Condyloma Acuminatum of Urinary Bladder in a Male Renal Transplant Recipient - A Diagnostic and Therapeutic Challenge

Condyloma acuminatum (CA) of urinary bladder is a rare entity, usually occurring in association with anogenital lesions in females. CA is caused by low-risk human papilloma virus (HPV) subtypes, most commonly HPV 11, and despite its propensity for frequent recurrences, it is considered a benign lesion, and conservative management is recommended. Isolated urinary bladder CAs occurring in the absence of preceding anogenital lesions are usually seen in immunosuppressed individuals. Renal transplant recipients (RTRs) are prone to developing anogenital and cutaneous CAs with an increased risk for malignant transformation. CA of the urinary bladder is extremely rare in RTRs, having been reported in only 5 patients to date, with at least 1 of them developing malignancy in the follow-up duration. The urinary bladder CA in our patient showed strong p16 accumulation, proliferative activity in superficial layers of the epithelium, and a moderate degree of dysplasia, and recurred multiple times following conservative management. The chronic immunosuppressive state in RTRs promotes HPV-induced oncogenesis, and a close followup of such lesions is warranted in recurrent/unresectable cases. (C) 2016 Elsevier Inc. All rights reserved.