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

Abstract

Giant condyloma acuminatum (GCA; Buschke-Löwenstein tumor) is a human-papillomavirus-induced cauliflower-like tumor of the genitoanal region. It is characterized by its size, capability of local infiltration and high recurrence rate. We report on a 50-year-old patient presenting with a maximum finding of GCA with deep infiltration into the adductor and perineal musculature, the scrotum, the penis and the pararectum. After performing a temporary loop colostomy, the tumor was removed by wide radical excision following plastic reconstruction with a myocutaneous gracilis flap. During a follow-up period of more than 5 years, no recurrence developed. Many treatment strategies (e.g. chemotherapy, radiation) have been published in the literature. Most authors recommend the radical surgical excision, allowing a complete histological examination and assessment of tumor-free resection margins. Despite the benign histological pattern of GCA in most cases, transformations into verrucous carcinoma and squamous-cell carcinoma have been described. In our case, the GCA seems to represent a continuum between normal condyloma acuminatum and an initial verrucous carcinoma.

Two Cases of Verrucous Carcinoma: Revisiting the Definition

“…Initially, VC shows indolent downgrowth of fingers of epithelium that gradually push rather that infiltrate. He emphasized that the epithelium is well differentiated and that the basement membrane is virtually intact 1 However, the BLT is reported to be the continuum between giant condyloma and VC 8 . Currently, differentiation between BLT and VC is controversial 2,3,8 .…”

“…He emphasized that the epithelium is well differentiated and that the basement membrane is virtually intact 1 However, the BLT is reported to be the continuum between giant condyloma and VC 8 . Currently, differentiation between BLT and VC is controversial 2,3,8 . The basement membrane adjacent to the epithelium has been reported to be often intact 3,6 .…”

“…Other options include cryosurgery, topical chemotherapy (mostly based on cisplatin, 5-fluorouracil and imiquimod), electrocautery, and photodynamic therapy 3,5,15 . Radiation therapy for VC is controversial 2,8 . This is because radiation was thought to cause anaplastic transformation with corresponding dedifferentiation and increased rates of metastasis, but a recent report indicates that chemoradiotherapy was effective 16 .…”

Giant Condyloma Acuminatum: A Surgical Riddle

“…These tumors are well-known for its neoplastic transformation, which is noted in about 50% of the cases (9). Presence or absence of the malignant transformation in the giant tumors is not easy to ascertain as no distinct histological features are known, which differentiate condyloma acuminatum from squamous cell carcinoma (10). Hematogenous or lymphatic spread and metastasis to distant organs is not seen in these tumors.…”

Buschke-Löwenstein-Tumor

“…Other adjuvant treatment modalities could be of interest to avoid mutilating surgical interventions such as laser, radiotherapy, intralesional interferon alfa, or topic imiquimod. 1,8,[17][18][19][20] A regular follow-up is necessary because of the frequent recurrences and possible malignant transformation. Malignant transformation has been reported in up to 50% of cases, 6 which is associated with a high recurrence rate and poor prognosis.…”