This clinical photograph sequence depicts the therapeutic progression and inflammatory response of anogenital warts (AGW) on the penile shaft treated with ingenol mebutate (IM) 0.05% gel. Panel (a) shows the baseline presentation with multiple, small, discrete, flesh-colored to slightly erythematous raised papules consistent with condyloma acuminatum. Panel (b) illustrates a severe local skin reaction 48 hours post-application, characterized by confluent, extensive erosive dermatitis. The area exhibits intense erythema, superficial tissue desquamation, and moist erosions without evidence of purulent superinfection. Panel (c) shows the clinical status four days later, demonstrating rapid wound healing and resolution of the acute inflammation. The skin displays significant reduction in erythema with early re-epithelialization and partial clearance of the original wart lesions. This series demonstrates the typical lesion-directed inflammatory response and subsequent uncomplicated healing process associated with topical ingenol mebutate treatment for genital viral lesions.

Gross pathology photograph of a bisected genital condyloma acuminatum lesion, showing a soft, fleshy exophytic mass with cauliflower-like papillary architecture. The specimen comprises two symmetrical halves laid side-by-side against a dark background; each fragment measures approximately 1–2 cm in greatest dimension as suggested by a 1 cm scale bar. The surface is pink-tan with irregular, frond-like projections and subtle keratotic grooves. The cut surfaces reveal a fibrous to loosely arranged stroma and thickened epidermis with pronounced papillary infoldings. The lesions are consistent with condyloma acuminatum, most commonly HPV types 6 and 11; they arise on mucocutaneous genital skin including corona of glans, urethral meatus, fossa navicularis, penile shaft, and scrotal skin; similar lesions may occur in vulvar region and perineum. In males, lesions may extend proximally toward the urethra and bladder in extensive disease; symptoms can include itching, bleeding, pain; sexual transmission risk is high; co-infection with other STIs is possible; recurrence is common after treatment. This image highlights the characteristic wart-like architecture: soft, friable, papillary projections with a cauliflower appearance. Understanding gross morphology aids clinical diagnosis and guides subsequent histopathologic confirmation and treatment planning (cryotherapy, topical agents, surgical excision).

Imaging modality and technique: Light microscopy of fixed tissue stained with Hematoxylin and Eosin (H&E). Specimen: genital mucosa biopsy from a cauliflowers-like neoplastic lesion on the penile skin, viewed at low magnification. Location: genital mucosa of penis, corona glandis region, a typical site for condyloma acuminatum. Morphology: hallmark papillary or polypoid fronds with warty, cauliflower-like architecture; marked papillomatosis and acanthosis producing thickened, undulating epithelium with elongated rete ridges; hyperkeratosis and parakeratosis at the surface. Cellular features: koilocytosis in the upper epithelial layers, characterized by nuclear enlargement with perinuclear halos and irregular nuclear membranes, consistent with HPV infection. The dermal stroma shows mild chronic inflammatory infiltrate and fibrovascular cores within the papillary projections; cytologic atypia is absent, indicating benign HPV-related lesion. Diagnostic impression: condyloma acuminatum (genital wart) most commonly caused by low-risk HPV types 6 and 11; presence of koilocytic change and papillomatous growth supports HPV-induced lesion. Clinical significance: differentiates from malignant or precancerous processes; important for STI counseling and management; differential diagnoses include verruca vulgaris, penile intraepithelial neoplasia, and Buschke-Lowenstein tumor in rare cases. Potential uses: educational reference, correlating histology with gross morphology, and guiding patient counseling and treatment planning. Correlation with clinical presentation strengthens diagnostic confidence and informs management.