Buschke-Lowenstein Tumors: A Review and Proposed Classification System

ABSTRACT

Buschke-Lowenstein (B-L) tumors or giant condylomata are large fungating lesions that are caused by human papillomavirus (HPV) and develop in the anogenital region. Although uncommon, physicians and surgeons who treat sexually transmitted diseases or other diseases involving the anogenital area will encounter these patients. The purpose of this study is to review the current literature regarding these lesions. We evaluated every published study in PubMed and Embase from 1925 to 2020, concentrating on the clinical data included in each report, such as presentation and treatment. We also evaluated each work for any definition used and found that there is no accepted definition for these lesions. As such, we provide an inclusive, workable definition. In addition, there are many misconceptions about B-L that continue to be propogated as more case reports are published every year. After evaluating every published case, we refute the fact that these lesions have a high mortality or a high malignancy rate. Furthermore, we refute that these lesions are synonymous with verrucous carcinoma. In addition to a definition, we also propose a simple grading system that we hope can be used to assist in the study and management of these patients moving forward. Although the literature is very heterogenous regarding B-L, they are caused by HPV and are distinct from verrucous carcinoma. Because of the majority of information is based on case reports, the literature concentrates on treatment, but more work is clearly needed to delineate the association with specific HPV types and optimal management of this disease.

[Perianal Buschke-Löwenstein tumour]

The Buschke-Löwenstein tumour is an extremely rare, slow-growing cauliflower-like mass, also known as giant condyloma acuminantum or verrucous carcinoma. It is located in the anogenital region and is characterized by its large size, locally destructive behaviour and a high recurrence rate. It has not the potentiel to metastasize but malignant transformation can occur. We report a case of a 49-year-old male patient with a 17 × 10 cm large perianal Buschke-Löwenstein tumour where histologic findings showed the presence of verrucous carcinoma.

Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature

Giant condyloma acuminatum, also known as Buschke-Löwenstein tumor (BLT) is a very rare sexually transmitted disease that affects the ano-genital region. BLT is a slow growing cauliflower-like tumor, but unlike simple condyloma, it is locally aggressive and destructive, malignant transformation occuring in 40-60% of cases. We present a case of perianal carcinomatous BLT and discuss some controversies about the nature and treatment of this disease. Our aim is to emphasize some basic points in the management of giant perianal condyloma acuminatum.

CONCLUSIONS

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. Wide perineal excision with histopathological margins control is the best surgical choice if the anal canal is not involved. The radical pelvic surgery is indicated only in patients with provable visceral invasion. Excision is mandatory even in very small condilomas to prevent BLT later development.

GIANT CONDYLOMA ACUMINATA: INCIDENCE AMONG CASES DIAGNOSED AS CARCINOMA OF THE PENIS

Twenty-four cases of giant condyloma acuminata were found among 100 cases diagnosed as carcinoma of the penis. One of the 24 tumours showed early malignant change. The characteristic histological pattern of giant condyloma consists of broad processes composed of prickle cells associated with little keratinization. The malignant condylomas show, in comparison, a loss of prickle cell preponderance, increased basal cell activity and frequent keratinization, or may present as a solid papillary epithelioma forming broad sheets of uniform cells with many mitoses. The incidence of malignant change in the giant condyloma and the relationship between the benign and malignant tumours are discussed.