A Gigantic Anal Mass: Buschke–Löwenstein Tumor in a Patient with Controlled HIV Infection with Fatal Outcome

Abstract

Buschke–Löwenstein tumor of anorectal and perianal area is a rare but highly aggressive tumor, frequently associated with human papillomavirus (HPV) types 6 and 11. It often grows over years in immunocompetent patients and can be highly destructive to local tissue. We present a case of a 61-year-old male with HIV infection who presented with worsening pain and swelling in the anorectal area for one-year duration. Exam revealed a 15 × 10 cm mass in the anorectal area with multiple sinuses and fistulas. MRI revealed extension of the mass through pelvic structures. Biopsy showed squamous epithelium with koilocytes and histochemistry positive for P16, suggestive of HPV infection. Biopsy was negative for malignant transformation. He was not a candidate for surgery or radiation due to extensive infiltration of deeper structures and multiple fistulas. He refused interferon therapy, and diverting colostomy was placed for palliation. He presented two months later with overwhelming sepsis and died despite maximal medical therapy.

Giant Condyloma Acuminate (Buschke-Löwenstein Tumor): A Case Report

“…In the majority of the cases it starts from long-standing condylomata that can reach up to 10-15 cm. The evolution period usually ranges from 2.8 to 9.6 years [1]. The most important risk factors include anal receptive sex, immunosuppression, HIV infection, chronic irritation and poor personal hygiene [1].…”

“…The evolution period usually ranges from 2.8 to 9.6 years [1]. The most important risk factors include anal receptive sex, immunosuppression, HIV infection, chronic irritation and poor personal hygiene [1]. BLT is sometimes associated with severe morbidity due to its invasive growth which can result into local tissue destruction and occlusion of the rectum, especially in cases of malignant transformation into squamous cell carcinoma [6,7].…”

“…BLT is sometimes associated with severe morbidity due to its invasive growth which can result into local tissue destruction and occlusion of the rectum, especially in cases of malignant transformation into squamous cell carcinoma [6,7]. Histologically BLT has benign appearance with negligible cellular atypia, papillomatosis, koilocytosis and epithelial hyperplasia [1,2]. However, these histological features are very similar to those of verrucous carcinoma and some authors do not differentiate between these diseases [4].…”

“…These tumors can grow rapidly and be potentially fatal to immunocompromised individuals [2,3]. A wide, radical surgical excision of the mass is considered the primary treatment, while a close follow-up is necessary due to its frequent recurrence and malignant potential [1][2][3]. In this article we report the case of a 71-year-old man who was misdiagnosed for 20 years with hemorrhoidopathy and was finally treated with wide excision of a giant perianal Buschke-Löwenstein tumor.…”

“…Condyloma acuminate is a painless growth over the skin surface, which is usually, associated with human papillomavirus (HPV) types 6 and 11 [1]. Buschke-Löwenstein tumor (BLT) or giant condyloma acuminatum (GCA) is a progressively growing, cauliflower-like, locally destructive tumor that is considered to be a verrucous carcinoma, which is an intermediate state between condyloma and squamous cell carcinoma [1,2]. Patients who suffer from these tumors are susceptible to secondary infections, foul odor and fistulations.…”