1
|
Purzycka-Bohdan D, Nowicki RJ, Herms F, Casanova JL, Fouéré S, Béziat V. The Pathogenesis of Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor): An Overview. Int J Mol Sci 2022; 23:4547. [PMID: 35562936 PMCID: PMC9100137 DOI: 10.3390/ijms23094547] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Giant condyloma acuminatum, also known as Buschke-Lowenstein tumor (BLT), is a rare disease of the anogenital region. BLT is considered a locally aggressive tumor of benign histological appearance, but with the potential for destructive growth and high recurrence rates. BLT development is strongly associated with infection with low-risk human papillomaviruses (HPVs), mostly HPV-6 and -11. Immunity to HPVs plays a crucial role in the natural control of various HPV-induced lesions. Large condyloma acuminata are frequently reported in patients with primary (e.g., DOCK8 or SPINK5 deficiencies) and secondary (e.g., AIDS, solid organ transplantation) immune defects. Individuals with extensive anogenital warts, including BLT in particular, should therefore be tested for inherited or acquired immunodeficiency. Research into the genetic basis of unexplained cases is warranted. An understanding of the etiology of BLT would lead to improvements in its management. This review focuses on the role of underlying HPV infections, and human genetic and immunological determinants of BLT.
Collapse
Affiliation(s)
- Dorota Purzycka-Bohdan
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland;
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland;
| | - Florian Herms
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (F.H.); (S.F.)
- Centre for Genital and Sexually Transmitted Diseases, APHP, Saint-Louis Hospital, 75010 Paris, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-1163, Necker Hospital for Sick Children, 75015 Paris, France;
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
- Imagine Institute, University of Paris Cité, 75015 Paris, France
- Department of Pediatrics, Necker Hospital for Sick Children, AP-HP, 75015 Paris, France
- Howard Hughes Medical Institute, New York, NY 10065, USA
| | - Sébastien Fouéré
- Department of Dermatology, APHP, Saint-Louis Hospital, Université de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (F.H.); (S.F.)
- Centre for Genital and Sexually Transmitted Diseases, APHP, Saint-Louis Hospital, 75010 Paris, France
| | - Vivien Béziat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-1163, Necker Hospital for Sick Children, 75015 Paris, France;
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY 10065, USA
- Imagine Institute, University of Paris Cité, 75015 Paris, France
| |
Collapse
|
2
|
Pineda-Murillo J, Lugo-García JA, Martínez-Carrillo G, Torres-Aguilar J, Viveros-Contreras C, Schettino-Peredo MV. Buschke–Löwenstein tumor of the penis. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0011-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
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.
Collapse
|
3
|
Zhang D, Gonzalez RS, Feely M, Umrau K, Lee H, Allende DS, Karamchandani DM, Zaleski M, Lin J, Westerhoff M, Zhang X, Alpert L, Liao X, Lai J, Liu X. Clinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases. Virchows Arch 2019; 476:543-550. [PMID: 31728626 DOI: 10.1007/s00428-019-02680-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/11/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
Buschke-Löwenstein tumor (BLT) is a rare sexually transmitted disease, mostly described in clinical literature as case reports or small series. Here, we investigated the clinicopathologic features of BLT in a total of 38 cases retrieved from multiple academic institutions. The average age was 47.6 ± 12.8 (mean ± SD) years old at diagnosis. The male to female ratio was 4.4:1. Common presenting symptoms were pain/discomfort, bleeding, mass lesion, and discharge. It was frequently linked to smoking and positive human immunodeficiency virus status. The tumor size and thickness were 8.5 ± 6.6 cm and 1.5 ± 1.3 cm, respectively. Histologically, 19 (50%) cases had an invasive squamous cell carcinoma component and were associated with high-risk human papillomavirus infection. There was no lymphovascular or perineural invasion, or nodal metastasis at initial diagnosis. BLTs with invasion had higher frequency of dyskeratosis, neutrophilic microabscesses, and abnormal mitoses, but lower frequency of pushing border compared with BLTs without invasion. All patients underwent wide excision, and some also received chemoradiation therapy. After a median follow-up of 23 months (range 1-207), the recurrence rate was 23.7% and disease-specific mortality was 2.6%. In summary, we presented the largest case series of BLT to date to characterize its unique clinicopathologic features. Our study indicated that certain histologic features such as dyskeratosis, neutrophilic microabscess, and abnormal mitosis in the non-invasive portion may be important clues on lesional biopsy to predict the presence of underlying invasive carcinoma.
Collapse
Affiliation(s)
- Dongwei Zhang
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA. .,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Feely
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kavita Umrau
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Hwajeong Lee
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | | | - Dipti M Karamchandani
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michael Zaleski
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Xiuli Liu
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
4
|
Molecular genotyping of human papillomavirus l1 gene in low-risk and high-risk populations in Bangkok. Sex Transm Dis 2015; 42:208-17. [PMID: 25763674 DOI: 10.1097/olq.0000000000000259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infections in Thailand are a public health concern, but information on HPV infection in sex workers and men who have sex with men (MSM) is limited. The aim of this study was to measure the prevalence and genotype distribution of HPV among low- and high-risk, HIV-negative populations. METHODS A total of 300 participants were categorized as general women, female sex workers, MSM, and MSM sex workers. Human papillomavirus infections were identified by the Papanicolaou test and nested polymerase chain reaction. A phylogenetic analysis of partial HPV L1 genes was performed. RESULTS Abnormal cytology was found in 5% of general women, 10% of female sex workers, 24% of MSM, and 28% of MSM sex workers. Human papillomavirus was detected in 9% of general women, 13% of female sex workers, and 30% in both MSM and the MSM sex workers. The prevalence of HPV high-risk genotypes was significantly higher in female sex workers and MSM, whereas low-risk genotypes and genital warts were significantly higher in MSM sex workers. Significantly more patients with genital warts and cervical intraepithelial neoplasia I/anal intraepithelial neoplasia I harbored low-risk genotypes, whereas those with cervical intraepithelial neoplasia II/anal intraepithelial neoplasia II harbored high-risk genotypes. CONCLUSIONS High- and low-risk HPV genotypes persist in high-risk groups in Bangkok. Some genotypes infecting at-risk populations are not vaccine preventable. These findings may help to elucidate the prevalence of HPV infections in Thailand and serve as the basis for additional investigations into risk factors for these populations.
Collapse
|
5
|
|
6
|
Yang C, Liu S, Wang Z, Yang S. Buschke-Löwenstein tumor in an old woman: cryotherapy and holmium laser treatment. Arch Gynecol Obstet 2012; 288:221-3. [PMID: 23229581 DOI: 10.1007/s00404-012-2670-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 11/28/2012] [Indexed: 11/26/2022]
|
7
|
Bambao C, Nofech-Mozes S, Shier M. Giant condyloma versus verrucous carcinoma: a case report. J Low Genit Tract Dis 2010; 14:230-3. [PMID: 20592560 DOI: 10.1097/lgt.0b013e3181c945ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Giant condyloma acuminatum is a large, slow-growing, exophytic, cauliflower-like tumor of the external genitalia. It is a histologically benign lesion, largely associated with human papillomavirus infection but with a high recurrence rate. The main differential diagnosis includes verrucous carcinoma. Differentiation between these 2 types of tumors is important with respect to treatment and prognosis. We present a case report of a 26-year-old woman with giant condyloma acuminata of the vulva and discuss the histological features and treatment modalities of this condition.
Collapse
Affiliation(s)
- Clarissa Bambao
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
8
|
Handisurya A, Rieger A, Bago-Horvath Z, Schellenbacher C, Bankier A, Salat A, Stingl G, Kirnbauer R. Rapid progression of an anal Buschke-Lowenstein tumour into a metastasising squamous cell carcinoma in an HIV-infected patient. Sex Transm Infect 2009; 85:261-3. [PMID: 19625295 DOI: 10.1136/sti.2008.034959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Buschke-Löwenstein tumour (BLT) of the anogenitalia is a locally invasive, destructively growing verrucous carcinoma that does not metastasise. Histologically BLT resembles benign condylomata acuminata. Nevertheless, the tumour grows relentlessly and may rarely progress into squamous cell cancer (SCC). RESULTS A human immunodeficiency virus (HIV)-infected immunosuppressed patient developed (peri)anal warts accompanied by recurrent abscesses and fistulae. Histology revealed condylomata acuminata, and low-risk genital human papillomavirus (HPV) type 11b was detected. Six months later, the tumour had progressed into an ulcerated SCC that destroyed the rectum and perineum, with metastases to the inguinal lymph nodes. Whereas highly active antiretroviral therapy (HAART) effectively suppressed HIV replication, radiochemotherapy plus anti-EGFR antibody did not halt tumour progression, and the patient died from tumour-cachexia. DISCUSSION As far as is known, this is the first report demonstrating rapid progression of a BLT into a metastasising SCC in an HIV-infected patient.
Collapse
Affiliation(s)
- A Handisurya
- Laboratory of Viral Oncology (LVO), Division of Immunology, Allergy and Infectious Diseases(DIAID), Department of Dermatology, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Stankiewicz E, Kudahetti SC, Prowse DM, Ktori E, Cuzick J, Ambroisine L, Zhang X, Watkin N, Corbishley C, Berney DM. HPV infection and immunochemical detection of cell-cycle markers in verrucous carcinoma of the penis. Mod Pathol 2009; 22:1160-8. [PMID: 19465901 DOI: 10.1038/modpathol.2009.77] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Penile verrucous carcinoma is a rare disease and little is known of its aetiology or pathogenesis. In this study we examined cell-cycle proteins expression and correlation with human papillomavirus infection in a series of 15 pure penile verrucous carcinomas from a single centre. Of 148 penile tumours, 15 (10%) were diagnosed as pure verrucous carcinomas. The expression of the cell-cycle-associated proteins p53, p21, RB, p16(INK4A) and Ki67 were examined by immunohistochemistry. Human papillomavirus infection was determined by polymerase chain reaction to identify a wide range of virus types. The expression of p16(INK4A) and Ki67 was significantly lower in verrucous carcinoma than in usual type squamous cell carcinoma, whereas the expression of p53, p21 and RB was not significantly different. p53 showed basal expression in contrast to usual type squamous cell carcinoma. Human papillomavirus infection was present in only 3 out of 13 verrucous carcinomas. Unique low-risk, high-risk and mixed viral infections were observed in each of the three cases. In conclusion, lower levels of p16(INK4A) and Ki67 expressions differentiate penile verrucous carcinoma from usual type squamous cell carcinoma. The low Ki67 index reflects the slow-growing nature of verrucous tumours. The low level of p16(INK4A) expression and human papillomavirus detection suggests that penile verrucous carcinoma pathogenesis is unrelated to human papillomavirus infection and the oncogenes and tumour suppressor genes classically altered by virus infection.
Collapse
Affiliation(s)
- Elzbieta Stankiewicz
- Centre for Molecular Oncology and Imaging, Barts and The London School of Medicine and Dentistry, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tytherleigh MG, Birtle AJ, Cohen CE, Glynne-Jones R, Livingstone J, Gilbert J. Combined surgery and chemoradiation as a treatment for the Buschke-Löwenstein tumour. Surgeon 2007; 4:378-83. [PMID: 17152203 DOI: 10.1016/s1479-666x(06)80114-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Buschke-Löwenstein tumour (BLT) or giant condyloma acuminata is a rare disease which affects the anogenital region. Although histologically benign, it behaves in a malignant fashion, infiltrating the surrounding tissues. The morbidity and mortality from this tumour is high, as is the risk of recurrence following treatment. It lies on the continuum between the benign condylomata acuminata and squamous cell carcinoma. The human papillomavirus is implicated in its aetiology. Treatment is controversial, with topical chemotherapy, radiotherapy, immunotherapy and radical surgery all having been employed. Chemoradiation remains the mainstay of treatment for anal cancers but has not been routinely employed in the management of the BLT without squamous cell carcinoma transformation. METHODS Two cases of extensive perineal BLT treated with chemoradiation and subsequent surgical excision are presented. RESULTS The first patient had a good symptomatic response to the chemoradiation but unfortunately died of recurrent disease following surgery. The second patient had a macroscopically complete response to chemoradiation and remains well following abdominoperineal excision. CONCLUSION Pre-operative chemoradiation has proved to be useful in management for histologically proven benign BLT
Collapse
Affiliation(s)
- M G Tytherleigh
- Department of Surgery, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
| | | | | | | | | | | |
Collapse
|
11
|
Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54:369-91; quiz 391-4. [PMID: 16488287 DOI: 10.1016/j.jaad.2005.05.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 03/30/2005] [Accepted: 05/03/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED Penile cancer, while relatively rare in the western world, remains a disease with severe morbidity and mortality, not to mention significant psychological ramifications. Furthermore, the disease is observed with dramatically increased incidence in other parts of the world. A review of the literature has shown that the overwhelming majority of penile cancers are in situ or invasive squamous cell carcinomas, including a well-differentiated variant, verrucous carcinoma. Important predisposing factors are lack of circumcision, human papillomavirus infections, and penile lichen sclerosus, although other factors have occasionally been reported as well. Prevention, careful monitoring of patients at risk, and early diagnosis are essential to reduce the incidence of penile carcinoma and to provide a definitive cure. Public health measures, such as prophylactic use of circumcision, have proved successful but are controversial. Also, no standard therapeutic guidelines as to the best treatment strategy according to different stages, including efficacy of conservative nonsurgical modalities and indications for lymph nodal dissection, are available so far. It is common opinion that penile cancer is an emerging problem that deserves further investigations, and physicians, especially dermatologists, should be aware of this issue. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with penile carcinoma, its risk factors, its clinical and histologic presentation, and the treatments currently available for its management.
Collapse
Affiliation(s)
- Giuseppe Micali
- Department of Dermatology, University of Catania School of Medicine, Catania, Italy.
| | | | | | | |
Collapse
|
12
|
Gross G, Pfister H. Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Med Microbiol Immunol 2004; 193:35-44. [PMID: 12838415 DOI: 10.1007/s00430-003-0181-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Indexed: 02/04/2023]
Abstract
Using PCR, the overall prevalence of human papillomavirus (HPV) DNA in penile carcinoma is about 40-45%, which is similar to the detection rate of HPV-DNA in vulvar carcinoma (50%). In analogy to vulvar cancer two different pathways of penile carcinogenesis seem to exist. In contrast to basaloid and warty penile cancers which are regularly HPV-associated (about 80-100%), only a part of keratinizing and verrucous penile carcinomas appear to be related with HPV (33-35%). Penile intraepithelial neoplasias comprising Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis are precursor lesions of basaloid and warty carcinomas of the penis. Precursors of keratinizing carcinomas and verrucous carcinomas are not established. Whether lichen sclerosus and squamous-cell hyperplasia precede penile keratinizing carcinoma is a matter of discussion. Giant condylomata acuminata may precede the development of verrucous carcinomas in some cases. Since high risk HPVs are more frequently found in verrucous carcinomas than in giant condylomas, HPV typing may be a helpful diagnostic step to differentiate giant condyloma from verrucous carcinoma.
Collapse
Affiliation(s)
- G Gross
- Department of Dermatology and Venereology, Faculty of Medicine, University of Rostock, Augustenstrasse 80-84, 18055 Rostock, Germany.
| | | |
Collapse
|
13
|
Affiliation(s)
- C B Bunker
- Chelsea and Westminster, Charing Cross and Royal Marsden Hospitals, London
| |
Collapse
|
14
|
Affiliation(s)
- M M Bagheri
- Department of Dermatology, New York Medical College, Valhalla, New York 10595, USA
| | | |
Collapse
|
15
|
Abstract
Human papillomavirus testing has been evaluated as an adjunct to cervical cytologic screening. There is a well-established association between high-risk malignant subtypes of human papillomavirus infection and the development of neoplastic change. Although human papillomavirus infection is a necessary condition for malignant transformation, it is not a sufficient condition. Multiple cofactors are necessary for progression to dysplasia and then to invasive cervical cancer. Because of the multifactorial nature of malignant transformation, current methods of human papillomavirus testing do not add sufficient predictive and diagnostic information over that obtained by cytology and colposcopic biopsy to warrant routine clinical use.
Collapse
Affiliation(s)
- A Goodman
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston 02114, USA.
| |
Collapse
|