Current Update on the Treatment of Genital Warts

Valerie R Yanofsky; Rita V Linkner; David Pompei; Gary Goldenberg

Disclosures

Expert Rev Dermatol. 2013;8(3):321-332. 

In This Article

Dermatopathology

HPV-infected cells can often be identified under the microscope based on their unique histopathological features. Typically, the epidermis will demonstrate a marked acanthosis with varying degrees of papillomatosis, hyperkeratosis and parakeratosis. This is frequently associated with a complete effacement of the granular cell layer.[15] Rete ridges are often elongated and tend to point inward towards the center of the lesion, and the dermis often displays increased vascularization including thrombosed capillaries. The hallmark of HPV infection, however, remains as the development of koilocytes, which are morphologically atypical keratinocytes that are grossly enlarged and contain eccentric, pyknotic nuclei surrounded by a perinuclear halo.

Despite these characteristic features, lesions can occasionally be morphologically ambiguous, in which case electron microscopy and an immunohistochemical peroxidase–antiperoxidase stain can provide a definitive diagnosis,[16] enabling direct visualization of viral particles within host cells. Furthermore, this can be supplemented with the use of MIB-1, a monoclonal antibody that targets the cell cycle-associated Ki-67 antigen, and can help highlight the presence of rapidly proliferating HPV-infected cells.[17]

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