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Luo WY, Hoang V, Varvoglis DN, Comer LH, Guillem JG. "Free-Floating Anus": A Flap-Free Approach for Definitive Excision of Circumferential Giant Condyloma Acuminata. Am Surg 2023; 89:6389-6392. [PMID: 37674401 DOI: 10.1177/00031348231199173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Giant condyloma acuminata (GCA), or Buschke-Löwenstein tumor, is a rare exophytic cauliflower-like growth in the anogenital region. The spectrum of treatment options is wide, ranging from the application of topical ointments to the performance of an abdominoperineal resection. Currently, wide local excision is the most common approach and may entail the creation of a protective loop ileostomy or implementation of flaps or grafts that facilitate closure. We describe a unique surgical approach for the management of circumferential GCA void of the use a protective loop ileostomy, flaps, or grafts. Our report highlights that the implementation of a radical, circumferential, wide excision resulting in "free-floating anus" and healing via secondary intention can ultimately lead to excellent functional and cosmetic results and therefore may be considered a minimally invasive surgical option for patients afflicted with a large, circumferential GCA.
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Affiliation(s)
- William Y Luo
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Van Hoang
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dimitrios N Varvoglis
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lydia H Comer
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - José G Guillem
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hsu FC, Yu DS, Pu TW, Wu MJ, Meng E. Unusual presentation of penile giant condyloma acuminatum with spontaneous prepuce perforation: A case report. World J Clin Cases 2023; 11:7107-7112. [PMID: 37946780 PMCID: PMC10631422 DOI: 10.12998/wjcc.v11.i29.7107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Giant condyloma acuminatum (GCA) is an uncommon condition affecting the anogenital area. CASE SUMMARY Here, we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft, pubis region, and groin as well as urine leakage along the distal penile shaft. Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base, which was initially suspected to be a urethral fistula. However, during surgery, it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening, with infection and high pressure causing subsequent skin perforation. He underwent circumcision and wide excision with electrocauterization of the warts. He was discharged after the surgery, and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil. CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.
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Affiliation(s)
- Fu-Chieh Hsu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Min-Jui Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
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Mumoli N, Evangelista I, Colombo A, Conte G, Mazzone A. Giant condyloma acuminatum of the perineum. IDCases 2021; 26:e01326. [PMID: 34804801 PMCID: PMC8585615 DOI: 10.1016/j.idcr.2021.e01326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
| | | | - Alessandra Colombo
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
| | - Giulia Conte
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
| | - Antonino Mazzone
- Department of Internal Medicine, ASST Ovest Milanese, Magenta, MI, Italy
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Ledouble V, Sclafani F, Hendlisz A, Gomez Galdon M, Liberale G. Buschke-Löwenstein tumor in a human immunodeficiency virus-positive patient: a case report and short literature review. Acta Gastroenterol Belg 2021; 84:343-5. [PMID: 34217186 DOI: 10.51821/84.2.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Giant condyloma acuminatum, also known as Buschke-Löwenstein tumor, is a rare variant of verrucous carcinoma presenting in the ano-genital region. While its metastatic potential is limited, aggressive local growth is common, with invasion and destruction of the surrounding tissues often causing important therapeutic challenges. Also, data to inform the optimal management approach are scarce and mostly limited to anectodical reports. We present the case of a human immunodeficiency virus-associated locally advanced Buschke Löwenstein tumor that was successfully treated with extensive surgery.
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Vîlcea AM, Stoica LE, Cernea N, Marinaş MC, Ţenea-Cojan TŞ. Vulvar Verrucous Carcinoma and Genital Condylomatosis. Curr Health Sci J 2021; 47:602-7. [PMID: 35444823 DOI: 10.12865/CHSJ.47.04.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/20/2021] [Indexed: 11/04/2022]
Abstract
Verrucous carcinoma is a histopathological type of well-differentiated squamous cell carcinoma, clinically characterized by slow and continuous growth, having a local destructive character, but low metastasis potential. Condyloma acuminatum is a sexually transmitted infection caused mainly by subtypes 6 and 11 of HPV, with subtypes 16, 18 being involved in malignant transformation. We present the case of a 70-year-old woman, hospitalized for a vulvar and perineal vegetative, ulcerated, bleeding tumor, with onset 20 years ago. The therapeutic option was surgical excision of the lesions and long-term oncological monitoring.
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Affiliation(s)
- Salma Salim
- Dermatology and Venereology Department, Ibn Sina University Hospital, Rabat, Morocco
| | - Badreddine Hassam
- Dermatology and Venereology Department, Ibn Sina University Hospital, Rabat, Morocco
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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: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Combaud V, Verhaeghe C, El Hachem H, Legendre G, Descamps P, Martin L, Bouet PE. Giant condyloma acuminatum of the vulva: Successful management with imiquimod. JAAD Case Rep 2018; 4:692-694. [PMID: 30128340 PMCID: PMC6098202 DOI: 10.1016/j.jdcr.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Vanessa Combaud
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Caroline Verhaeghe
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Hady El Hachem
- Department of Obstetrics and Gynecology, Clemenceau Medical Center, Beirut, Lebanon
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Philippe Descamps
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, Angers, France
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Aydogdu I, Uzun E, Mirapoglu SL, Kilincaslan H, Yildiz P. Buschke-Löwenstein tumor: Three pediatric cases. Pediatr Int 2016; 58:769-72. [PMID: 27384409 DOI: 10.1111/ped.12960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ibrahim Aydogdu
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ersan Uzun
- Department of Pediatric Surgery, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Semih Lutfi Mirapoglu
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Huseyin Kilincaslan
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Pelin Yildiz
- Department of Pathology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Pătrașcu V, Enache O, Ciurea R. Verrucous Carcinoma - Observations on 4 Cases. Curr Health Sci J 2016; 42:102-110. [PMID: 30568820 PMCID: PMC6256150 DOI: 10.12865/chsj.42.01.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
Verrucous carcinoma (VC) is a rare well-differentiated squamous cell carcinoma with the clinical forms: oral florid papillomatosis, epithelioma cuniculatum, papilomatosis cutis and Buschke-Löwenstein tumor. We present four patients and the four clinical forms of CV. The diagnosis we held after clinical examination and histopathological examination of the balance sheet expansion. First described by Ackermanin the oral mucosal, today it has a reported incidence of 1-3 cases per million inhabitants. CV can involve both skin and mucous membranes. Etiopathogenesis is uncertain, but participation HPV is widely accepted. WHO recognizes the CV as a rare form of well-differentiated squamous cell carcinoma with slow and continues evolution, with the invasion of underlying tissues, frequent relapses and very low risk of metastasis. The elective therapy is surgical excision with safety oncological margins. Diagnosis involves corroboration of clinical data with histopathological appearance and evolutive behavior of the tumor. Given the increased risk for recurrence, the patient should be reviewed quarterly to finding healing.
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Affiliation(s)
- V Pătrașcu
- Dermato-venerology Department, University of Medicine and Pharmacy of Craiova
| | - O Enache
- Dermato-venerology Department, University of Medicine and Pharmacy of Craiova
| | - R Ciurea
- Pathology Department, University of Medicine and Pharmacy of Craiova
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Anissa Z, Houda HG, Wafa K, Olfa M, Rym BM, Achraf D, Samy F. Successful treatment with topical imiquimod of anal Buschke-Löwenstein tumor in a child. Dermatol Ther 2015; 28:363-5. [PMID: 26179407 DOI: 10.1111/dth.12261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Buschke-Lowenstein tumor (BLT) is a large exophytic lesion of the anogenital region with a clinically malignant aspect but a benign histology. Because of its low incidence, this pathology is exceptional in childhood. Surgical excision is the main therapeutic approach. Herein, we report a case of BLT successfully treated with imiquimod in a 2-year old boy. Young children with BLT should be offered a chance of medical treatment before extensive surgical destruction is used.
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Affiliation(s)
- Zaouak Anissa
- Dermatology Department, Habib Thameur Hospital, LR12SP03, Tunis, Tunisia
| | | | - Koubaa Wafa
- Anatomopathology Department, Habib Thameur Hospital, LR12SP03, Tunis, Tunisia
| | - Midassi Olfa
- Dermatology Department, Habib Thameur Hospital, LR12SP03, Tunis, Tunisia
| | | | - Debbiche Achraf
- Anatomopathology Department, Habib Thameur Hospital, LR12SP03, Tunis, Tunisia
| | - Fenniche Samy
- Dermatology Department, Habib Thameur Hospital, LR12SP03, Tunis, Tunisia
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