This rare condition is important because it can be confused condyloma. A correct diagnosis can save the patient an unecessary and potentially expensive work up. Recent investigative work has found no substantial evidence that this disease is related to Human Papilloma Virus (HPV) infection. It is best considered a variant of the normal vulva anatomy and is a benign condition with no known sinister associations.
Epidemiology Disease Associations Pathogenesis Laboratory/Radiologic/Other Diagnostic Testing Gross Appearance and Clinical Variants Histopathological Features and Variants Differential Diagnosis Commonly Used Terms Internet Links
EPIDEMIOLOGY CHARACTERIZATION SYNONYMS Pseudocondylomata
Hirsuties papillaris vulvae
Pruritic squamous papillomatosis
Hirsutoid papillomas of the vulva
INCIDENCE Rare AGE RANGE-MEDIAN (18-53 years) Mean 29 years
PATHOGENESIS CHARACTERIZATION Considered a female homologue to pearly penile plaques On the penis, located on the corona of the glans penis and are smooth, flesh colored elevations ROLE OF HPV In situ hybridization for Human Papilloma virus 2/29 (6.9%) cases tested were positive which may represent the background frequency of HPV DNA found in the normal vulva Careful clinical and physical examination revealed no evidence of HPV infection either in patients or partners NOTE: Vulvar warts coexisted with papillae in 3/29 (10%) of cases, but located out of the vestibular area
What is vestibular papillomatosis? A study of its prevalence, aetiology and natural history.
Welch JM, Nayagam M, Parry G, Das R, Campbell M, Whatley J, Bradbeer C.
Department of Genitourinary Medicine, St. Thomas' Hospital, London, UK.
Br J Obstet Gynaecol 1993 Oct;100(10):939-42 Abstract quote
OBJECTIVES: To clarify the prevalence, aetiology, symptoms and natural history of vestibular papillomatosis.
DESIGN: Study in two parts: 1. prevalence assessed by colposcopic examination of the vulva of unselected patients by one doctor (J.M.W.); 2. patients selected by clinical appearance as having vestibular papillomatosis (by J.M.W. and other doctors) assessed in a research clinic.
SETTING: Outpatient genitourinary medicine clinic in South London.
SUBJECTS: Part 1 study: 295 female clinic attenders; part 2 study: 18 women with clinical vestibular papillomatosis.
MAIN OUTCOME MEASURES: Part 1 study: number of unselected patients found to have vestibular papillomatosis. Part 2 study: associated symptoms, histology, DNA hybridisation and polymerase chain reaction on vulval biopsies. Clinical regression of lesions. Cervical cytology and colposcopy.
RESULTS: Part 1 study: Vestibular papillomatosis was identified by colposcopic examination of the vulva in 3/295 (1%) of women. Part 2 study: 9/18 (50%) women with vestibular papillomatosis were asymptomatic; the other nine had intermittent mild symptoms. Thirteen (72%) had a history of genital warts. Vulval biopsies had features suggestive of wart virus infection on histology in 17/18 (94%) and HPV16 was found by DNA hybridisation studies or polymerase chain reaction in 7/18 (39%). On follow up (mean duration 9 months) the vulval lesions had regressed in 9/12 patients. Ten patients had cervical wart virus infection or intraepithelial neoplasia (CIN), or both, and five needed laser treatment for this.
CONCLUSIONS: In this study vestibular papillomatosis was associated with human papillomavirus (HPV) infection. This study suggests that vestibular papillomatosis need not be treated, but patients with it may be at increased risk for CIN.
Histologic and biomolecular aspects of papillomatosis of the vulvar vestibule in relation to human papillomavirus.
de Deus JM, Focchi J, Stavale JN, de Lima GR.
Department of Gynecology, Escola Paulista de Medicina, Sao Paulo, Brazil.
Obstet Gynecol 1995 Nov;86(5):758-63 Abstract quote
OBJECTIVE: To determine whether human papillomavirus (HPV) plays a role in the genesis of papillomatosis of the vulvar vestibule.
METHODS: We conducted a study based on molecular hybridization and histology of biopsy material obtained from the inner surface of the labia minora of 25 women with papillomatosis of the vulvar vestibule who presented no abnormal clinical, cytologic, or colposcopic changes in the cervix or vagina. These women were compared with 24 women with condyloma acuminatum of the vulvar vestibule and with ten women with normal vulvar epithelium and no cervicovaginal changes. All patients included in the study were 35 years or younger, and none was pregnant.
RESULTS: Papillomatosis of the vulvar vestibule was rarely found to be HPV positive by molecular hybridization (one of 25, 4%, by dot blot hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]). This result did not differ significantly from that obtained for the group with normal vulvar epithelium (none of 10 by dot blot and none of six by PCR), but did differ (P = .001) from the result obtained for the group with condyloma acuminatum of the vestibule (12 of 24, 50%, by dot blot and six of six, 100%, by PCR). The biomolecular study of vestibular papillomatosis showed that focal koilocytosis was not correlated with HPV infection.
CONCLUSION: Papillomatosis of the vulvar vestibule is not associated with HPV and should be considered a paraphysiologic formation of the vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided in the absence of more explicit clinical-histologic evidence, with no need for biopsies or unnecessary treatments.
Is vestibular micropapillomatosis associated with human papillomavirus infection?
Gentile G, Formelli G, Pelusi G, Flamigni C.
1st Obstetrics and Gynecology Department, University of Bologna, Italy.
Eur J Gynaecol Oncol 1997;18(6):523-5 Abstract quote
The aetiology and clinical significance of vulvar papillomatosis is still controversial. To verify the association of micropapillomatosis labialis with certain types of HPV-related lower genital tract infections, 25 patients with colposcopic aspects of vulvar papillomatosis were recruited and vulvar biopsies were obtained for histologic examination and in situ hybridization. Sixteen patients with vulvodynia, without any pathologic vulvar aspects, served as a control group.
Histologic evidence of HPV was found in 20 cases (80%) of vulvar papillomatosis while only one (4%) of the study patients was positive for HPV-DNA. These results seem to confirm the scarse correlation between vestibular papillomatosis and HPV.
In our opinion physicians must be cautions when treating these lesions even in cases with positive histologic results. Colposcopy is, therefore, of fundamental importance for an accurate diagnosis of vestibular papillomatosis and successful management.
Human papillomavirus with co-existing vulvar vestibulitis syndrome and vestibular papillomatosis.
Origoni M, Rossi M, Ferrari D, Lillo F, Ferrari AG.
Department of Obstetrics and Gynecology, University of Milano School of Medicine, Italy.
Int J Gynaecol Obstet 1999 Mar;64(3):259-63 Abstract quote
OBJECTIVE: The role of HPV infection in cases of vulvar papillomatosis and vulvar vestibulitis syndrome is still unclear and data from the literature is controversial. In this study we intended to investigate the prevalence of viral infection, with a multidisciplinary approach, in cases with a co-existence of the two patterns.
METHOD: Sixteen consecutive cases with diagnosis of vulvar vestibulitis syndrome and co-existence of vestibular papillomatosis were enrolled in the study and investigated by the means of vulvar cytology, vulvoscopy, histology, ViraPap and Polymerase Chain Reaction.
RESULT: Cytology, vulvoscopy and histology did not demonstrate suitable accuracy for the diagnosis. Viral DNA identification revealed two (12.50%) positive cases using PCR and one (6.25%) positive case with ViraPap.
CONCLUSION: The results of the present investigation indicate that even in cases of co-existing vulvar papillomatosis and severe vulvar vestibulitis syndrome, the prevalence of HPV infection is too low to be considered causal.
HISTOLOGICAL TYPES CHARACTERIZATION General Connective tissue papillae with normal covering squamous epithelium
No viral cytopathic changes of HPV
CLINICAL DIFFERENTIAL DIAGNOSIS
CLINICAL FEATURES VESTIBULAR PAPILLAE VESTIBULAR CONDYLOMATA Distribution Symmetrical, linear array Random Palpation Soft Firm Color Pink, same as adjacent mucosa Pink, white, and red lesions Base Bases of individual projections remain separate Superficial filiform projections coalesce in a common base Acetic acid test No circumscribed whitening Whitening in most cases
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