Case Number : Case 772 - 3rd June Posted By: Guest

Condyloma

Pearly penile papule.

Agree, pearly penile papule.

Don't biopsy these often as this is really a clinical diagnosis. But agree that would be consistent with pearly penile papules.

Hmm. This looks more like an acanthotic epidermal proliferation than an angiofibroma, as pearly penile papule would be. I'm leaning towards a subtle condyloma, although I'd like more clinical info or photos.

Clinical is critical on this one. Non-specific changes, favor subtle condyloma in the appropriate clinical context. I would have trouble calling this pearly penile papule from these photos. As mentioned by sfwenson,convincing fibrous-papule-like dermal features appear absent.

There is tangential orientation (supported by the en face folliculosebaceous unit and dermal pegs) that makes assessment of acanthosis vs. angiofibroma-like dermal expansion more difficult, but nevertheless neither acanthosis nor dermal expansion seems prominent.

There are very subtle epidermal features that would suggest a condyloma in the appropriate clinical context, as there is slightly increased nuclear size, subtly increased pleomorphism, and binucleation in the suprabasal layer, with binucleation extending to the granular layer. (Arguably, this could also be non-specific and reactive, in the absence of overt koilocytosis.)

Bowenoid papulosis.

agree on pearly penile papules (couldn't find koilocytes or overt dysplasia)

I thought it had a condylomatous profile (rather rounded acanthosis). I don't see obvious koilocytosis not that this would necessarily rule out a condyloma. Diagnosing viral warts can be a little concerning for clinicians and patients so I might couch it something like this: Vaguely condylomatous bland papular acanthotic lesion please correlate clinically!!

Favoring condyloma, for clinical correlation

This is a case of condyloma accuminatum.