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Grosu-Bularda A, Hariga CS, Dumitru CS, Calcaianu N, Creanga CA, Enache V, Tache SE, Bordeanu-Diaconescu EM, Ratoiu VA, Teodoreanu RN, Lascar I. Clinicopathological Findings and Comprehensive Review of Buschke-Lowenstein Tumors Based on a Case Study. J Pers Med 2024; 14:887. [PMID: 39202078 PMCID: PMC11355402 DOI: 10.3390/jpm14080887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
The Buschke-Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is a rare, exophytic tumor, arising from pre-existing warty lesions associated with human papillomavirus (HPV) infection, particularly strains 6 and 11, which are considered to have low oncogenic potential. BLT presents as a large, cauliflower-like growth typically affecting the penis, vulva, vagina, perineum, scrotum, anus, and perianal area. Despite being a benign lesion, BLT is locally aggressive with a high recurrence rate, and can potentially undergo malignant transformation into squamous cell carcinoma, contributing to an overall mortality rate of 20-30%. The primary treatment is complete surgical excision with wide margins, frequently requiring complex reconstructive techniques for defect coverage. We report on a 68-year-old patient, with multiple comorbidities, who presented with a two-year history of a large exophytic tumor in the genital region, affecting the penis, along with progressive erectile dysfunction and urinary problems. The tumor was surgically excised with oncological safety margins, and reconstruction was performed using advancement and rotation flaps from the scrotum and intact penile skin. Histopathological examination confirmed the diagnosis of Giant Condyloma (Buschke-Löwenstein tumor), showing acanthosis, papillomatosis, parakeratosis, and koilocytic cell collections, with positive immunohistochemical staining for p16, p63, and ki67. Postoperatively, the patient had a good clinical outcome and a complete surgical cure. This case highlights the critical need for timely intervention and comprehensive management strategies in treating giant condyloma, given its potential for local invasion and substantial impacts on patient quality of life. Early diagnosis and thorough surgical excision are crucial for effective management and to reduce the high recurrence, morbidity and malignant transformation risk associated with this condition.
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Affiliation(s)
- Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Catalina-Stefania Dumitru
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Nicolae Calcaianu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Cosmin-Antoniu Creanga
- Department of Anatomical Pathology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Valentin Enache
- Department of Anatomical Pathology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Silvia-Elena Tache
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Eliza-Maria Bordeanu-Diaconescu
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Vladut-Alin Ratoiu
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Razvan-Nicolae Teodoreanu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
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Labon M, Czajkowski M, Matuszewski M. Penile Buschke-Lowenstein tumor in HCV patient. Urol Case Rep 2024; 55:102758. [PMID: 38841428 PMCID: PMC11152650 DOI: 10.1016/j.eucr.2024.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Buschke-Löwenstein tumor (BLT), also called giant condyloma acuminatum is a rare clinical manifestation caused by human papillomavirus (HPV), usually type 6 or 11 (90 %). The BLT is described as a tumor with localized aggressiveness, rather slow but destructive and invasive growth of surrounding tissues, benign histology, low metastatic potential, and a high tendency of recurrence. We present the case of a 55-year old non-immunocompetent man, with beige, cauliflower-like papillomae presented on glans penis and coronal sulcus which increased in size for a few weeks. The lesions were surgically removed, while maintaining negative surgical margins and good cosmetic outcomes.
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Affiliation(s)
- Marta Labon
- Student Research Group at the Department of Urology, Medical University of Gdansk, Gdansk, Poland
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3
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Achdiat PA, Septharina R, Rowawi R, Dharmadji HP, Puspitosari D, Usman HA, Maharani RH. A Review and Case Study of Genital and Extragenital Human Papillomavirus Type 6 and 11 Infections in Men Who Have Sex with Men Accompanied by Human Immunodeficiency Virus Infection. HIV AIDS (Auckl) 2024; 16:175-182. [PMID: 38706527 PMCID: PMC11069368 DOI: 10.2147/hiv.s451989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
Extragenital warts caused by HPV types 6 and 11 are rarely reported. However, major risk factors for anogenital warts (AGW) include men who have sex with men (MSM) and Human Immunodeficiency Virus (HIV) infection. The incidence of extragenital warts among these populations has not been reported. This study presented a case report of a 33-year-old male with high-risk sexual behavior who showed symptoms of flesh-colored and hyperpigmentation papules. Furthermore, verrucous surfaces were observed at genital and extragenital. The patient had a history of using the same razor for pubic and armpit hair, bathing with a mesh scrub, and scratching the anal area. The histopathological result showed koilocytes, while polymerase chain reaction (PCR) examination for both genital and extragenital lesions confirmed HPV type 6 and 11. This represented the first reported case describing the incidence of extragenital and AGW caused by HPV types 6 and 11. The transmission of extragenital warts was facilitated through fomites autoinoculation, particularly in the immunocompromised condition induced by HIV, which was common among MSM. Extragenital warty-like lesions were considered as warts caused by HPV type 6/11, in HIV-infected persons, specifically MSM.
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Affiliation(s)
- Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rita Septharina
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rasmia Rowawi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Diah Puspitosari
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Hermin Aminah Usman
- Department of Anatomy Pathology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Retno Hesty Maharani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Unique hybrid double apposing flap in a Z-plasty technique to reconstruct major perianal defect resulting from chondyloma acuminatum resection - Case report. Int J Surg Case Rep 2021; 83:106002. [PMID: 34090197 PMCID: PMC8188379 DOI: 10.1016/j.ijscr.2021.106002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 11/23/2022] Open
Abstract
Perianal area is anatomically challenging location to reconstruct after wide extensive local excision especially when preserving the anus anatomy anal sphincter continence is a requirement. That is the case in many benign locally aggressive conditions, due to high risk of suture line disruption, wound dehiscence, and wound infection. Many surgical options like primary closure, loco reginal flaps, distant or pedicled flaps, or even free flaps are available for such reconstruction. This is a report of a case of locally aggressive infection that was initially confused as complex perianal fistula, then sarcoma after the initial resection. Surprisingly, the permanent pathology confirmed the diagnosis of a giant condyloma acuminatum extending to the anal area, for which an extensive wide local resection with margin and temporary colostomy was done, this resulted in a large defect necessitating a reconstruction with hybrid double apposing Superior gluteal artery perforator flap (SGAP flap) and Inferior gluteal artery perforator flap (IGAP flap) in Z-plasty fashion. That healed completely with no local complication. Chondyloma acuminatum is a benign but rare inflammatory disease Its treated as a local malignant condition Preserving the anal anatomy and function is crucial Combining local perforator flaps in the defect provide excellent option SGAP, IGAP is useful local option
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Hagstrom EL, Haynes D, Ortega-Loayza AG. A Treatment-Refractory, Perianal Tumor Arising in an Otherwise Healthy Older Adult Woman. JAMA Dermatol 2020; 156:453-454. [PMID: 32049309 DOI: 10.1001/jamadermatol.2019.4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erika L Hagstrom
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland
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Abstract
Buschke-Lowenstein tumors primarily are slow-growing giant condylomata accuminata of the anogenital region. They are locally destructive with a low rate of metastasis. Sexually transmitted oncogenic human papillomavirus type 6 and 11 are the greatest risk factors for Buschke-Lowenstein tumors or verrucous carcinomas, a type of squamous cell cancer. Grossly, the tumor appears as a large fungating, erythematous, cauliflower-like mass. Radical surgical excision of the tumor is the treatment of choice and close follow-up for recurrence is essential. The use of radiation or chemotherapy as adjunct treatments is controversial. This case report describes a patient with this rare condition.
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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.
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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
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Shimizu A, Hoashi T, Kataoka K, Shirakawa N, Mayumi N, Funasaka Y, Saeki H. Two Cases of Verrucous Carcinoma: Revisiting the Definition. J NIPPON MED SCH 2018. [PMID: 29540646 DOI: 10.1272/jnms.2018_85-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Verrucous carcinoma (VC) is an uncommon, distinct type of well-differentiated squamous cell carcinoma. Here we present two cases of VC, one arising from the lower leg and the other from genital skin. Case 1, a female patient, aged 95 years, had a brownish verrucous plaque on her right lower leg. Histopathologically, epithelial tumor cells grew pushing the stroma, while the basement membrane was intact. No prominent cellular atypia or hyperchromatin was found. Case 2, a male patient, aged 53 years, had a verrucous plaque at the border between his scrotum and inner aspect of his thigh. A pathological diagnosis of VC was made using an excisional specimen. Making a definitive diagnosis of VC is challenging but crucial. Pathological diagnosis using a small specimen might cause underdiagnosis or overdiagnosis. To avoid this, pertinent pathological diagnosis using an ample specimen is required. We also revisited the definition of VC to precisely understand its nature.
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Affiliation(s)
- Ai Shimizu
- Department of Dermatology, Nippon Medical School
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Abstract
BACKGROUND A giant condyloma acuminatum which shows destructive growth but lacking invasion is designated as a Buschke-Lowenstein tumor (BLT). OBJECTIVES Classification of the BLT and therapeutic guidelines are provided. MATERIALS AND METHODS A MEDLINE literature search from 2006-2016 was performed. RESULTS Induction through low-risk mucosotropic human papillomavirus (HPV) infection separates BLT from verrucous carcinoma. In the last 10 years, slightly more than 100 new cases have been described. Invasion as a true sign of malignancy was described in 12% of cases. HIV infection was observed in 14%. As invasion often occurs only focally and may only be detected after complete resection, BLT must be treated and considered as a low grade in situ epithelial cancer that evolves from condylomata acuminata. Diagnosis is confirmed by HPV detection and typical histology. CT scans are recommended to rule out deeper invasion. Organ preservation surgery remains the recommended therapy. CONCLUSIONS Buschke-Lowenstein tumors represent low grade epithelial in situ carcinomas which evolved from condylomata acuminata. Focal invasion is frequent but metastases occur only rarely. Organ preservation surgery is recommended.
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Affiliation(s)
- M Sporkert
- Anästhesiologie und operative Intensivmedizin, Luisenhospital Aachen, Boxgraben 99, 52064, Aachen, Deutschland
| | - A Rübben
- Hautklinik, Universitätsklinikum der RWTH-Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Erman-Vlahovic M, Vlahovic J, Mrcela M, Hrgovic Z. Coexistence of Condylomata Acuminata with Warty Squamous Cell Carcinoma and Squamous Cell Carcinoma. Med Arch 2017; 71:72-75. [PMID: 28428680 PMCID: PMC5364785 DOI: 10.5455/medarh.2017.71.72-75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Condyloma acuminatum has previously been considered to be a benign growth with no malignant potential, but a review of the literature supports the concept that condylomata acuminata may precede or be associated with invasive squamous cell carcinoma (ISCC) or warty squamous cell carcinoma (WSCC). Case report: We present a clinical case of a 58-year old woman with large, slow-growing, exophytic tumor of external genitalia shaped like a cauliflower with the propagation to both legs and behind. We performed multiple biopsies to detect potential malignancy but malignancy was not confirmed histologically. The presence of HPV (human papilloma virus) low and high risk was discovered. Inguinal lymph nodes were enlarged both sides, but cytologic examination identified no malignant cells. The patient was initially treated by the loop electro surgical excision procedure (LEEP) and podophilin solution on the rest of the condylomas. Condyloma acuminatum was confirmed histologically. Later, we performed a wide surgical excision of the rest of the condylomas. The new changes on the previously treated region were removed using LEEP. WSCC and ISCC were confirmed histologically so were radical vulvectomy and inguinal lymphadenectomy performed. The patient was advised to remain under close follow-up.
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Affiliation(s)
- Mirna Erman-Vlahovic
- Department of Gynecology and Obstetrics, Clinical Hospital Center Osijek, Croatia
| | - Jelena Vlahovic
- Universitiy Medical School Osijek, Clinical Hospital Center Osijek, Croatia
| | - Milanka Mrcela
- Department of Pathology, Clinical Hospital Center Osijek, Croatia
| | - Zlatko Hrgovic
- Department of Gynecology and Obstetrics, Clinical Hospital Center Osijek, Croatia
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Shukla A, Bharti R, Verma A, Chaudhry R, B Anand R. Giant Condyloma Acuminatum: A Surgical Riddle. ANNALS OF COLORECTAL RESEARCH 2016; 4. [DOI: 10.17795/acr-38307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
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Buschke-Löwenstein Tumour: Successful Treatment with Minimally Invasive Techniques. Case Rep Dermatol Med 2015; 2015:651703. [PMID: 26417462 PMCID: PMC4568359 DOI: 10.1155/2015/651703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/23/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of an 80-year-old female who presented with a four-year history of a growing mass in the perianal area with pain and bleeding during defaecation. Clinical examination revealed a locally destructive, cauliflower-like, verrucous mass measuring 10 × 12 cm in diameter. Histologic findings revealed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis, features that are consistent with Buschke-Löwenstein tumour. Polymerase-chain-reaction assay for human papillomavirus (HPV) showed an infection with HPV type 11. Full-thickness excision of involved skin was undertaken by cryotherapy and electrocautery over five months. The entire wound was left open to heal by secondary intention. After 3 years of follow-up, the patient has not experienced a recurrence, with excellent functional results, but the cosmetic results were satisfactory. These minimally invasive techniques can be safer and more cost-effective than surgery and the General Practitioner can play a key role in diagnosis.
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Nordsiek M, Ross C, Metro M. Successful Surgical Management of Giant Condyloma Acuminatum (Buschke Lowenstein Tumor) in the Urethra of a Female Patient: A Case Report. Curr Urol 2015. [PMID: 26195964 DOI: 10.1159/000365689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The Buschke-Lowenstein tumor (BLT) is a slow-growing, locally destructive verrucous plaque that typically appears on the penis but may occur elsewhere in the anogenital region. It most commonly is considered to be a regional variant of verrucous carcinoma. It is rare but accounts for 5-24% of all penile cancers. It can also affect the perineum and other portions of the genitalia. It was first described by Buschke and Löwenstein in 1925, and is also known as giant condyloma acuminatum (GCA). Regardless of the treatment modality, careful follow-up is recommended because of the high risk of recurrence and the possibility for malignant transformation in 30-56% of patients. We present a case of a 47-year-old Hispanic female that presented to the urology clinic for dysuria and upon work-up was found to have a GCA. GCA typically affects the penis, although the perianal region, vulva, vagina, rectum, scrotum, perineum and bladder may be involved. To date, we believe this is the only reported case of GCA in the urethra of a female patient with sparing of the bladder. This lesion was successfully removed with wide local excision. We believe that further studies are needed to define this disease, identify its pathogenesis, and the most successful treatment protocol.
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Affiliation(s)
- Michael Nordsiek
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pa., USA
| | - Curtis Ross
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pa., USA
| | - Michael Metro
- Department of Urology, Albert Einstein Medical Center, Philadelphia, Pa., USA
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14
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Lebelo RL, Thys S, Benoy I, Depuydt CE, Bogers JP, Bida MN, Mphahlele MJ. Laser micro-dissection and qPCR for identifying specific HPV types responsible for malignancy in penile lesions. J Med Virol 2015; 87:1761-8. [PMID: 26112393 DOI: 10.1002/jmv.24229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 11/07/2022]
Abstract
The aim of the study was to identify specific human papillomavirus (HPV) type responsible for malignancy in penile tissue samples using laser micro-dissection and TaqMan quantitative real-time PCR (qPCR). The study was based on two pre-malignant and seven malignant penile tissue samples and laser micro-dissection was performed on all. Genotyping was performed on whole tissue sections and laser micro-dissection samples using qPCR. Two whole tissue section samples were HPV negative while seven were HPV positive. In four samples that were single HPV infections with whole tissue section PCR, identical HPV types were confirmed with laser micro-dissection PCR. Clearly confirming that the single HPV type detected is responsible for malignancy. In two samples that had multiple HPV infections with whole tissue section PCR, only one HPV type with the highest viral load was detected with laser micro-dissection PCR, suggesting that the HPV type with the highest viral load is most likely the cause of that particular lesion. HPV 11 and/or HPV 16 were the only types detected with laser micro-dissection PCR in these cases, compared to multiple HPV types (HPV 11, HPV 16, HPV 18, HPV 31, HPV 33, HPV 35, and HPV 39) initially detected with whole tissue section PCR. HPV 11 was associated with verrucous lesions while HPV 16 was associated with squamous cell carcinoma and PIN 3 lesions. This study confirms that laser micro-dissection and qPCR are essential tools in identifying the HPV types responsible for malignancy in penile lesions, particularly in samples with multiple infections.
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Affiliation(s)
- Ramokone L Lebelo
- Department of Virology, Sefako Makgatho Health Sciences University/National Health Laboratory Service, Medunsa, Pretoria, South Africa
| | - Sofie Thys
- Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Ina Benoy
- Department of Molecular Diagnostics, Laboratory for Clinical Pathology AML, Sonic HealthCare Benelux, Antwerp, Belgium
| | - Christophe E Depuydt
- Department of Molecular Diagnostics, Laboratory for Clinical Pathology AML, Sonic HealthCare Benelux, Antwerp, Belgium
| | - John-Paul Bogers
- Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium.,Department of Molecular Diagnostics, Laboratory for Clinical Pathology AML, Sonic HealthCare Benelux, Antwerp, Belgium
| | - Meshack N Bida
- Division of Anatomical Pathology, Sefako Makgatho Health Sciences University/National Health Laboratory Service, Medunsa, Pretoria, South Africa
| | - M Jeffrey Mphahlele
- Department of Virology, Sefako Makgatho Health Sciences University/National Health Laboratory Service, Medunsa, Pretoria, South Africa
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15
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Skowrońska-Piekarska U, Kościński T. Buschke - Loewenstein tumor resection with simultaneous reconstruction of extensive tissue losses: case report. BMC Surg 2015; 15:41. [PMID: 25885184 PMCID: PMC4399229 DOI: 10.1186/s12893-015-0026-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/20/2015] [Indexed: 12/19/2022] Open
Abstract
Background Giant condyloma acuminatum or Buschke - Loewenstein tumor is a very rare disease usually located in the genital, anorectal, and perianal regions. It is locally invasive but in mostly cases displays a benign cytology on preoperative tissue sampling. Because of its low incidence little is known about treatment outcomes. Complete surgical excision is the treatment of choice. Different surgical methods have been applied to reach curability. To our knowledge such an advanced sized tumors in this localization has only been reported few times before with different surgical techniques being applied. Case presentation We describe a case of 56 years old female with 20 years persisting condyloma acuminatum progressing to a very huge dimensions perianal Buschke-Lowenstein tumor with one of the widest excision in the literature without the need for diverting stoma. The tumor size and its location determined the choice of treatment option and suspected prognosis for the patient outcome. Treatment was impeded by patient’s malnutrition. The giant Buschke - Loewenstein tumor was resected from the anus, perineum and gluteal areas. The large tissue losses were simultaneously covered with rotational skin and fatty subcutaneous tissue flaps, mobilized from neighboring gluteal and femoral areas. The circumferential part of the anal canal was covered with skin grafted from the mentioned flaps and it was attached to the anal mucosa. No protective stoma was formed. Despite temporary problems with healing of the covering skin flaps, full permanent coverage of the resection site has been achieved. Anal canal function has also improved within the time. Conclusion The patient with BLT must be very carefully clinical and imagistic investigated in order to detect the tumor visceral invasion and to establish the extension of the surgical procedure. There exists an extensive and time-consuming surgical procedure which allows to remove the giant anorectal Buschke - Loewenstein tumors with good function of the anorectum and without the necessity of diverting stoma creation.
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Affiliation(s)
- Urszula Skowrońska-Piekarska
- The Chair and Department of General, Endocrine and Gastroenterological Oncology Surgery, Karol Marcinkowski University of Medical Sciences in Poznań, ul. Przybyszewskiego 49, 60-355, Poznań, Poland.
| | - Tomasz Kościński
- The Chair and Department of General, Endocrine and Gastroenterological Oncology Surgery, Karol Marcinkowski University of Medical Sciences in Poznań, ul. Przybyszewskiego 49, 60-355, Poznań, Poland
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17
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Wollina U, Steinbach F, Verma S, Tchernev G. Penile tumours: a review. J Eur Acad Dermatol Venereol 2014; 28:1267-76. [DOI: 10.1111/jdv.12491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/03/2014] [Indexed: 12/13/2022]
Affiliation(s)
- U. Wollina
- Department of Dermatology and Allergology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
| | - F. Steinbach
- Department of Urology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
| | - S. Verma
- Nirvana Clinic; Vadodara; Gujarat India
| | - G. Tchernev
- Policlinic for Dermatology and Venerology; Saint Kliment Ohridski University; University Hospital Lozenetz; Sofia Bulgaria
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Safi F, Bekdache O, Al-Salam S, Alashari M, Mazen T. Giant condyloma acuminatum of Buschke-Lowenstein tumour: Disease development between 2000 and 2010. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Farouk Safi
- Department of Surgery; United Arab Emirates University; Al Ain United Arab Emirates
| | - Omar Bekdache
- Department of Surgery; Tawam Hospital; Al Ain United Arab Emirates
| | - Suhail Al-Salam
- Department of Pathology; United Arab Emirates University; Al Ain United Arab Emirates
| | - Mouied Alashari
- Department of Pathology; Tawam Hospital; Al Ain United Arab Emirates
| | - Taha Mazen
- Department of Internal Medicine; Tawam Hospital; Al Ain United Arab Emirates
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19
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Kutlubay Z, Engin B, Zara T, Tüzün Y. Anogenital malignancies and premalignancies: facts and controversies. Clin Dermatol 2013; 31:362-373. [PMID: 23806153 DOI: 10.1016/j.clindermatol.2013.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anogenital malignancies and premalignancies are an important personal/public health problem due to their effects on individuals' physical, mental, and sexual health. Also, due to their etiological association with human papillomavirus (HPV) infection, anogenital malignancies and premalignancies constitute an immense public health burden. In addition to HPV infection, immunosuppression, HIV infection, chronic dermatoses, such as lichen sclerosis, previous radiotherapy and chemotherapy treatments, and smoking, are the other important etiopathologic factors in the development of anogenital malignancies and premalignancies. The incidence of anal squamous cell carcinoma (SCC) has increased considerably in the past decade, mainly due to the growing number of cases in high-risk groups, such as men who have sex with men, immunosuppressed individuals, and patients with HIV infection. Also, an increase in vulvar intraepithelial neoplasia (VIN) and VIN-related invasive vulvar cancer has been noted in women younger than age 50 years due to its association with HPV infections over the past decade. SCC of the scrotum seems to be the first cancer linked to occupational exposure. Bowen's disease, Bowenoid papulosis, and erythroplasia of Queyrat are the most widely seen premalignancies of anogenital region and are all forms of squamous intraepithelial neoplasia. Histopathologically, these conditions share identical histologic features of SCC in situ, but their clinical features differ. Early diagnosis is vital to improve prognosis, especially in anogenital malignancies. Also, if a delay occurs in diagnosis, treatment options used will be associated with significant negative effects on the patient's psychological well-being and quality of life; hence, management of anogenital malignancies and premalignancies should be organized in a multidisciplinary fashion.
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Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey
| | - Tuba Zara
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey.
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Linnemann T, Müller F, Löhnert M, Hirnle P, Görner M. Successful treatment of paraneoplastic hypercalcemia in a patient with giant condyloma acuminatum: a case report. J Med Case Rep 2013; 7:251. [PMID: 24200238 PMCID: PMC3843559 DOI: 10.1186/1752-1947-7-251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction While paraneoplastic syndromes in patients with malignant and metastasizing tumors are common, they are rarely associated with skin tumors showing predominantly local growth patterns. This case report relates to a patient with giant condyloma acuminatum, also called Buschke-Löwenstein tumor, with paraneoplastic hypercalcemia, who was successfully treated with conservative treatment. Case presentation The patient in question is a 48-year-old German man with a giant periscrotal tumor. Before and during the therapy, two episodes of symptomatic hypercalcemia occurred, which were successfully treated by bisphosphonates, intravenous fluids and diuretics. No evidence of lytic bone affection was found. Conclusions Paraneoplastic hypercalcemia may occur in patients who have a Buschke-Löwenstein tumor. For patients, where surgery is not an option, established medical therapies like bisphosphonates may be useful in addition to diuretics and infusions.
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Affiliation(s)
- Thomas Linnemann
- Department of Hematology and Oncology, Academic Teaching Hospital Bielefeld, Teutoburger Str, 50, Bielefeld 33604, Germany.
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Tian YP, Yao L, Malla P, Song Y, Li SS. Successful treatment of giant condyloma acuminatum with combination retinoid and interferon-γ therapy. Int J STD AIDS 2013; 23:445-7. [PMID: 22807543 DOI: 10.1258/ijsa.2011.011331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Giant condyloma acuminatum, or Buschke-Löwenstein tumour, is a unique variant of anogenital warts. It is characterized by locally aggressive behaviour but rarely metastasizes. Many treatment strategies such as radical surgery, radiation and chemotherapy have been used to treat it but their efficacy is often poor and the recurrence rates are high. We report a case of 16-year-old girl who was treated with oral retinoid combined with intramuscular interferon-γ. All lesions cleared within three months. During a follow-up period of more than two years, no recurrence has developed. This relatively painless, non-scarring treatment may represent a novel therapeutic option.
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Affiliation(s)
- Y P Tian
- Department of Dermatology and Venereology, First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, China
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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]
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Ahmed K, Singh H, Kumar A, Ahmed I. A case of a large verrucous swelling over the scrotum. Indian J Sex Transm Dis AIDS 2012. [PMID: 23188943 DOI: 10.4103/0253-7184.102133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kamal Ahmed
- Departmant of Dermatology and STD, Owaisi Hospital and Research Centre, DCMS, Hyderabad, Andhra Pradesh, Departmant of Plastic Surgery, Bangalore Medical College, Bangalore, Karnataka, India
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Management of peri-anal giant condyloma acuminatum--a case report and literature review. Asian J Surg 2012; 36:43-52. [PMID: 23270825 DOI: 10.1016/j.asjsur.2012.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 05/22/2012] [Accepted: 06/01/2012] [Indexed: 11/22/2022] Open
Abstract
Giant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity; however, malignant transformation to frankly invasive squamous-cell carcinoma has been described in about one-third of patients. In addition, malignant transformation has been reported in patients with "ordinary" condylomata acuminata. Human papillomavirus, known to cause condylomata acuminata, is also known to induce these tumors and was found in 96% of 63 cases reviewed in the last 10 years. These lesions have a propensity for recurrence and a likelihood of malignant transformation, and lead to significant mortality. Therefore, early and radical R0 excision, along with vigilant follow-up, provides the hope for cure. Conservative and/or multimodal therapy has been reported in a few cases, but its effect is not yet proved. The authors report one case of GCA; in addition, they reviewed the literature over the last 10 years and compared with previous reviews.
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Martin JM, Molina I, Monteagudo C, Marti N, Lopez V, Jorda E. Buschke-Lowenstein tumor. J Dermatol Case Rep 2011; 2:60-2. [PMID: 21886716 DOI: 10.3315/jdcr.2008.1019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/12/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Verrucous carcinoma of the skin and mucosa is an uncommon type of well-differentiated squamous cell carcinoma. When it is present in the genitoanal region the term used is Buschke-Lowenstein tumor. The human papillomavirus seems to be implicated in its aetiology. Treatment is controversial. Topical chemotherapy, radiotherapy, immunotherapy and radical surgery have been employed. MAIN OBSERVATIONS We report a rapidly progressing penile verrucous carcinoma which was treated sucessfuly with conservative surgery and CO2 laser. CONCLUSION Treatment with CO2 laser in combination with conservative surgery may be a therapeutic option in Buschke-Lowenstein tumor.
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Affiliation(s)
- Jose M Martin
- Department of Dermatology, Hospital Clinico Universitario Valencia, Spain
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Battaglia L, Vannelli A, Belli F, Rampa M, Milione M, Gasparini P, Leo E. Giant Condyloma Acuminatum of the Anorectum: Successful Radical Surgery with Anal Reconstruction. TUMORI JOURNAL 2011; 97:805-7. [DOI: 10.1177/030089161109700620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Buschke-Löwenstein tumor, or giant condyloma acuminatum, is a relatively uncommon lesion of the anus with aggressive local invasive behavior which may present as a large warty tumor of the genital region with expansive and destructive growth. Many sporadic reports have been published suggesting various therapeutic strategies. We report a case of Buschke-Löwenstein tumor treated with conservative surgery followed by reconstructive procedures without a loop colostomy.
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Affiliation(s)
- Luigi Battaglia
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Vannelli
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filiberto Belli
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Rampa
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Milione
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Unit of Molecular Cytogenetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ermanno Leo
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Li AL, Walsh S, McKay DR. Surgical management of a giant condyloma of Buschke-Löwenstein in a patient with Netherton syndrome using the pedicled anterolateral thigh flap — a case report. J Plast Reconstr Aesthet Surg 2011; 64:1533-6. [DOI: 10.1016/j.bjps.2011.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 03/02/2011] [Indexed: 11/29/2022]
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Nthumba PM, Ngure P, Nyoro P. Giant condyloma acuminatum of the scrotum in a man with AIDS: a case report. J Med Case Rep 2011; 5:272. [PMID: 21722389 PMCID: PMC3141715 DOI: 10.1186/1752-1947-5-272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 07/02/2011] [Indexed: 11/30/2022] Open
Abstract
Introduction Giant condyloma acuminatum, also called a Buschke-Löwenstein tumor, first described in 1925, is a slow-growing, locally aggressive, destructive tumor of the ano-genital region. Scrotal tumors are rare. Reports on giant condyloma acuminatum lesions in patients with HIV and AIDS are surprisingly even rarer. Case presentation In this report, we present the case of a 42-year-old African man with AIDS who was undergoing anti-retroviral therapy. He was found to have a giant condyloma acuminatum of the scrotum. Wide surgical excision and scrotal reconstruction with a pedicled anterolateral thigh flap was performed, significantly improving his quality of life. Conclusion Decision making regarding the goals of surgical intervention in the terminally ill is a complex process. The options include conservative medical palliation or palliative excision versus a curative excision that has the potential for significant morbidity. Wide surgical excision with local flap reconstruction significantly improved the quality of life of the patient described herein. The challenges presented by emerging or unusual presentations of surgical pathology secondary to HIV and AIDS in patients who are on anti-retroviral therapy provide an opportunity for research and the establishment of guidelines for the use of adjuvant chemotherapy in these patients.
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Affiliation(s)
- Peter M Nthumba
- Plastic, Reconstructive and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe 00220, Kenya.
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Stefanaki C, Rozakou A, Stavropoulos P, Gregoriou S, Hadjivassiliou M. Buschke-Löwenstein tumour. Int J STD AIDS 2010; 21:787-8. [PMID: 21187367 DOI: 10.1258/ijsa.2009.009405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C Stefanaki
- Sexually Transmitted Infections Unit, Dermatology Department, University of Athens, Andreas Sygros Hospital, 5 Ionos Dragoumi Street, Athens, Greece
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Kim TH, Lee HH. Giant condyloma accuminatum in postmenopausal elderly woman. Eur J Obstet Gynecol Reprod Biol 2010; 151:111-2. [DOI: 10.1016/j.ejogrb.2010.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 01/21/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
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