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Ajagbe OA, Ayandipo OO, Afuwape OO, Idowu OK, Adeleye AO, Ogundiran TO. Surgical treatment of perineal giant condylomata acuminata (Buschke Lowenstein tumor): Case series from a developing country. Int J Surg Case Rep 2024; 121:109994. [PMID: 38981296 PMCID: PMC11294696 DOI: 10.1016/j.ijscr.2024.109994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Giant condylomata acuminatum (GCA) also referred to as Buschke-Lowenstein tumor (BLT) is a rare tumor primarily associated with low-risk HPV 6 and 11, which is believed to be a slow growing intermediate tumor with low potential to transform into invasive cancer. CASE PRESENTATION We presented our experience with three cases of BLT (one woman and two men). CLINICAL DISCUSSION The three patients had surgical excision and two of them had reconstruction of the surgical defect with good clinical outcome. CONCLUSION We highlighted the importance of early identification of symptoms, treatment options and risk of recurrence as well as primary preventive strategies.
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Affiliation(s)
- O A Ajagbe
- Department of Surgery, University College Hospital Ibadan, Nigeria
| | - O O Ayandipo
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery College of Medicine University of Ibadan, University College Hospital Ibadan, Nigeria.
| | - O O Afuwape
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery College of Medicine University of Ibadan, University College Hospital Ibadan, Nigeria
| | - O K Idowu
- Department of Anesthesia, College of Medicine University of Ibadan, University College Hospital Ibadan, Nigeria
| | - A O Adeleye
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery College of Medicine University of Ibadan, University College Hospital Ibadan, Nigeria
| | - T O Ogundiran
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery College of Medicine University of Ibadan, University College Hospital Ibadan, Nigeria
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2
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Arruza-Frau C, López-García A, Morales-López R. Squamous cell carcinoma of the neovagina 47 years after gender-affirming surgery. Urol Case Rep 2023; 50:102488. [PMID: 37719184 PMCID: PMC10504474 DOI: 10.1016/j.eucr.2023.102488] [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: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 09/19/2023] Open
Abstract
A 74-year-old transgender female presented with urinary difficulty and a painful lesion at her neo-vagina, 47 years after undergoing gender-affirming vaginoplasty. Initial biopsy reported Low-Grade Squamous Intraepithelial Lesion (LGSIL), while MRI revealed no inguinal or pelvic lymphadenopathy. Patient underwent partial neo-vaginectomy with wide local excision and formal urethroplasty. Pathology revealed verrucous carcinoma of the neovagina, a rare neoplasm in transgender female patients. This case highlights the importance of considering squamous cell carcinoma in the differential diagnosis of patients presenting lesions at neo-vagina and the need of screening methods for early detection of such neoplasms.
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Affiliation(s)
- Cristina Arruza-Frau
- Urology Section, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
- School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Ariana López-García
- Urology Section, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Ramphis Morales-López
- Urology Section, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
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3
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Ye Q, Jia M, Deng LJ, Fang S. Cutaneous Verrucous Carcinomas: A Review. J Cutan Med Surg 2023; 27:150-156. [PMID: 36789508 DOI: 10.1177/12034754231155895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Verrucous carcinoma (VC) is a relatively rare locally aggressive, slow-growing, well-differentiated squamous cell carcinoma with minimal metastatic potential and is most frequent in the mucosa. Although rarely reported on the skin, cutaneous verrucous carcinomas (CVC) can appear anywhere, most commonly on the feet. However, clinical and pathologic diagnosis of CVC has been confusing and challenging. It can easily be mistaken for benign or more malignant conditions such as giant condyloma acuminata, keratoacanthoma, and pseudoepithelioma-like hyperplasia or squamous cell carcinoma, resulting in inappropriate management. In this review, we describe the different aspects associated with CVC, including its pathogenesis and clinicopathologic features. The available evidence for the differential diagnosis and treatment of CVC is discussed, and specific management recommendations are made. After the treatment, careful follow-up examinations of the excised area should be performed at regular intervals.
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Affiliation(s)
- Qian Ye
- 117972 Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Meng Jia
- 117972 Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Jia Deng
- 117972 Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sheng Fang
- 117972 Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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4
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Ye Q, Hu L, Jia M, Deng LJ, Fang S. Cutaneous verrucous carcinoma: A clinicopathological study of 21 cases with long-term clinical follow-up. Front Oncol 2022; 12:953932. [PMID: 36313691 PMCID: PMC9606218 DOI: 10.3389/fonc.2022.953932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/20/2022] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Cutaneous verrucous carcinoma (CVC) is a rare variant of squamous cell carcinoma and sometimes shares similar clinical and histopathological features with other verrucous lesions. METHODS We performed a retrospective study of 21 patients diagnosed with CVC between 2012 and 2022 by reviewing clinical and histopathological data. We also compared the clinicopathological features of patients with CVC, giant condyloma acuminatum (GCA), and pseudoepitheliomatous hyperplasia (PEH). We obtained follow-up data by reviewing medical records and telephone interviews. RESULTS The average age of patients with CVC was 63.6 years, with a male predominance. The location of disease is mostly found in the foot, followed by the lower legs. Histologically, CVC is characterized by an exo-endophytic growth pattern with severe keratinization and a blunted rete ridge with pushing margins. Clinical features including exudation and crusting, induration, irregular borders, and warty surface, as well as pathological features including growth pattern, koilocytotic cells, depth and morphologic features of acanthosis, severe keratinization, and degree of dermal inflammation, were significant in distinguishing cutaneous CVC, GCA, and PEH. CONCLUSION Identification of the clinicopathological features is essential to distinguish CVC from its mimics and to make an early diagnosis. Because of the potential for recurrence and metastasis, CVC requires aggressive treatment.
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Affiliation(s)
| | | | | | | | - Sheng Fang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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5
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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: 9] [Impact Index Per Article: 4.5] [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.
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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
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Dai Y, Yu L, Wang Y, Gao M, Wang P. Case Report: A Case of Hailey-Hailey Disease Mimicking Condyloma Acuminatum and a Novel Splice-Site Mutation of ATP2C1 Gene. Front Genet 2022; 12:777630. [PMID: 34970303 PMCID: PMC8712934 DOI: 10.3389/fgene.2021.777630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/26/2021] [Indexed: 12/11/2022] Open
Abstract
Hailey–Hailey disease (HHD) is a rare autosomal-dominant blistering disorder characterized by recurrent vesicular and erosive lesions at intertriginous sites. We described a 24-year-old male who presented with multiple bright red verrucous papules in his mons pubis, bilateral groins, scrotum, perineum, and crissum, clinically resembling condyloma acuminatum. The histopathology showed extensive acantholysis with the characteristic appearance of a dilapidated brick-wall. The mutation analysis revealed a novel splice-site mutation in the ATP2C1 gene. The patient was definitely diagnosed with HHD. The antibacterial treatments resulted in a dramatic improvement. Our findings help to broaden the understanding of clinical manifestations of HHD and improve the clinical diagnosis and treatment of this disease.
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Affiliation(s)
- Yuwei Dai
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Lingling Yu
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Yu Wang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Min Gao
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
| | - Peiguang Wang
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, China.,Institute of Dermatology, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Anhui Medical University, Ministry of Education, Hefei, China.,Provincial Laboratory of Inflammatory and Immune Mediated Diseases, Hefei, China
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7
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Curious Condylomatous Lesion on the Perianal Skin-The Great Imitator Struck Again: Answer. Am J Dermatopathol 2022; 44:73-74. [PMID: 34889816 DOI: 10.1097/dad.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Clinical Efficacy of Carbon Dioxide Laser Combined with ALA Photodynamics in the Treatment of Condyloma Acuminatum. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7211055. [PMID: 34707674 PMCID: PMC8545531 DOI: 10.1155/2021/7211055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022]
Abstract
'Purpose. To observe the clinical efficacy and safety of carbon dioxide laser combined with ALA photodynamics in the treatment of condyloma acuminatum. Method. A total of 211 patients with condyloma acuminatum admitted to our hospital from April 2018 to June 2021 were selected as the observation object. They were divided into the intervention group (CO2 laser combined with ALA photodynamic therapy, 125 cases) and conventional group (CO2 laser treatment, 86 cases), and the efficacy and incidence of adverse reactions between the two groups were compared. Result. The total effective rate of the intervention group (96.00%) was significantly higher than that of the conventional group (84.88%) (P < 0.05). The total incidence of adverse reactions in the intervention group (8.00%) was lower than that in the conventional group (32.56%) (P < 0.05). Univariate analysis showed that the patient's smoking history, drinking history, course of disease, wart area, and number of sexual partners were related to the short-term prognosis (P < 0.05). Multivariate logistic regression analysis showed that the patient's course of disease, the area of the wart body, and the number of sexual partners were independent factors affecting the prognosis of patients with condyloma acuminatum (P < 0.05). Conclusion. Carbon dioxide laser combined with ALA dynamics treatment of condyloma acuminatum significantly improves the clinical efficacy, does not increase the incidence of adverse reactions, and has important clinical therapeutic value. The course of the disease, the area of the wart, and the number of sexual partners are independent factors affecting the prognosis of patients with condyloma acuminatum.
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9
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Aung PP, Wimmer DB, Lester TR, Tetzlaff MT, Prieto VG. Perianal condylomata lata mimicking carcinoma. J Cutan Pathol 2021; 49:209-214. [PMID: 33470447 DOI: 10.1111/cup.13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel B Wimmer
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Todd R Lester
- Department of Pathology, CHI St. Luke's Health, Houston, Texas, USA
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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10
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Cig Taskın O, Pehlivanoglu B, Reid MD, Friedman T, Lee M, Tadros TS, Bandyopadhyay S, Akinfolarin J, Armutlu A, Basturk O, Adsay V. Löwenstein-Buschke: Clinicopathologic Analysis of 78 Cases of Large and Giant Condyloma Acuminata of the Anus. Turk Patoloji Derg 2021; 37:18-25. [PMID: 33021736 PMCID: PMC10508923 DOI: 10.5146/tjpath.2020.01508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/27/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The nature and clinicopathologic associations of Löwenstein-Buschke disease are unclear. MATERIALS AND METHODS 78 anal condylomatous lesions (≥2 cm) were analyzed. Cases were classified based on size as "medium-large"(2-5 cm, n=59), "large" (5-10 cm, n=13) and "giant" ( > 10 cm, n=6). RESULTS Patients were predominantly males (male/female=70/8). The mean age was 38 years (range:20-66). Two distinct lining types were recognized: 1) Epidermal type, typically lacking overt koilocytotic change, with associated invasive carcinoma in 8%; 2) Mucosal type, often manifesting koilocytotic change, with associated invasive carcinoma in 21%. Three types of high-grade dysplasia were discerned: 1) Basaloid, 8/9 showing high-grade dysplasia/carcinoma in-situ but non-invasive lesions; 2) Keratinizing, innocuous-appearing, but 5/6 was associated with invasion; 3) Giant cell, showing scattered individual bizarre cells, with 3/5 showing invasive carcinoma. Overall, invasion was found in 14% of the cases. The bulbous, broad-based destructive pattern characterizing verrucous carcinomas of the upper aerodigestive tract was not observed. A statistically significant trend existed between the incidence of invasion and size: 8.5% for medium-large, 23% for large, and 50% for giant (p=0.02). There was no discernable trend in the depth of invasion relative to condyloma size. CONCLUSIONS Our findings suggest that Löwenstein-Buschke lesions are mega versions of conventional condyloma. Being verrucoid, large and minimally invasive, they can be conceptually regarded as a form of verrucous carcinoma, but they do not display the histologic characteristics of verrucous carcinoma defined in the aerodigestive tract. They exhibit two types of linings: the mucosal type that often shows koilocytotic changes, and the epidermal type that can be difficult to recognize in biopsies. These lesions may be associated with invasive carcinoma, albeit limited in amount.
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Affiliation(s)
- Orhun Cig Taskın
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Burcin Pehlivanoglu
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michelle D. Reid
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Theodore Friedman
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Lee
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Talaat S. Tadros
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Ayse Armutlu
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
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11
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Ginsberg AS, Rajagopalan A, Terlizzi JP. Epidermolytic acanthoma: A case report. World J Clin Cases 2020; 8:4094-4099. [PMID: 33024766 PMCID: PMC7520793 DOI: 10.12998/wjcc.v8.i18.4094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/26/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Epidermolytic acanthoma (EA) is a rare benign skin lesion, usually found in the genital area of men and women, with epidermolytic hyperkeratosis as its distinguishing histologic characteristic. It is commonly misdiagnosed as condyloma accuminatum, verruca, and seborrheic keratosis. Since this lesion is benign, treatment is not necessary. However, it is often misdiagnosed, and patients are likely to undergo incorrect counseling and unnecessary treatment, causing undue burden to the patient. This study seeks to increase awareness of this rare condition to prevent future misdiagnoses.
CASE SUMMARY A 55-year-old man living with human immunodeficiency virus presented for anal cancer screening. His physical examination revealed a flesh colored papule at the anal margin. The initial differential diagnosis included molluscum contagiosum, anal condyloma, and basal cell carcinoma. The lesion was excised to obtain a definitive diagnosis and was discovered to be EA.
CONCLUSION EA is often misdiagnosed due to its similarity to other dermatologic conditions. Careful examination and pathologic evaluation should be obtained to ensure proper diagnosis.
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Affiliation(s)
- Ariana S Ginsberg
- Department of Colon and Rectal Surgery, Laser Surgery Care, New York, NY 10011, United States
| | - Archeta Rajagopalan
- Department of Colon and Rectal Surgery, Laser Surgery Care, New York, NY 10011, United States
| | - Joseph P Terlizzi
- Department of Colon and Rectal Surgery, Laser Surgery Care, New York, NY 10011, United States
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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12
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Wang G, Mochel MC, Randall MB, Gandhi JS, Udager AM, Chan MP, Patel RM, Amin MB, Osunkoya AO, Smith SC. Genital verruciform xanthoma: lessons from a contemporary multi-institutional series. Histopathology 2020; 77:841-846. [PMID: 32598505 DOI: 10.1111/his.14198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/23/2022]
Abstract
AIMS Verruciform xanthoma (VX) is an uncommon lesion, seen in the oral mucosa and rarely occurring at cutaneous genital sites. Reports of exceptional VX presentations dominate the literature; herein, we assess the clinical and histological features of a cohort of routine, consecutive cases. METHODS AND RESULTS Clinicopathological features of genital VXs from four academic centres were reviewed. A cohort of 25 lesions from 24 patients (22 male, two female; median age = 62 years), occurred on the scrotum (84%), penis (8%) and perineum/vulva (8%). VX was never suspected clinically; considerations ranged from fibroepithelial polyps to squamous cell carcinoma. Classic diagnostic criteria were present at least focally in each lesion, including verrucous architecture, prominent wedge-shaped parakeratosis extending between exophytic epidermal projections and neutrophils in the stratum corneum. Xanthomatous cells were present in all cases, but scattered to rare in 24%. CONCLUSIONS Consecutive genital VXs reliably exhibited classic histopathological features, although the essential finding of xanthomatous cells may be scarce. Our comparison to meta-analyses of published cases found relatively fewer penile and vulvar examples. Additionally, the median age was older than in published series, which have emphasised syndromic associations.
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Affiliation(s)
- Grace Wang
- Department of Pathology, VCU School of Medicine, Richmond, VA, USA.,Department of Dermatology, VCU School of Medicine, Richmond, VA, USA
| | - Mark C Mochel
- Department of Pathology, VCU School of Medicine, Richmond, VA, USA.,Department of Dermatology, VCU School of Medicine, Richmond, VA, USA
| | - M Barry Randall
- Department of Dermatology, University of Tennessee Health Sciences Center, Memphis, TN, USA.,Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Jatin S Gandhi
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Aaron M Udager
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rajiv M Patel
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Adeboye O Osunkoya
- Departments of Pathology and Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven C Smith
- Department of Pathology, VCU School of Medicine, Richmond, VA, USA.,Division of Urology, Department of Surgery, VCU School of Medicine, Richmond, VA, USA
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13
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Shu HL, Yu B, Li CQ. Treatment of giant condyloma acuminatum with paiteling: A case report. Dermatol Ther 2020; 33:e13936. [PMID: 32602599 DOI: 10.1111/dth.13936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/05/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hui-Ling Shu
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bei Yu
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Chang-Qiang Li
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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14
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Loo GH, Lim LY, Zainuddin ZM, Fam XI. Staged resection in the management of HIV-related anogenital giant condyloma acuminatum. A case report. Ann Med Surg (Lond) 2019; 48:73-76. [PMID: 31737262 PMCID: PMC6849151 DOI: 10.1016/j.amsu.2019.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/24/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Giant condyloma acuminata (GCA), also known as Bushke-Lowenstein tumour, is a rare disease which affects 0.1% of the population. Although histopathologically benign, it tends to be locally destructive. The common sites of involvement include the penis and the anorectum. Due to the rarity of the disease, there is a lack of controlled studies on the optimal management of this entity. Thus, we report a case of anogenital GCA in a 40-year-old HIV-positive man. Case presentation A 40-year-old man presented with progressive anogenital warts associated with foul-smelling discharge and fever. He has been diagnosed with HIV and was on HAART on presentation. A warty excrescence had infiltrated the entire external genitalia, gluteals and sacral region. Serial excision was performed along with a defunctioning colostomy. The patient recovered well, and the final histopathological showed features of GCA. Discussion With HIV, the HPV infection goes unchecked may develop into GCA. Malignant transformation to squamous cell carcinoma may occur in more than half of the cases. A complex interaction between HIV and HPV may lead to a higher risk of recurrence even after resection. The diagnosis is usually clinical. Imaging modalities may be used in identifying the extent and depth of invasion. Conclusion The optimal management of anogenital giant condyloma acuminata remains to be determined. Staged surgical excision should be conducted to achieve an optimum outcome. Radical reconstructive surgery should be reserved for patients with recurrence, malignant transformation or sphincter involvement.
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Affiliation(s)
- Guo Hou Loo
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Li Yi Lim
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Zulkifli Md Zainuddin
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Xeng Inn Fam
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
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Dupont A, Marescassier H, Kaya G. Epidermolytic Acanthoma Mimicking Condyloma: A Case Report. Dermatopathology (Basel) 2019; 6:23-27. [PMID: 31700841 PMCID: PMC6827452 DOI: 10.1159/000499366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022] Open
Abstract
Epidermolytic acanthoma is a rare benign tumor that appears as a solitary papule or, rarely, multiple small papules on the trunk and extremities, or on genitalia. They are generally asymptomatic, although they can be pruritic. The clinical presentation is often misleading, and the lesions are often misdiagnosed histologically and frequently confused with condyloma acuminatum. Here, we report a case of an epidermolytic acanthoma on the penis of a 57-year-old male, whose final diagnosis was made after several years.
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Affiliation(s)
- Amandine Dupont
- Department of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Hélène Marescassier
- Department of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
| | - Gürkan Kaya
- Department of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland.,Department of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
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16
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Roy SF, Ghazawi FM, Choate KA, McNiff JM. Solitary and multiple epidermolytic acanthoma: A demographic and clinical study of 131 cases. J Cutan Pathol 2019; 46:305-309. [PMID: 30663082 DOI: 10.1111/cup.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Epidermolytic acanthoma (EA) is a rare, benign acquired cutaneous keratosis displaying epidermolytic hyperkeratosis in more than 50% of its surface. Because of the sparsity of comprehensive studies, little is known on the patient demographics and clinical characteristics of this uncommon entity. We wish to comprehensively characterize the clinical and demographic features of EA and to differentiate it from its mimickers. METHODS We carried out a retrospective review of 131 cases of EA, recorded clinical and histopathologic features and performed linear regression of yearly incidence rates to assess for possible under-reporting of this entity. RESULTS EA affected both genders equally. We found 9.08 cases per 100 000 biopsy specimens per year and linear regression analysis showed significantly decreasing incidence rates. Analysis of the anatomical site distribution of EA lesions showed a more frequent genital location in men (39.1% of cases in men, as compared to 11.3% for women). Contrary to previous studies, lesions were most frequently single (91.7%) and the mean age of presentation was 57.8 years. CONCLUSION The presented largest case series to-date indicates that EA is probably an underdiagnosed entity and establishes the demographic and clinical features of EA.
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Affiliation(s)
- Simon F Roy
- Department of Pathology, University of Montréal, Montréal, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Canada
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, CT.,Department of Genetics, Yale University School of Medicine, New Haven, CT.,Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Jennifer M McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT.,Department of Pathology, Yale University School of Medicine, New Haven, CT
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