Staged resection in the management of HIV-related anogenital giant condyloma acuminatum. A case report

Abstract

IntroductionGiant condyloma acuminata (GCA), also known as Bushke-Lowenstein tumour, is a rare disease which affects 0.1% of the population. Although histopathologically benign, it tends to be locally destructive. The common sites of involvement include the penis and the anorectum. Due to the rarity of the disease, there is a lack of controlled studies on the optimal management of this entity. Thus, we report a case of anogenital GCA in a 40-year-old HIV-positive man.Case presentationA 40-year-old man presented with progressive anogenital warts associated with foul-smelling discharge and fever. He has been diagnosed with HIV and was on HAART on presentation. A warty excrescence had infiltrated the entire external genitalia, gluteals and sacral region. Serial excision was performed along with a defunctioning colostomy. The patient recovered well, and the final histopathological showed features of GCA.DiscussionWith HIV, the HPV infection goes unchecked may develop into GCA. Malignant transformation to squamous cell carcinoma may occur in more than half of the cases. A complex interaction between HIV and HPV may lead to a higher risk of recurrence even after resection. The diagnosis is usually clinical. Imaging modalities may be used in identifying the extent and depth of invasion.ConclusionThe optimal management of anogenital giant condyloma acuminata remains to be determined. Staged surgical excision should be conducted to achieve an optimum outcome. Radical reconstructive surgery should be reserved for patients with recurrence, malignant transformation or sphincter involvement.

Electrosurgery on Giant Condyloma Acuminata

“…Condyloma Acuminata (GCA) is a sexually transmitted infection caused by certain types of Human Papillomavirus (HPV) such as type 6 and 11 (Hall, 2019;Loo et al, 2019;Pennycook & McCready, 2022). The HPV virus is a double-stranded DNA virus that primarily infects squamous epithelial cells.…”

“…Keratotic papules lesion can grow solitary or in clusters to form a cauliflower shape. Most of these skin lesions are accompanied by itching, burning and pain, but can also be asymptomatic (Diţescu et al, 2021;Loo et al, 2019). The diagnosis of GCA can be made from the history and physical examination and the skin lesions that are same with the characteristic of the disease.…”

“…Electrosurgery therapy has various modalities that can be an option for GCA therapy. Electrosurgery therapy in GCA cases has the advantage that able to remove almost all lesions at one time with the lowest recurrence rate (Nieves-Condoy et al, 2021).However, this electrosurgery therapy also has some disadvantages such as pain (Loo et al, 2019) and unavoidable actions (Baigrie et al, 2022). The aim of this study was to evaluate the effectiveness of electrosurgery in GCA patients, where electrosurgery was found to be able to remove all skin lesions and prevent recurrence in previous case reports (Baigrie et al, 2022;Workowski & Berman, 2011).…”

“…The types of HPV that are known to be associated with GCA are HPV types 6 and 11. GCA skin lesions are characterized by multiple papules with clear edge developing a cauliflower-like appearance with a size of more than 10 (Hall, 2019;Loo et al, 2019;Sterling, 2019). The prevalence of GCA increases every year, between 9 -13% of the world's population.…”

Giant Condyloma Acuminatum Treated Successfully with Mild Local Hyperthermia: Two Case Reports

“…GCA, first described in 1925, is a rare disease, which affects 0.1% of the population ( 5 ). Immunocompromised conditions, such as HIV infection, diabetes, malignancy and post-transplantation, seem to increase the risk of GCA ( 6 ). HPV, commonly the low-risk strains (6 and 11) and occasionally the high-risk strains (16 and 18), are the underlying cause of GCA ( 7 ).…”