Buschke‑Löwenstein tumors: A series of 7 case reports

Abstract

Giant condyloma acuminatum (GCA), or Buschke-Löwenstein tumor (BLT), represents an infrequent sexually transmitted disease (STD), caused by human papillomavirus (HPV), especially genotype 6 or 11. There are numerous risk factors for HPV, such as multiple sexual partners, homosexuality, prostitution, chronic genital infections, as well as the lack of proper hygiene. HPV infection is a field infection, where large areas of cells at a tissue surface are affected by the HPV virus; therefore, once the GCA is excised, treatment of the whole affected genital area needs to be undertaken. The treatment is classified into topical therapy (podophyllin, 5-FU, radiotherapy, topical photodynamic therapy), excisional therapy (CO 2 laser, cryotherapy, electrotherapy, surgery) and immunotherapy (imiquimod). However, the 'gold standard' therapy is represented by wide surgical excision without grafting, since it is considered that healing per secundam is an improved approach, because there is no risk of recurrences on fibrotic tissue. A total of 7 cases of the BLT with comorbidities and particularities are presented and it is recommended that it be taken into consideration that the incidence of the disease is increasing, emphasizing the importance of an early diagnosis, as well as an adequate treatment.

Surgical Management of Giant Condyloma Acuminata Involving Vulva, Perineum and Perianal Area

“…In 1925, Buschke and Lowenstein described a unique neoplasm of the penis which, to them, bore similarities to CCA as well as SCC. Clinically it looked like CA but behaved like locally invasive malignancy, whereas histologically it was more like condyloma acuminatum without any evidence of anaplasia [12,14].…”

“…Although, the GCA and GCBL/BLT are often used mutually, it is prudent to compare and contrast the two as it has clinical implications. Both GCA and GCBL have similar risk factors including immunosuppression, diabetes, smoking, multiple partners, men having sex with men (MSM), poor hygiene as well as other STDs [7,12]. They have comparable clinical presentation and management but the risk of malignant transformation, recurrence rates and prognosis are different.…”

A Report of Two Rare Cases of Buschke-Löwenstein Tumor

“…Giant condyloma acuminatum or Buschke-Löwenstein tumor (BLT) is a large cauliflower-like budding tumor generally exceeding 10 cm in size presenting in the anogenital region caused by several types of human papillomavirus (HPV), the most common types involved are HPV 6, 11, 16, and 18 [ 1 , 2 ]. It is a sexually transmitted infection often affecting the penile region [ 3 ]. This slowly growing tumor is known for its local invasion and the high risk of recurrence and malignant transformation [ 4 ].…”

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“…The Buschke-Löwenstein tumor was first described in 1886 by the German dermatologist Abraham Buschke; It is a strange manifestation of condyloma acuminata, it begins as a small gradual keratotic growth over several years and transforms into a mass similar to a cauliflower; It occurs in the vulva, scrotum, foreskin, coronal sulcus of the penis, perineum and perianal, extremely rare in the rectum and bladder. 1,2 Macroscopically, it presents as an exophytic, polypoid lesion; similar to a cauliflower, characterized by slow growth, local infiltration, contiguous tissue destruction, with a tendency to recur and produce fistulas or abscesses around the affected area. The idea that Buschke-Löwenstein tumor should be considered a premalignant lesion with a high potential for malignant degeneration or a clinical manifestation of verrucous carcinoma is controversial; 3 occurs more frequently in men than in women; mainly uncircumcised and under 50 years old; Incidence rates are higher in men who have sex with men; It is caused by low-risk human papillomavirus (HPV) serotypes; HPV-6 and 11.…”

“…Other treatments are described such as podophyllin gel, 5-fluorouracil, bleomycin combined with cisplatin, methotrexate or interferon alfa to reduce size, there are no standard guidelines or doses, imiquimod 5%, applied 3 times a week at night and up to 16 weeks, complete responses were reported in 37 to 54% of patients; Recurrence occurs in 19% of cases after 12 weeks of follow-up; 14,15 cryotherapy alone or in combination with topical 5-fluorouracil obtains good results, laser phototherapy, CO 2 or argon laser, is reserved for recurrence; Its advantages are the hemostatic incision and sterilization of the wound (16). Radiotherapy is controversial since it can induce dedifferentiation of tumor cells, progression of the lesion, even malignant transformation to anaplastic carcinoma and metastasis; 1,[15][16][17] the effectiveness of neoadjuvant chemoradiotherapy at 45 Gy in the pelvis plus an increase of 14.4 Gy to the primary tumor, for a total of 59.4 Gy concomitant with mitomycin-C or 5-fluorouracil and subsequent local surgical excision, showed complete regression, in case of recurrent tumors after radiotherapy alone or surgical excision. Flap reconstructive surgery is used to cover the defect that remains after its removal.…”