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Clinical Images  |   October 2020
Recurrent Condylomata Acuminata in a Transplant Patient
Author Notes
  • From the Department of Gynecologic Surgery (Drs Delara and Wassoon); the Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology (Dr Chen); and the Division of Colon and Rectal Surgery, Department of Surgery (Dr Young-Fadok) at the Mayo Clinic in Phoenix, Arizona. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Ritchie Delara, MD, 5777 E Mayo Blvd, Phoenix, AZ 85054. Email: ritchiemaed@gmail.com
     
Article Information
Gastroenterology / Hypertension/Kidney Disease / Obstetrics and Gynecology
Clinical Images   |   October 2020
Recurrent Condylomata Acuminata in a Transplant Patient
The Journal of the American Osteopathic Association, October 2020, Vol. 120, 711-712. doi:https://doi.org/10.7556/jaoa.2020.126
The Journal of the American Osteopathic Association, October 2020, Vol. 120, 711-712. doi:https://doi.org/10.7556/jaoa.2020.126
A 49-year-old woman presented with recurrent vulvar and perianal condyloma for 1 year (image A). Her medical history included deceased donor renal transplant. She was taking 500 mg of mycophenolate orally twice per day and 2 mg of tracrolimus orally twice per day for immunosuppressive therapy. She had prior wide local excision of bilateral vulva with laser fulguration of a condyloma and subsequent trichloroacetic acid ablation. An anal Papanicolaou test was positive for low-grade squamous intraepithelial lesion (image B). Vulvar and anorectal condyloma excision was performed (image C and image D). Vulvar condylomas were negative for dysplasia and high-risk human papillomavirus. Perianal condylomas were positive for squamous cell carcinoma in situ and positive for (other high-risk) human papillomavirus (image E). 
Women who are immunosuppressed and aged 40 years or older with a history of vulvar or cervical dysplasia have an increased risk for anogenital cancer.1-5 Abnormal cytologic findings should prompt high-resolution anoscopy or referral to colorectal surgery.1,3 When managing benign conditions like vulvar condylomas, gynecologists should strongly consider anal cancer screening using history, examination, and anal cytology with cotesting. 
References
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