Papillomas of the ectocervix (Figs. 86–89) occur predominantly in young women and are mainly caused by HPV infection 6 and 11. Some may be inverted, hence their surfaces are flat. Histologically they consist of thick layers of stratified squamous epithelium with elongated rete pegs that extend deeply into the lamina propria (Fig. 87). The basal membrane is intact, the epithelial layers are well differentiated, and acanthosis is usually pronounced. More advanced lesions may also contain koilocytes in the upper layers. Mitoses are rare. Besides the flat, inverted type of papilloma, others may be quite condylomatous and closely resemble the condylomata of the vulva and vagina (Fig. 88) or form verrucae covered by parakeratosis or hyperkeratosis (Fig. 89). These papillomas may be sessile or pedunculated.
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