Intra-Abdominal Localisation of a Buschke-Lowenstein Tumour: Case Presentation and Review of the Literature

Abstract

Giant condyloma acuminatum or Buschke-Lowenstein tumour is a very rare disease which usually is located in the genital, anorectal, and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. We describe a case of a 24-year-old woman with persisting condyloma acuminata progressing to a large intra-abdominal Buschke-Lowenstein tumour. To our knowledge such an advanced stage has only been reported once before. The severity and extent of the tumour both determine the treatment and patient outcome. Treatment was impeded by cachexia, an immunosuppressive state after kidney transplantation and difficulties in establishing a reliable diagnose. Interferon treatment was started which initially led to tumour reduction but was complicated by an interferon-induced pancreatitis, pneumonia, and fasciitis necroticans resulting in death. We present a literature overview on the treatment options for a Buschke-Lowenstein tumour, with emphasis on interferon therapy, with all the advantages and disadvantages.

Condiloma gigante de Buschke-Lowenstein: um relato de caso

“…Isso faz com que a excisão cirúrgica completa seja o tratamento de escolha, 7,9,11,12 ressaltando-se que a radioterapia e a quimioterapia também podem ser empregadas para evitar que o cancro se estenda para o canal anal. Em um estudo de seguimento realizado por 21 anos em 24 pacientes diagnosticados com CEC anal e tratados, 8 pacientes foram tratados com ampla excisão local e nesses não foram detectadas nem recorrência, nem mortalidade, dado consistente com a literatura.…”

“…Ademais, exibe o potencial de se transformar em carcinoma de cé-lulas escamosas (CEC) 6 -essa associação tem a prevalência de 0,75 a 3,00% na Europa e 1,00% nos Estados Unidos. Um dos fatores de risco para o desenvolvimento de carcinoma é um estado de imunodepressão, 7 visto que o sistema imunológico repele com eficácia a maioria das infecções por HPV. Na história natural do carcinoma espinocelular anal, que é um CEC, a neoplasia intraepitelial anal (NIA), um precursor desse, está associada aos HPVs tipo 16, 18 e 31.…”

Buschke – Löwenstein Tumor of the Vulva in a Patient with HIV-positive Status: General Information and Description of a Clinical Case

“…Они также обнаружили, что степень развития остроконечных кондилом коррелирует с количеством CD4+ T-клеток. Это объясняет тот факт, что ОБЛ чаще встречается у лиц с ВИЧ-инфекцией или принимающих иммунодепрессанты, например, у пациентов с пересадкой стволовых клеток или трансплантацией паренхиматозных органов [36][37][38][39][40][41][42][43][44]. Риск быстрого прогрессирования ОБЛ в плоскоклеточный рак также повышен у ВИЧ-инфицированных пациентов [45].…”

Buschke-Lowenstein Tumors: A Review and Proposed Classification System

“…Urosepsis secondary to urethral obstruction 16 and even necrotizing soft tissue infections have been reported. 17 Buschke-Lowenstein tumors are typically described as slow growing. 18 In reality, it is difficult to accurately describe the growth pattern because it has not been well evaluated.…”

“…25,26 It is unclear if HIV infection is associated with an increasing incidence of B-L, as it is in other forms of anogenital warts, or if B-L lesions exhibit a more aggressive behavior in these patients. 27 Patients with a history of solid organ transplant requiring immunosuppression are also prone to B-L, 17,28 as are patients with other causes of immunosuppression, including malignancy 29 or cirrhosis. 30 The actual incidence of immunosuppression in patients with B-L is difficult to assess and is another area that is lacking data.…”