Successful application of aminolevulinic acid/photodynamic therapy in the treatment of giant condyloma acuminatum in an 87-year-old patient.

Condyloma acuminatum is a common sexually transmitted disease caused by human papillomavirus infection and is a benign hyperplastic lesion of the genital and perianal areas. The principle of its treatment is to remove the visible warts as much as possible and to prevent recurrence. Traditional treatment methods of condyloma acuminatum, such as CO2 laser, liquid nitrogen freezing, surgery, and topical medications, can remove warts. However, these methods have disadvantages such as pain, high recurrence rates, long treatment cycles, and scarring. Aminolevulinic acid/photodynamic therapy (ALA-PDT), a safe and effective method, has been widely used to treat condyloma acuminatum in recent years. Condyloma acuminatum occurs relatively rarely in elderly patients, in whom treatment is difficult owing to poorer physiological function. We successfully treated an 87-year-old patient with a giant condyloma acuminatum of the glans penis using six sessions of ALA-PDT at 7-day intervals and obtained satisfactory results. No recurrence was observed during a 6-month follow-up. Therefore, ALA-PDT is worth popularizing in clinical practice.

Case report: Buschke-Lowenstein tumor, a giant anal condyloma acuminata.

24-year-old man with positive HIV, with a giant exofitic anal condyloma, with a clinical presentation of a painfull suppurative anal condyloma with a pathology report of an in situ squamous cell carcinoma. The purpose of the investigation is a case report and the procedure was observational. The finding was a Buschke-Lowenstein tumor.

Varón de 24 años, con infección por el virus de la inmunodeficiencia humana, que presenta una tumoración exofítica, dolorosa y supurativa, con reporte positivo de virus de papiloma humano y reporte histopatológico de carcinoma espinocelular sin evidencia de diseminación (in situ). El propósito de la investigación es un reporte de caso y el procedimientos fue observacional. El hallazgo fue un tumor de Buschke-Lowenstein.

Giant condyloma acuminatum (Buschke-Lowenstein tumour) of the vagina during pregnancy.

A primiparous woman in her mid-30s presented at 31 weeks of gestation with a large vaginal mass obstructing the cervix, initially concerning for malignancy. Pelvic MRI confirmed a vaginal lesion located on the lateral wall, and histopathology diagnosed a giant condyloma acuminatum. The vaginal lesion was surgically resected at 34 weeks of gestation, and the patient proceeded to have a successful vaginal birth. Our case report demonstrates an unusual presentation of a rare anogenital disease and highlights a differential diagnosis for cervical and vaginal lesions.

"Free-Floating Anus": A Flap-Free Approach for Definitive Excision of Circumferential Giant Condyloma Acuminata.

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.

Squamous Cell Carcinoma of perineal area developed from the Buschke-Löwenstein tumor.

The Buschke-Löwenstein tumor is a rare disease associated with human papillomavirus infection. The condition manifests with an ulcerative, exophytic tumor localized in the perineal area. Generally considered as non-cancerous, the growth may develop malignant transformation. Our manuscript highlights the importance of early diagnosis with histopathological analysis.

Verrucous Carcinoma Arising in an Extended Giant Condyloma Acuminatum.

A 43-year-old heterosexual Tunisian man presented to the dermatology department with complaints of a genital friable mass. He had a past medical history of chronic hepatitis B. He was married and had a history of multiple sexual partners. The lesion had been present for over 10 years and gradually increased in size, disfiguring his genitalia. It had a major impact on his quality of life, preventing sexual intercourse and resulting in poor personal hygiene. On physical examination, the vegetative lesion presented as a giant cauliflower-like tumor (Figure 1) with a foul smell. The tumor involved the left inguinal region, the suprapubic genitalia, and was encircling the entire penile shaft. He also had inguinal lymphadenopathies. Under local anesthesia, a skin biopsy of the vegetative tumor was performed and sent for histopathologic examination. It revealed an exophytic epithelial tumor with papillomatosis, marked acanthosis, and many koilocytes, especially in the superficial layers of the epidermis. These signs along with the preservation of regular cytology were consistent with the diagnosis of condyloma acuminatum (Figure 2a). The histologic examination also showed clusters of atypical keratinocytes with high mitotic activity and keratinization, suggesting nests of squamous cell carcinoma (SCC) (Figure 2b and 2c). DNA-polymerase chain reaction (PCR) marker for Human papilloma virus (HPV) stains 11 was positive. Serology for hepatitis C, HIV, and syphilis non-reactive. Computed tomography scan of the abdomen and pelvis showed inguinal lymphadenopathies. The patient was referred to the oncologist for radiotherapy to reduce the size of the tumor followed by surgery. (SKINmed. 2023;21:53-54).

Cutaneous Verrucous Carcinomas: A Review.

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.

Vulvar Buschke-Löwenstein tumor in a HPV 16 infected woman: case report.

The Buschke-Löwenstein tumor is characterized by an exophytic lesion on the perianal region. It is considered benign but there is a high risk of recurrence and degenerative potential. It is commonly associated with human papillomavirus (HPV) especially subtypes 6 and 11, its evolution depends on the host's immunity and the association with other sexually transmitted diseases. Surgical excision is the recommended treatment in most cases. We report the case of a 54-year-old woman with only diabetes history, who had verrucous vulvar lesion associated to HPV subtype 16 treated with large excision.

Modified photodynamic therapy of vulvar giant condyloma acuminatum complicated by systemic lupus erythematosus: A case report.

Giant condyloma acuminatum (GCA) is a rare disease characterized by cauliflower-like tumors in the genital area, with a peculiar smell, bleeding, and local infection. Its occurrence is related to a variety of risk factors, such as human papillomavirus infection, immune deficiency, poor sanitary conditions, multiple sexual partners, and chronic genital infection. Surgical resection is still the preferred treatment for the disease. This paper reports that a patient with GCA complicated by systemic lupus erythematosus (SLE) and persistent thrombocytopenia who could not be treated surgically was treated with modified photodynamic therapy (M-PDT) in our outpatient department. After several treatments, the pain, odor, and secretion on the surface of the wart were significantly reduced, although the size of the wart was not significantly improved. Unfortunately, the patient died subsequently due to the aggravation of SLE. However, clinical treatment with M-PDT may be used as a palliative treatment when similar patients are encountered.

Tumor de Buschke ­ Löwenstein: Presentación de un Caso y Revisión Bibliográfica / Buschke ­ Löwenstein Tumor: A Case Report and Review of the Literature

Introducción: El tumor de Buschke ­ Lowenstein (TBL) es enfermedad de transmisión sexual causada por el virus del papiloma humano (VPH), descrita como una forma intermedia entre un condiloma acuminado y un carcinoma de células escamosas. Afecta principalmente al área genital y anorrectal, posee capacidad de transformación maligna y una alta tasa de recurrencia. La cirugía es el tratamiento de primera línea. Caso clínico: Presentamos el caso de un paciente masculino de 27 años con lesiones verrucosas de crecimiento progresivo en el área inguinal y genital. Mediante la correlación clínico-patológica se llegó al diagnóstico de TBL. Tras discusión en comité multidisciplinario se declaró irresecable y se resolvió tratamiento con radioterapia, además vacunación terapéutica contra el VPH, tanto sistémica como intralesional. Conclusión: El TBL es localmente agresivo y de difícil tratamiento, por lo que la prevención contra el VPH es fundamental. La vacunación terapéutica en conjunto con la radioterapia ofreció mejoría clínica.

Introduction: Buschke-Lowenstein tumor (BLT) is a sexually transmitted disease caused by the human papillomavirus (HPV), described as an intermediate form between condyloma acuminata and squamous cell carcinoma. It mainly affects the genital and anorectal areas and has the capacity for malignant transformation and a high recurrence rate. Surgery is the first-line treatment. Clinical case: We present the case of a 27-year-old male patient with warty lesions of progressive growth in the inguinal and genital areas. Through the clinical-pathological correlation, the diagnosis of BLT was reached. After discussion in a multidisciplinary committee, it was declared unresectable, and treatment with radiotherapy was resolved, in addition to therapeutic vaccination against HPV, both systemic and intralesional. Conclusion: BLT is locally aggressive and challenging to treat, so prevention against HPV is essential. Therapeutic vaccination in conjunction with radiotherapy offered clinical improvement.

The Pathogenesis of Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor): An Overview.

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.

Clinical Conundrum: A Case of Cervical Giant Condyloma Acuminatum.

Giant condyloma acuminatum (GCA) is a benign anogenital lesion caused by human papilloma virus. It is rarely found on the cervix and is difficult to differentiate from malignancy. It is associated with a propensity for invasion, recurrence, and malignant transformation. A 35-year-old woman presented with abnormal uterine bleeding and a suspicious cervical mass. After a Pap test revealed high-grade squamous intraepithelial lesion, cervical biopsies revealed cervical dysplasia. A diagnostic loop electrical excision procedure identified a giant condyloma. A total hysterectomy was performed, confirming the diagnosis. This condition should be in the differential diagnosis for a cervical mass suspicious for malignancy. Prompt biopsy of mass is crucial.

Giant anogenital tumor of Buschke-Löwenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report.

BACKGROUND: Buschke-Löwenstein tumor is a giant condyloma acuminata infection that is characterized by degeneration, invasion, and recurrence. It is associated with human papilloma virus infection. It develops around the genital and perineal area, sometimes causing a large budding ulcerated lesion. Although human immunodeficiency virus infection is frequent in Africa, there are few descriptions of Buschke-Löwenstein tumor diagnosis and its management. Screening for other sexually transmitted infections must be systematic among these patients. CASE PRESENTATION: We report herein the case of a 21-year-old African origin male patient who developed a perineal swelling. Physical examination showed evidence of a huge exophytic tumor made up of budding pinkish vegetations, with serrated crests, a ''butterfly wing'' structure, and a cauliflower-like appearance crowned with centrifugal circinate lesions. Multiple condylomatous lesions of the anal margin were also present. The patient tested positive for human immunodeficiency virus (cluster of differentiation 4 count of 119 cells/mm3) and hepatitis B infections. Real-time polymerase chain reaction revealed human papilloma virus-16 and other high-risk human papilloma virus deoxyribonucleic acid. The diagnosis of Buschke-Löwenstein tumor was made on mass biopsy, and the patient underwent multidisciplinary intervention (surgery, podophyllin application, and antiretroviral therapy). Medium-term evolution was, however, fatal due to opportunistic infection. CONCLUSION: Buschke-Löwenstein tumor is a rare tumor associated with human immunodeficiency virus infection. It is more frequent in male human immunodeficiency virus-positive patients. There is a need to screen for other sexually transmitted infections. In most cases, the treatment is surgical, in association with local therapies. However, recurrences are common.

A rare case of self-healing giant condyloma acuminatum.

Giant condyloma acuminatum (GCA) which is also called Buschke-Lowenstein tumor. It is a rare tumor of the anorectal area and external genitalia associated with low-risk HPV types 6 or 11. GCA has a high-rate of recurrence (66%) and malignant transformation (56%). The clinical features of GCA are progression of exophytic, ulcerative, and cauliflower-shaped tumors, it has significant dimensions and may undergo malignant transformation such as squamous cell carcinoma or cervical cancer. It is difficult to treat GCA, and it may be impossible for GCA to self-healing, but we herein report a rare case of a 19-year-old female with self-healing GCA.

Squamous Cell Carcinoma Arising from Perianal Buschke-Lowenstein Tumor (Giant Condyloma Acuminatum): Comprehensive Literature Review.

PURPOSE: This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum. METHODS: We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020. RESULTS: A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2). CONCLUSION: Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.

[Giant condyloma acuminatum in pregnancy]. / La tumeur de Buschke Lowenstein chez la femme enceinte.

Buschke Lownestein's tumour is a giant acuminate condyloma characterised by its degenerative potential, its invasive nature and its recurrence after treatment. It is a rare condition, transmitted mainly by sexual transmission and induced by to the human papillomavirus (HPV). The discussion will be illustrated by a clinical case The treatment is still under discussion but surgery seems to be the best option. Management during pregnancy is more complex since it must take into account the mother and her fetus. The delivery route is still debated. The post-treatment evolution was satisfactory and without recurrence until the delivery which, due to the antecedent of 3 caesarean sections, was carried out by cesarean section. HPV vaccination, sex education and early treatment of condyloma lesions should prevent and in any case improve the prognosis of this disease.

Recurrent fungating tumor and a chronic rash in an immunosuppressed transgender patient: a case of Buschke-Lowenstein condyloma and epidermodysplasia verruciformis.

A transgender female in her 40s with history of HIV and testicular cancer status post-genital X-irradiation presented with a perianal mass and pruritic rash across her chest. Physical examination revealed a bulky, verrucous tumor protruding outward from the anus involving the medial buttocks. Examination of the chest and arms showed numerous guttate, pink, flat-topped papules coalescing into plaques. Clinically and histologically the lesions were consistent with Buschke-Löwenstein condyloma (BLC) and acquired epidermodysplasia verruciformis (AEDV). Buschke-Löwenstein condyloma incisional biopsy tested negative for common low- and high-risk human papillomavirus (HPV) subtypes, including 6, 11, 16, and 18, possibly implicating beta HPV subtype or a less common pathogenic subtype. The patient underwent abdominoperineal resection of the BLC, which tested positive for low-risk HPV subtypes, suggesting the possibility of multiple implicated HPV subtypes in the same tumor. This case demonstrates a possible role of beta HPV or rarer HPV subtypes in the pathogenesis of verrucous carcinoma, particularly in the setting of immunosuppression.