Case: Hyperplasia vs Neoplasm? HPV

[lizzylu]

Ok, I massively need some help! I've looked in 5+ books and none have really answered this question about an HPV case.

The case presents This 20-year-old woman sought medical attention because of "growths" on her vulva and perineum. She was 5-months pregnant and had noted a yellow vaginal discharge for 4 months.Multiple raised growths ranging in size from 0.2 to 2.0 cm in diameter on the perineum, vulva, and perianal skin.

Ok, and the picture--it's definitely Condyloma acumulata.

However, two questions I'm having terrible difficulty answering:
Does this process represent hyperplasia or a benign neoplasm? Evidence?
Unfortunately I've found answers saying both---I tend to think it's a benign neoplasm, but many definitions for a neoplasm state it should come from 'clonal expansion'. And with this in mind---then I think hyperplasia.
Help?!!

And then the follow-up question: is a wart 'neoplasia' or 'hyperplasia'? Gosh, everything tends to point to hyperplasia, but then a nevus is considered a 'benign neoplasm'.

Can someone help me sort this out? Much appreciated.

--baffled M2

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[lattimer13]

neoplasia baby!

 

[primadonna22274]

New genital warts: neoplasia (new). Existing genital warts that have grown huge with pregnancy: hyperplastic process superimposed on neoplasia.
Not at all unusual to see HPV explode during pregnancy. Seems that the surge in estrogen promotes them. They can be pretty darn ugly. Your treatment choices are limited (e.g. no podophyllin, although not my preferred treatment anyway). You can do cryo or excision if indicated. I'm sure Aldara (imiquimod) is contraindicated in pregnancy also.
FWIW, they will most likely involute post-partum. If not, they can be treated then.
They SHOULD be biopsied though to prove not VIN (vulvar and/or vaginal intraepithelial neoplasia)...not at all rare. If VIN, excision and treatment is mandatory.
Lisa PA-C