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

Abstract

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.

Giant condyloma acuminatum in pregnancy: A case report

“…The development of malignancy has been reported in 30-56% of cases (Akdag & Yildiran, 2018;Indinnimeo et al, 2013). In this case, squamous mucosa with dysplasia and the viral cytopathic effect were noticed, signs of expectable spontaneous regression.…”

“…The risk of recurrence in the anorectal and perianal regions after excision is 60–66%, with an overall mortality of 20–30%. The development of malignancy has been reported in 30–56% of cases (Akdag & Yildiran, ; Indinnimeo et al, ). In this case, squamous mucosa with dysplasia and the viral cytopathic effect were noticed, signs of expectable spontaneous regression.…”

Immunohistochemical findings and differential diagnosis of papillary-type cutaneous verrucous carcinoma of the neck: A case report

“…Surgical resection is the preferred treatment strategy for patients with VC, however, anal and perianal lesions have a high recurrence rate of ~70%, and a mortality rate of 20-30%. Although radiation therapy is not considered to be as effective as surgery, its efficacy as an adjuvant treatment strategy remains a topic of debate (4,5). The present case report describes a rare case of papillary-type cutaneous VC of the neck, including the immunohistochemical findings, which have not previously been well described.…”

Anal verrucous carcinoma is not related to infection with human papillomaviruses and should be distinguished from giant condyloma (Buschke–Löwenstein tumour)

“…However, the situation is also complex, because of the possibility that both VC and BLT may contain foci of conventional SCC. [27][28][29] The main limitation of our study is the small number of patients. Anal VC, however, is extremely rare, and even with this small number of patients the results were uniform, strongly supporting the suggestion that anal VC and BLT should be regarded as separate entities, similarly to VC and BLT at other locations.…”

“…The GP5+/ 6+/68 PCR protocol was performed as described previously, 14,17 and the INNO-LiPA HPV Genotyping Extra II test (Fujirebio) was performed, following the manufacturer's instructions. To detect low-risk alpha-PVs associated with different mucosal and cutaneous warts, we used a PCR protocol targeting an approximately 190-bp fragment of the E1 gene of HPV2, 3,6,7,10,11,13,27,28,29,32,40,42,43,44,57,74,77,78,91,94, 117 and 125, as described elsewhere. 9 The presence of beta-PVs was examined by the use of a reverse line-blot hybridization-based RHA Kit Skin (beta) HPV test (Diassay BV, Rijswijk, the Netherlands), enabling detection of at least 25 different HPV types, including HPV5, 8,9,12,14,15,17,19,20,21,22,23,24,25,36,37,38,47,49,75,76,80,92, 93 and 96.…”