does not rule out the possibility of HPV involvement, which could lead to the development of more concerning lesions in the future.

Regarding your concerns about the accuracy of the pathology report, it is important to understand that while misdiagnosis can occur, it is relatively rare, especially when a qualified pathologist examines the tissue. If there is uncertainty, a second opinion from another pathologist or a specialized center may provide additional clarity. This is particularly relevant if you continue to experience new growths or changes in the existing lesions.

Your worry about the association of these lesions with sexual activity is understandable, especially given the stigma surrounding HPV. However, it is important to note that HPV can be transmitted through non-penetrative sexual contact and even through skin-to-skin contact. Therefore, even without direct anal intercourse, it is possible to contract HPV through other forms of intimate contact.

In terms of management, the recurrence of these lesions suggests that ongoing monitoring and treatment may be necessary. If the lesions are bothersome or if there are changes in size, color, or symptoms, further intervention may be warranted. Treatments can include cryotherapy, topical agents, or surgical excision, depending on the specific characteristics of the lesions and your overall health.

In conclusion, while the pathology report indicates a benign squamous papilloma, it is essential to remain vigilant and maintain open communication with your healthcare providers. Regular follow-ups and monitoring for any changes in the lesions are crucial. If you have persistent concerns or if the lesions continue to recur, seeking a referral to a specialist in dermatology or urology who has experience with HPV-related conditions may provide you with the reassurance and management plan you need. Remember, your health and peace of mind are paramount, and it is always acceptable to seek further clarification and support regarding your condition.

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