This slide shows subclinical HPV infection. No lesion was visible prior to the application of acetic acid. The patient had been experiencing pruritus. Biopsies of the rounded surface in the right intralabial fold revealed VIN usual (VIN 3) with viral changes.
HPV manifests itself in this patient as florid condyloma acuminata of the vestibule with scattered acuminata lesions in the near by skin and anal region. Topical therapy with an immune modulator reseated in complete and sustained regression
Benign HPV infection. This patient has flat condyloma. The surface is micropapillomatous; the infection is diffuse around the introitus.
Condyloma acuminata involving the labia majora, labia minora, and vestibule.
HPV involves the clitoris, the right labium minus, and the upper perineum. Lesions are red, gray, and white. Histology showed VIN usual (VIN 3) and typing revealed HPV type 16.
HPV may manifest itself as rough plaque similar to basal cell carcinoma in some cases. This plaque in the left interlabial fold showed VIN usual (VIN 3) with viral changes. Note: the hyper pigmentation as a result of “pigmentary incontinence”.
HPV infection may present as a lesion with hyperkeratosis similar to hyperkeratoic changes in lichen planus or lichen sclerosus. The lesion involving the inner aspect of right labium minus extends to the surface of that structure as a red macular lesion. Histology after excision showed VIN usual (VIN 3).
This is more or less a flat lesion and gray in color. Histology in other locations revealed VIN usual (VIN III). Viral studies were positive for HPV type 16.
Example of subclinical HPV infection showing full thickness atypia. Note: diffuse plaque-like lesion and associated satellite lesions. Histology revealed VIN usual (VIN 3) and HPV infection.
HPV infection presenting as pigmented samples. This mixed infection involves HPV type II at periphery and HPV type 16 at the perineum. Histology revealed condyloma acuminata and VIN usual (VIN 3) in gray warty plaque at the introitus.