Buschke–Löwenstein tumor (giant condyloma acuminatum) successfully treated by topical photodynamic therapy: a case report

Buschke-Lowenstein tumor in the penis and anorectal region: case report

The Buschke-Lowenstein Tumor is a giant condyloma acuminatum caused by human papillomavirus, most commonly types 6 or 11. It is a rare condition with an estimated frequency of 0.1% in the general population. Transmission primarily occurs through sexual contact. It particularly affects men, predominantly appearing on the penis, characterized by its deep-seated growth, potential for degeneration, and tendency to recur after treatment. Surgery is the preferred treatment. We present the case of a50-year-old patient with a history of recurrent urethritis and multiple sexual partners. The patient sought medical attention for a swelling on the penis that had been progressively developing over the past 10 years. An MRI was performed for a locoregional study, revealing a perineal and penile mass with polylobed contours resembling a cauliflower, along with a sizable perineal mass Histological examination of a biopsy sample from the penis confirmed the diagnosis. Unfortunately, due to the tumor's characteristics and the patient's condition, surgery was contraindicated.

Radiation Therapy in the Management of Extensive Giant Condyloma Acuminata With Rectal Involvement: A Case Report

Giant condyloma acuminata (GCA) is a rare, locally aggressive manifestation of human papillomavirus (HPV) infection, typically affecting the anorectal area. Patients with GCA often have a poor prognosis due to the high risk of malignant transformation. In this case report, we present a 39-year-old man with HIV who developed progressive and refractory anorectal GCA. Despite initially non-cancerous pathology results, there were concerns regarding a malignant component to the mass. Multidisciplinary discussions led to the decision to pursue definitive radiation therapy. This case report and review of the literature highlight the role of radiation in the management of GCA and the importance of a multidisciplinary approach in the treatment of complex cases.

Cure of condyloma acuminata covering the glans penis using aminolevulinic acid/photodynamic therapy

Condyloma acuminata are a type of verrucous hyperplasia in the genital and perianal areas caused by human papilloma virus (HPV) infection. Traditional treatment methods for condyloma acuminata, such as topical medications, carbon dioxide (CO₂) laser, cryotherapy, and surgical excision, can be effective at removing warts, however, they do not eliminate subclinical and latent HPV infection, resulting in a high recurrence rate and even leaving trauma and scars. We report a case of condyloma acuminata covering the glans penis, considering our patient had a singular, large lesion, thus, to reduce the risk of recurrence and minimize the trauma caused by treatment, we chose ALA/photodynamic therapy (ALA-PDT). We provided eight rounds of ALA-PDT at a treatment interval of 7 days, the skin lesion disappeared completely, leaving a chapped, flushed glans without scarring. There was no recurrence during the 6-month follow-up period. Thus, we firmly believe that ALA-PDT is an effective, safe, and curative treatment, and is worth popularizing in clinical practice.

Buschke–Löwenstein tumor of the penis

Background

The Buschke–Löwenstein tumor comes from the confluence of multiple condyloma acuminata and is clinically manifested by warty, exophytic, ulcerated lesions, with aggressive behavior, rapid growth, invasion and destruction of adjacent structures.

Case presentation

A 57-year-old man with type II diabetes mellitus, high blood pressure and a history of high-risk sexual behavior with multiple partners was evaluated in the urology department for multiple penile lesions of verrucous appearance and fetid odor of 10 months of evolution. Biopsy of the lesion was performed revealing a giant condyloma acuminatum.

Conclusions

Radical surgical excision with wide surgical margins remains the first line of treatment. Close follow-up of these patients is crucial given the complexity and tumor recurrence.

Trends and targets in antiviral phototherapy

Photodynamic therapy (PDT) is a well-established treatment option in the treatment of certain cancerous and pre-cancerous lesions. Though best-known for its application in tumor therapy, historically the photodynamic effect was first demonstrated against bacteria at the beginning of the 20^th century. Today, in light of spreading antibiotic resistance and the rise of new infections, this photodynamic inactivation (PDI) of microbes, such as bacteria, fungi, and viruses, is gaining considerable attention. This review focuses on the PDI of viruses as an alternative treatment in antiviral therapy, but also as a means of viral decontamination, covering mainly the literature of the last decade. The PDI of viruses shares the general action mechanism of photodynamic applications: the irradiation of a dye with light and the subsequent generation of reactive oxygen species (ROS) which are the effective phototoxic agents damaging virus targets by reacting with viral nucleic acids, lipids and proteins. Interestingly, a light-independent antiviral activity has also been found for some of these dyes. This review covers the compound classes employed in the PDI of viruses and their various areas of use. In the medical area, currently two fields stand out in which the PDI of viruses has found broader application: the purification of blood products and the treatment of human papilloma virus manifestations. However, the PDI of viruses has also found interest in such diverse areas as water and surface decontamination, and biosafety.

A case study: progressive recurrent course of a giant condyloma (Buschke - Lowenstein tumor)

The authors describe two clinical cases of a malignant giant condyloma (Buschke - Lowenstein tumor), one of which resulted in a lethal outcome. Despite its benign histology, this neoplasm demonstrates evident aggressive and malignant clinical characteristics. The development of this tumor is associated with the papilloma viral infection. Immunodeficiency was diagnosed in the patients in both cases. The lethal outcome was a result of severe anemia, intoxication and local complications. Surgery was the main method of treatment. However, the results were unsatisfactory in view of a weak response to treatment and high risk of relapses. Administration of up-to-date topical immunopotentiators such as Imiquimod seems to be promising because in addition to its principal immunopotentiating effect it may also have a haemostatic action.

Buschke-Lowenstein tumour of glans penis

INTRODUCTION

Buschke-Löwenstein tumour, also known as Giant condyloma acuminatum, is a rare, sexually transmitted disease that affects ano-genital region. BLT is a slow growing cauliflower-like tumour, locally aggressive and destructive. Human papillomavirus has been identified as an important contributory factor in the development of tumour.

PRESENTATION OF CASE

A 45 year uncircumcised male presented with complaints of cauliflower like growth on glans penis. Growth started as a small papule on the corona sulcus at 12 O'clock position 6 months back. Patient developed pain and dysuria due to compression of urethral meatus. Patient has history of multiple sexual partners.

DISCUSSION

BLT, first described by Buschke and Lowenstein in 1925. They observed a penile lesion that clinically resembled both common condyloma acuminata and squamous cell carcinoma, but differing from both of them regarding the biological behaviour and the histopathological appearance. GCA can be differentiated from ordinary condylomas by the characteristic "pushing" rather than "infiltrating" effect that tends to compress and displace the underlying tissue.

CONCLUSION

We have successfully treated a penile BLT with surgical excision and no relapse up to 6 months. Surgical excision could be considered an effective therapy in the treatment.