Giant condyloma acuminatum (Buschke-Lowenstein tumor): Combined treatment with surgery and chemotherapy.

We present a case of giant condyloma acuminatum (Buschke-Lowestein tumor) managed with combined treatment of surgery of chemotherapy.

Recalcitrant extragenital giant condyloma acuminatum: A need for combination therapy.

Giant condyloma acuminatum (GCA), also known as Buschke -Löwenstein tumor, is a huge, rapidly growing variant of condyloma found in the anogenital region. Extragenital GCA is rare and, in most cases, affecting the intertriginous area and treated by excision. We described a case of refractory extragenital GCA involving the large part of the left axilla area successfully treated with immunotherapy and podophyllotoxin. Considering the large size and the location, the lesions were not treated by wide excision because it might result in scar contracture with limitation of shoulder movement or axillary web syndrome. Our case illustrates that combination therapy of podophyllotoxin, imiquimod plus weekly cryotherapy may be an effective and less invasive option for treating GCA of the axilla with good cosmetic and functional outcomes.

Human Papillomavirus-Associated Invasive Condylomas in a Man with Immunosuppressive Comorbidities.

Human papilloma virus (HPV) infections are one of the most common sexually transmitted diseases. We present the case of a 77-year-old Caucasian male with enormous genital warts of the penis, scrotum, groins and anus. Lesions were excised by electrosurgery. The histological examination revealed Condylomata gigantea as well as an invasive perianal squamous cell carcinoma. Mucosal "low-risk" HPV type 6 was detected. The patient had a history of an immunosuppressing disease. During the 4-year follow-up, multiple relapses occurred. Thus, particularly in immunosuppressed patients, early prophylactic HPV vaccination seems to be indicated for use in the prevention of HPV-associated mutilating and life-threatening disease. Vaccination should also protect from "low-risk" HPV.

Tumor de Buschke-Löwenstein: presentación de un caso / Buschke-Löwenstein tumor. Case report

Se presentó un paciente masculino de 68 años, que acudió a consulta de Dermatología por presentar lesiones vegetantes en coliflor en región inguinal izquierda, pubis y perineales, de 10 años de evolución y nunca tratadas. El tumor de Buschke-Löwenstein o condiloma acuminado gigante es una tumoración epitelial benigna, causada por el virus del papiloma humano, trasmisible sexualmente, en raros casos puede malignizar. Se realizó escisión quirúrgica y estudio histopatológico de la lesión inguinal, las restantes lesiones fueron eliminadas con ácido tricloroacético, tratamiento tópico, logrando regresión total de las mismas y se le administró levamisol, inmunomodulador sistémico. La evolución posquirúrgica fue satisfactoria(AU)

A male patient of 68 years was presented who consulted Dermatology to present vegetating and cauliflower lesions in the left inguinal, pubic and perineal region, 10 years of evolution and never treated. Tumor of Buschke-Löwensteinor giant condyloma is a benign epithelial tumor is caused by the human papillomavirus, sexually transmitted and in rare cases can become it in malignant. Surgical excision and histopathological examination of the inguinal lesion was done, the remaining lesions were removed with trichloroacetic acid, topical treatment, achieving complete regression thereof and administered levamisole and systemic immunomodulator. The postoperative course was satisfactory(AU)

Paciente do sexo masculino, 68 anos, apresentou-se aoServiço de Dermatologiadevido a lesões vegetantes nacouve-flor naregião inguinal esquerda, púbis e períneo, comduração de 10 anose nunca tratadas. O tumor de Buschke-Löwenstein ou o condiloma acuminado gigante é um tumor epitelial benigno, causado pelo papilomavírus humano sexualmente transmissível, podendo, em casos raros, malignizar. Excisãocirúrgica e estudo histopatológico da lesão inguinal foram realizados, as lesõ es remanescentesforam eliminadas com ácido tricloroacético, tratamento tópico, obtendoregressão total das mesmas e foi administrado levamisol, imunomodulador sistêmico. A evoluçãopós-operatória foi satisfatória(AU)

Tumor de Buschke-Löwenstein: relato de três casos / Buschke-Löwenstein Tumor: report of three cases

O tumor de Buschke-Löwenstein é uma doença rara, de transmissão sexual, associada ao papilomavírus humano, principalmente dos subtipos 6 e 11. Caracteriza-se como uma lesão exofítica, em forma de couve-flor, de progressão lenta, com alto poder de infiltração local. O seu principal fator de risco é a imunossupressão e o tratamento geralmente é cirúrgico, com ou sem terapias adjuvantes. O impacto na vida da paciente é grande, com altas taxas de recorrência após excisão cirúrgica. Relatamos 3 casos de condiloma gigante com achados histopatológicos diversos, com graus de infiltração e papilomatose variados.

The Buschke-Löwenstein Tumor is a rare, sexually transmitted disease, triggered by human papillomavirus, specially the subtypes 6 and 11. It is characterized as a cauliflower-shape exophytic mass, slowly progressive, with high local recurrence rates and high infiltration. The main risk factor is immunosuppression. Surgical treatment is usually preferred, with or without adjuvant therapy. It has a great impact on the patients' life, impairing their life quality. We report three cases of Giant Condyloma with diverse histopathological findings with varying degrees of infiltration and papillomatosis.

A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin.

We report here a case of giant vulval condyloma in a two-year-old infant infected by her "baby sitter" without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient.

Condiloma gigante de Buschke y Lowenstein / Buschke- Lowenstein Giant Condyloma

Introducción: los condilomas o verrugas genitales son producidos por el virus del papiloma humano, del que existen más de 100 genotipos diferentes. De ellos, cerca de 40 son transmitidos sexualmente. Objetivo: describir las características clínicas del condiloma gigante (Tumor de Buschke - Lowenstein) y el tratamiento utilizado, a través de la presentación del caso de una mujer con condiloma acuminado gigante de localización vulvo perineal y peri anal, de cinco años de evolución que le dificultaba la micción, las relaciones sexuales, e incluso la marcha; además había fetidez, prurito y en ocasiones dolor. Resultados: el examen histopatológico fue compatible con condiloma acuminado. Se realizó extirpación quirúrgica radical del tumor con excelentes resultados funcionales y cosméticos, sin complicaciones postoperatorias y sin recurrencias ni cicatrices hipertróficas al año de evolución. Conclusiones: el condiloma gigante es el resultado final de la confluencia de múltiples condilomas, hasta recubrir toda la superficie penianal o vulvar, dando un aspecto clínico de malignidad. No es muy frecuente y suele estar asociado a estados de comprometimiento del sistema inmunológico(AU)

Introduction: condyloma or genital warts are caused by human papiloma virus of which there are over 100 different genotypes; around 40 of them are sexually transmitted. Objective: to describe the clinical characteristics of the giant condyloma (Buschke-Lowenstein tumor) and their treatment through a case report. A woman with giant condyloma acuminatum located in the perineal and perianal area of 5 years of progression, which made it difficult for her to urinate, to have sexual intercourse and even to walk; she also suffered pruritus and pain and bad smell. Results: the histopathological exam showed condyloma acuminatum. She was operated on and the tumor was completely excised, with excellent functional and cosmetic results; neither postoperative complications nor relapses or hypertrophic scars were observed after a year. Conclusions: giant condyloma is the final result of the confluence of multiple condylomas until they cover the whole perianal or vulvar surface, giving it a clinical look of malignancy. It is rare and may be associated to compromised condition of the immune system(AU)

Buschke-Löwenstein tumor with squamous cell carcinoma treated with chemo-radiation therapy and local surgical excision: report of three cases.

Treatment of anorectal Buschke-Löwenstein tumor (BLT) with squamous cell carcinoma (SCC) transformation is not univocal given the rarity of the disease. BLT is characterized by its large size and tendency to infiltrate into underlying tissues. Malignant transformation can occur and it is important to identify the presence of neoplastic foci to decide the proper treatment. Our aim was to assess the effectiveness of neo-adjuvant chemo-radiation therapy (CRT) and local excision in order to avoid abdomino-perineal resection (APR). Three cases of anorectal BLT with SCC transformation are presented. All patients were HIV positive and treated with antiretroviral drugs. They underwent preoperative endoanal ultrasound, biopsies, total body tomography and anal brushing. Treatment consisted of neo-adjuvant chemo-radiation therapy (45 Gy to the pelvis plus a boost with 14.40 Gy to the primary tumor for a total of 59.40 Gy, and mitomycin-C in bolus on the first day, plus 5-fluorouracil by continuous infusion in the first and in the sixth week) and subsequent local surgical excision. During the follow-up, patients were subjected to the same preoperative diagnostic investigations and high resolution anoscopy. All patients showed a complete regression of the lesion after CRT and were treated by local surgical excision, thus avoiding permanent colostomy. In conclusion neo-adjuvant chemo-radiation therapy with local surgical excision could be considered an effective therapy in the treatment of anorectal BLT with SCC transformation to avoid APR.