Invasive squamous-cell carcinoma in giant anorectal condyloma (Buschke-L�wenstein tumor)

Abstract

Giant condyloma acuminata, first described by Buschke and Löwenstein in 1925 as a penile lesion, is extremely rare in the anorectal region. The cauliflower-like tumor behaves clinically in a malignant fashion, although it shows no histomorphological criteria of malignancy. Up to the time of writing only 33 cases of anorectal origin, 42% with malignant transformation, have been published. The authors report 2 more cases of squamous-cell carcinoma in giant anorectal condylomata acuminata. Buschke-Löwenstein tumor is an intermediate entity between "ordinary" condyloma acuminata and squamous-cell carcinoma. Benign condyloma acuminata is caused by human papillomavirus 6 or 11. Carcinogenic cofactors promote the transition to giant, locally destructive condyloma acuminata and subsequent malignant transformation. Cure can only be achieved by early and radical excision. Formation of multiple fistulas and destruction of the sphincter may necessitate abdomino-perineal resection. Adjuvant radiation therapy should only be considered to render a tumor operable, as radiation may act as a cocarcinogenic effect and lead to a less differentiated and more aggressive cancer. The small number of cases reported and the variety of treatment regimens applied, however, do not allow the formulation of definitive therapeutic guidelines.

Successful Surgical Management of Giant Condyloma Acuminatum (Buschke-Löwenstein Tumor) in the Genitoanal Region: A Case Report and Evaluation of Current Therapies

“…Bertram et al [5 ]have made similar considerations classifying the tumor as a low-malignant SCC. They assume that carcinogenic cofactors conduce to the transformation from condyloma acuminatum to an initial VC.…”

The treatment of squamous anal carcinoma: guidelines of the Italian society of colo-rectal surgery

“…Intermediate between classical condyloma and squamous cell cancer, it is characterized by a local invasive behavior with a combination of exophytic and endophytic growth with very rare metastasis and a variable risk of showing malignant transformation (around 42 %) [71].…”

Surgical Management of Perianal Giant Condyloma Acuminatum (Buschke-Löwenstein Tumor)

“…The use of radiotherapy is still controversial, because of the evidence of anaplastic transformation and extensive appearance of new condylomas after its use, and because of the lack of long-term results [19][20][21] . The role of systemic chemotherapy is not well defined because of paucity of data, and also topical chemotherapy with 5-fluorouracil seems to give poor results in the case of GCA [7] .…”