Clonality Of Condyloma Acuminata Of Vulva

Condyloma acuminata is a type of proliferative lesions of squamous epithelium, believed to be caused by chronic infection of human papillomavirus (HPV), frequently of types 6 and 11, and considered a sex-transmitted disease. The lesion is found most frequently in patients aging 20 to 30 years. Some rare cases were found in old patients and children. The nature of condyloma acuminata remains unknown. Many authors consider it a inflammatory reaction. Some authors, however, put the lesion in the category of squamous epithelial neoplasia.To demonstrate the clonality status of condyloma acuminata of vulva, we use an assay based on microdissection and inactivation mosaicism of the length polymorphic X chromosomes at the androgen receptor (AR) locus to examine the clonality of the following tissues: 1) epithelial components of the condyloma lesions with the stroma components as parallel controls; 2) normal epithelial components from the cervix with the stroma components as parallel controls; 3) cervix carcinomas with the stroma components as controls; 4) uterine leiomyomas with the peritumorous normal smooth muscle tissues as controls. Furthermore, we calculate the mitotic indices and apoptotic bodies counts in all monoclonal and polyclonal condyloma lesions for possible changes in cellular kinetics.To ensure the reliability of the assay, we examined the clonality of theformalin-fixed, paraffin-embedded tissues of uterine leiomyomas. Four samplessuitable for the clonality test showed monoclonality being in agreement with our previous results obtained using fresh tissues. This demonstrates that formalin-fixed, paraffin-embedded tissue samples can be used for the assay. Seven samples of cervical carcinoma, suitable for the test, were microdissected and demonstrated to be of monoclonal origin, while five samples of normal epithelial components of cervix, obtained also by microdissection, were shown to be polyclonal. These data illustrated the difference in clonal composition between the neoplastic and the normal epithelial tissues. Meanwhile, application of microdissection can reduce interference from the admixed non-neoplastic cell, and enhance accuracy of the assay.A total number of 95 condyloma samples were examined. Seventy-six samples were amplified successfully and 62 (81.5%) of them were shown to carry length polymorphism at the AR locus. Fifty-four samples were suitable for the clonality test. Among them, 43 (80%) were shown to be polyclonal. Loss of X-chromosome inactivation mosaicism was found in 11 (20%) lesions, reflecting their monoclonality. Mitotic indices were higher in the monoclonal condyloma lesions than those in the polyclonal lesions, but no significant difference was found between their apoptotic body counts.In summary, most of vulvar condyloma acuminata are polyclonal, thereby being responsive proliferative lesions. About 20% of the condyloma lesions, however, show monoclonal cell expansion, and these may be already neoplastic.