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Squamous mucosa with dysplasia and viral cytopathic effect from pathology study of the surgical specimen, consistent with koilocytosis of HPV infection (hematoxylin and eosin staining, ×200)
Source publication
The giant condyloma acuminatum (GCA), also known as Buschke‐Löwenstein tumor (BLT), is a type of HPV‐associated sexually transmitted infection (STI). Treatment options for condyloma acuminatum remain controversial, but surgery seems to be the best option. The management of GCA during pregnancy is more complicated since one has to evaluate the condi...
Citations
... Se estima que tiene una incidencia del 0.1% en la población; sin embargo, en las mujeres embarazadas se han publicado solo 6 casos 8 . La infección por VPH puede transmitirse al producto de forma vertical por medio del canal de parto o durante la ruptura de membranas, inclusive representa un factor de riesgo para papilomatosis laríngea juvenil 8,9 . Se ha reportado que la transmisión fetal consigue alcanzar hasta un 20% 10 . ...
... Los interferones, por sus acciones antivirales y antiproliferativas, han sido utilizados a manera de inyecciones locales con resultados positivos en cuanto a reducción del tamaño tumoral 21 . Otras sustancias que comprenden el dióxido de carbón, el argón y la terapia con láser se han empleado como recursos en el abordaje de las recurrencias 9 . ...
Caso clínico:
Paciente primigesta de 14 años, con un embarazo de 21 semanas de gestación, quien ingresó a urgencias por una masa dolorosa en región perineal de 5 meses de evolución. A la exploración física se encontraron en región perineal 2 lesiones exofíticas, coliformes, irregulares, ulceradas de aproximadamente 20 × 10 cm con presencia de secreción amarillenta fétida. Se realizó escisión del tumor con amplios márgenes quirúrgicos y cierre por segunda intención. Por parte de patología se reportó un condiloma acuminado gigante sin lesión en borde quirúrgico. La prueba por PCR detectó el genotipo 53 del virus de papiloma humano. Después de 12 semanas se presentó epitelización completa, sin complicaciones.
Conclusión:
El tumor de Buschke-Löwenstein es considerado como benigno, no obstante, representa cierto grado de malignidad y tiende a recurrir después del tratamiento, por lo que es importante reforzar las medidas de tamizaje y prevención del Virus del Papiloma Humano.
... Cases of GCA have been reported in the pediatric age group, and a limited number of cases also have been reported in pregnant women [7,8]. The types of HPV causing condyloma acuminatum warts of the anal and genital regions were 6, 11, 42, 44, and 54 [9]. ...
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.
... Additionally, a few cases have been described in the pediatric population [6]. The mean age reported by L. J. Trombetta and R. J. Place is 43.9 years old, with a male-to-female ratio of 2.7 to 1, with a few cases described in pregnant women [7,8]. HPV is the main agent in BLT pathogenesis, with subtypes 6 and 11 contributing to over 90% of cases in both immunocompetent individuals and those with immunosuppressive conditions [9,10]. ...
Introduction:
The Buschke-Löwenstein tumor (BLT) is an uncommon sexually transmitted ailment attributed to the human papillomavirus (HPV)-usually the 6 or 11 type (90%)-with male predominance and an overall infection rate of 0.1%. BLT or giant condyloma acuminatum is recognized as a tumor with localized aggressiveness, displaying distinctive features: the potential for destructive growth, benign histology, a rate of 56% malignant transformation, and a high rate of recurrence after surgical excision. There are several treatment choices which have been tried, including laser, cryotherapy, radiotherapy, electrocoagulation, immunotherapy, imiquimode, sincatechins, intralesional injection of 5-fluoruracil (5-FU), isolated perfusion, and local or systemic chemotherapy. In the case of an extensive tumor, preoperative chemotherapy or radiotherapy is used for tumor shrinkage, making the debulking procedure safer. HPV vaccines significantly decrease the incidence of genital warts, also decreasing the risk of BLT; HPV-6 and HPV-11 are included in these vaccines.
Materials and methods:
We present a 53-year-old heterosexual man, hospitalized in our department in June 2021 with a typical cauliflower-like tumor mass involving the perianal region, which progressively increased in size for almost 7 years. The perianal mass was completely removed, ensuring negative surgical margins. The large perianal skin defect which occurred was reconstructed with fascio-cutaneous V-Y advancement flap. There was no need for protective stoma. The literature review extended from January 1980 and December 2022, utilizing Pubmed and Google Scholar as search platforms.
Results:
Due to the disease's proximity to the anal verge and the limited number of reported cases, arriving at a definitive and satisfactory treatment strategy becomes challenging. The optimal approach entails thorough surgical removal of the lesion, ensuring well-defined surgical margins and performing a wide excision to minimize the likelihood of recurrence. In order to repair the large wound defects, various rotation or advancement flaps can be used, resulting in reduced recovery time and a diminished likelihood of anal stricture or other complications. Our objective is to emphasize the significance of surgical excision in addressing BLT through the presentation of a case involving a substantial perianal condyloma acuminatum, managed successfully with complete surgical removal and the utilization of a V-Y advancement flap technique. In the present case, after 5 months post operation, the patient came back with a buttock abscess, which was incised and drained. After another 5 months, the patient returned for difficult defecation, with an anal stenosis being diagnosed. An anal dilatation and sphincterotomy were carried out, with good postoperative results.
Conclusions:
The surgical management of Buschke-Löwenstein tumors needs a multidisciplinary team with specialized expertise. The reconstruction techniques involved can be challenging and may introduce additional complications. We consider aggressive surgery, which incorporates reconstructive procedures, as the standard treatment for Buschke-Löwenstein tumors. This approach aims to achieve optimal surgical outcomes and prevent any recurrence.
... Notably, this disease is more prevalent in individuals with an active sexual life [2] . Risk factors such as multiple sexual partners, poor body hygiene, and low socioeconomic status contribute to its incidence [4,6] . Early detection and timely management are crucial to prevent complications, particularly in high-risk populations. ...
... The limited therapeutic options available for pregnant patients necessitate a careful approach to treatment. Surgical resection remains the preferred treatment option for this condition [6] . However, "en bloc" surgical resection during pregnancy is associated with higher risks of abortion, hemorrhage, and preterm delivery, making it advisable to defer the procedure until the puerperium. ...
... Infection with human papillomavirus, especially the low-risk serotypes (6 and 11), corresponds to 90% of cases, with reports of association with serotypes 16, 18, and 52 considered high risk [1,13,14] . Risk factors that may predispose to the transformation of classic condyloma acuminata into Buschke-Löwenstein tumor include congenital or acquired immunosuppression (human immunodeficiency virus infection, diabetes, drugs), smoking, alcoholism, multiple sexual partners, previous genital infections, poor body hygiene, or low socioeconomic status [4,6] . ...
We present a case of Giant condyloma of Bushke-Löwenstein (GCBL) in a 15-year-old pregnant woman from the Tarahumara ethnic group. GCBL is a rare sexually transmitted disease caused by the the Human Papillomavirus (HPV) with a high risk of malignant transformation. Surgical resection is the main treatment, but managing GCBL during pregnancy requires careful consideration. This case highlights a rare and challenging condition that shares features with both classic condyloma acuminata and squamous cell carcinoma, making its differentiation difficult and the importance of comprehensive sexual education, culturally sensitive healthcare, and follow-up care in underserved communities. Challenges in post-surgical monitoring and limited knowledge of perinatal outcomes underscore the need for increased awareness, prevention, and early detection strategies, including HPV vaccination.
... 8 La infección por virus del papiloma humano puede transmitirse al feto de forma vertical, mediante el canal del parto, o durante la ruptura de membranas, incluso representa un factor de riesgo de papilo-matosis laríngea juvenil. 8,9 Se ha reportado que la transmisión fetal alcanza un 20% de los casos. 10 ...
... 14 El tratamiento tópico se ha implementado en combinación con crioterapia (óxido nítrico o nitrógeno líquido), con respuesta favorable para lesiones pequeñas. 9 La podofilina en monoterapia ha demostrado resultados poco favorables. 19 El tratamiento con imiquimod, un modulador de la respuesta inmunitaria, sugiere regresión completa de la lesión, incluso en niños. ...
... 21 El tratamiento con dióxido de carbono, argón y terapia con láser se han empleado como recursos adicionales en pacientes con recurrencias. 9 Aunque el condiloma acuminado gigante es una lesión benigna, se han reportado tasas de malignidad del 30 al 56%, por lo que es importante reforzar las medidas de tamizaje y prevención del virus del papiloma humano. 9 Existen tres vacunas aprobadas por la Organización Mundial de la Salud (OMS) contra el VPH: bivalente (Cervarix contra VPH 16,18), tetravalente (Gardasil para VPH 6,11,16,18) y nonavalente (Gardasil-9 frente a VPH 6,11,16,18,31,33,45,52,58). ...
ANTECEDENTES:
El tumor de Buschke-Löwenstein, también denominado condiloma acuminado gigante, es una alteración excepcional causada por el virus del papiloma humano, con una incidencia de 0.01% en la población general y solo 6 casos reportados en pacientes embarazadas. No existe un consenso respecto al tratamiento; sin embargo, la cirugía es la técnica más descrita.
CASO CLÍNICO:
Paciente primigesta de 14 años, con embarazo de 21 semanas, que ingresó al servicio de Urgencias por una masa dolorosa en la región perineal, de cinco meses de evolución. A la exploración física se encontraron, en la región perineal, dos lesiones exofíticas, coliformes, irregulares, ulceradas, de aproximadamente 20 x 10 cm, acompañadas de secreción amarillenta fétida. El tumor se extirpó y se dejaron márgenes quirúrgicos amplios y cierre por segunda intención. El estudio de patología reportó un condiloma acuminado gigante, sin lesión en el borde quirúrgico. La prueba de PCR detectó el genotipo 53 del virus del papiloma humano. Después de 12 semanas hubo epitelización completa, sin complicaciones adicionales para la paciente.
CONCLUSIÓN:
El tumor de Buschke-Löwenstein es benigno pero representa cierto grado de malignidad y tiende a recurrir después del tratamiento, por lo que es importante reforzar las medidas de tamizaje y prevención del virus del papiloma humano.
... [8] Surgical excision of large lesions before delivery is seldom considered reasonable management because the fetus may be affected during anesthesia. [12,13] In the present case, the patient 1 st visited another hospital, where the lesion was highly likely to be malignant. The lesion showed risky features, including rapid outgrowth and contact bleeding, during her 1 st visit to our outpatient clinic. ...
Rationale:
Condyloma acuminata and anogenital warts are protruding papillomatous lesions caused by human papillomavirus. In pregnant women, condyloma acuminata over the cervical region may grow rapidly, mimicking cervical cancer.
Patient concerns:
A pregnant woman at 14 weeks of gestation with condyloma acuminatum mimicking cervical cancer was referred to our hospital for further management.
Diagnosis:
Condyloma acuminata.
Interventions:
Tumor biopsy was performed twice, and the pathology confirmed condyloma acuminatum. Immunohistochemistry revealed focal positivity for p16 and Ki-67. Cryotherapy was performed and regular follow-up was performed at 2-week intervals. A small residual condyloma acuminata was found and treated with cryotherapy.
Outcome:
During the follow-up period, no recurrence of condyloma acuminata was noted. She delivered a baby at 37 weeks of gestation via cesarean section, without complications.
Lessons:
Condyloma acuminata of the cervix may grow faster during pregnancy, mimicking cervical cancer. Multiple factors must be considered when treating condyloma acuminata during pregnancy. Cryotherapy is proposed as a 1st-line treatment in all trimesters because of its safety, convenience, and cost-effectiveness. Serial follow-up at 2-week intervals to observe post-cryotherapy conditions is recommended.
... However, another study stated that the disease was introduced by Abraham Buschke and Lowenstein Ludwig in 1925 [2], [7]. Giant condyloma acuminata is rarely found in pregnant women [8]. Giant condyloma acuminata has a higher risk of becoming malignant than classical condyloma acuminata [9]. ...
BACKGROUND OF THE STUDY: Condyloma acuminata, a sexual infectious disease caused by Human Papilloma Virus (HPV) or Chlamydia trachomatis is more commonly in pregnant women and severe than in non-pregnant women. Pregnant women are susceptibility to infection due to the immunologic suppression and continues according to gestational age. AIM OF THE STUDY: Delivering a case report about a primigravida diagnosed with massive condyloma acuminata. METHODOLOGY: A 27-year old primigravida, 20 weeks gestation age with clinical manifestation of massive condyloma acuminata. In speculo, cauliflower-like masses in vaginal into cervix , intact, livide and grandson cervix, a lot of vaginal discharge/flour albus from ostium uteri externum. Vaginal swab and serology test for Chlamydia was conducted. RESULTS: The patient was treated by cauterization and clinical manifestations after cauterization was observed until delivered. Termination at 37 weeks gestation age , aterm , estimated fetal weight > 2500 grams by cesarean section. Improvement of healing process without new tissue pasca cauterization. CONCLUSION: The cauterization conducted on a 27-year old primigravida, 20 weeks gestation age with a massive condyloma acuminata showed a clinical recovery result and finally the pregnancy was terminate by cesarean section at the 37 weeks and > 2500 grams fetus weight safely.
... It is a sexually transmitted infection caused by Human Papilloma Virus (HPV) with the most common types (90%) being 6 and 11, with lesser involvement of phenotypes 16 and 18 [3]. The most common risk factors are related to immunosuppressed states, including HIV infection [4,5], pregnancy [6], smoking and alcohol. Other risk factors include poor hygiene, homosexuality and multiple sexual partners. ...
Introduction: Buschke-Löwenstein tumour (BLT) is a rare sexually transmitted infection of the skin caused by the Human Papilloma Virus with common involvement of the types 6 and 11. The preferential location being the genital area. It is very rare in children and mostly affects males over the age of 40. The diagnosis is mostly clinical. The goal standard for management is surgery. This is a case report of BLT in a Cameroonian child. Case History: A skin sample was received at the anatomy and pathology laboratory of the Centre Pasteur in Cameroon. It came from a 13 year old child with no prior history who initially presented with a large genitoscrotal tumour. In the light of these clinical facts that did not tie to a certain diagnosis, a histopathological analysis was carried out which revealed a Buschke-Löwenstein tumour. Discussion: This case history describes an original case of a clinically unsuspected BLT in a Cameroonian child aged 13-year-old, with no prior history. This case was diagnosed on histology and confirms the importance of histopathological analysis to this diagnosis which remains difficult for non-dermatologists. Conclusion: To our knowledge and according to the data at our disposal, this is the first time that BLT has been described in a child in Cameroon.
... In the most recent series of cases, a 2.7 : 1 male/female ratio was reported, with an age range of 24 to 77 years, a mean age of 43.9 years (42.9 years in men and 46.6 years in women), and a tendency to present at younger ages [5]. Very few cases have been described in pregnant women [10]. Although it is considered a sexually transmitted disease and sexual abuse should always be suspected when it occurs in pediatric age, cases not associated with sexual transmission have been described, suggesting a mechanism of autoinoculation and heteroinoculation [11]. ...
... During pregnancy it is suggested to defer surgical management until after delivery because it is associated with spontaneous abortion, intrapartum hemorrhage, preterm delivery, low birth weight. Delivery must be carried out by caesarean section to avoid vertical transmission [10]. ...
Giant condyloma acuminatum (GCA) or Buschke-Loewenstein tumor is a rare disease, with an estimated prevalence of 0.1%. It was initially described in 1896 by Buschke and later in 1925 by Buschke and Loewenstein. Classic condyloma acuminata (CCA) and squamous cell carcinoma (SCC) were initially described as different entities. These three entities are currently considered to correspond to the same spectrum of different but not exclusive malignant transformations, associated with multiple risk factors such infection by human papilloma virus (HPV), immunodeficiencies, poor hygiene, multiple sexual partners, and chronic genital infections. HPV subtypes 6 and 11 are associated with 90% of GCA. It presents as a cauliflower-like tumor in the genital region with bad odor, bleeding, and local infection, differential diagnosis with multiple conditions should be considered, and sexually transmitted diseases should always be investigated. GCA has a higher rate of malignant transformation than CCA and tends to infiltrate adjacent soft tissues. The therapeutic approach is controversial but is considered that the resection with free edges is the gold standard and can be combined with adjuncts. The recurrence rate is high. Overall mortality is 21% and is associated with morbidity caused by recurrences. Imiquimod cream 5% has recently shown good results as monotherapy and in combination with ablative and surgical treatments. The quality of life is diminished in patients with this condition. In this review, we address the different aspects of this rare entity including the therapeutic approach.
... It is rare, the reported incidence being 0.1% in the general population. 1 GCA can present as a cauliflower-like lesion 2 with broad-based papillomas up to several centimeters in diameter or as large confluent plaques. These lesions mostly occur in the perineum, vulva, vagina, perianal region and rectum, 3 rarely developing in extragenital areas. 4 Because these lesions frequently recur, being benign but contagious, lack a definitive form of treatment, and their treatment is expensive, 5 they can adversely affect patients' functioning and psychological health. ...
Background
Giant condyloma acuminatum (GCA), also called Buschke–Löwenstein tumor, presents as a verrucous infiltrating lesion and is caused by sexual transmission of human papilloma virus. The optimal treatment is controversial and there are no standard guidelines because of its rarity and frequent recurrence. It has a relatively high local recurrence rate.
Objective
We here report eight patients (six men and two women) with GCA whose lesions were successfully treated topically with traditional Chinese medicine (TCM) preparations, paiteling.
Methods and Materials
We administered topical TCM preparations to eight patients diagnosed with GCA who had refused surgery. The treatment process included three stages, their durations depending on the speed of resolution of the lesions and the results of visual inspection with acetic acid.
Results
No significant complications occurred in any patient. The functional and esthetic outcomes were satisfactory. No recurrences were detected during follow-up.
Conclusion
Topical treatment with TCM preparations may be a good alternative to surgery or other traditional methods for the treatment of GCA. This treatment has the advantages of being non-invasive, painless, and having a low risk of recurrence, and may be a useful adjunct to mainstream medical treatments.
