Giant Condylomata Acuminata of Buschke and Lowenstein Workup

  • Author: Catharine Lisa Kauffman, MD, FACP; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 26, 2012
 

Imaging Studies

GCBL has shown mild, heterogenous enhancement with gadolinium-diethylenetriamine pentaacetic acid (DTPA) contrast on MRI. This study may be useful in delineating the expansion of the lesion when planning for removal.[7]

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Procedures

Biopsy is the diagnostic procedure necessary for evaluation. It must be sufficiently deep and generous to evaluate for possible foci of SCC because lesions with these changes have been shown to have a higher recurrence rate and to metastasize. Vacuolar change is not a reliable differentiator between GCBL and condyloma, and visualizing the base of the lesion and the characteristic broad, blunt, deeply penetrating rete pegs is necessary to make the diagnosis.

Although the rate of regional lymph node involvement is low, sentinel lymph node biopsy should be considered if clinical findings suggest the need for it.

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Histologic Findings

GCBL characteristically has massive epidermal hyperplasia, hyperkeratosis, and parakeratosis and is markedly exophytic. Granular vacuolization may be present, and individual keratinocytes have large cytoplasm and a nucleus with prominent nucleoli.

Blunt-shaped masses of tumor project deeply into the dermis and contiguous structures. The tumor cells have little evidence of atypia and are not found inside blood vessels or lymphatics. Individual keratinocytes may show keratinization, but no horn pearls are seen. Lymphohistiocytic inflammation is usually present.

Giant condyloma acuminatum is differentiated histologically from ordinary condyloma acuminata by its thicker stratum corneum and the presence of an endophytic downgrowth, along with a tendency to invade deeper.

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Contributor Information and Disclosures
Author

Catharine Lisa Kauffman, MD, FACP  Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Doru Traian Alexandrescu, MD  Assistant Professor of Medicine, Georgetown University

Doru Traian Alexandrescu, MD is a member of the following medical societies: American Association for Cancer Research, American Cancer Society, American College of Physicians, American Medical Association, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark W Cobb, MD  Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Christopher Norwood, MD, and Mary K. Mather, MD, to the development and writing of this article.

References

  1. Wiedemann A, Diekmann WP, Holtmann G, Kracht H. Report of a case with giant condyloma (Buschke-Lowenstein tumor) localized in the bladder. J Urol. Apr 1995;153(4):1222-4. [Medline].

  2. Dianzani C, Bucci M, Pierangeli A, Calvieri S, Degener AM. Association of human papillomavirus type 11 with carcinoma of the penis. Urology. Jun 1998;51(6):1046-8. [Medline].

  3. Castren K, Vahakangas K, Heikkinen E, Ranki A. Absence of p53 mutations in benign and pre-malignant male genital lesions with over-expressed p53 protein. Int J Cancer. Aug 31 1998;77(5):674-8. [Medline].

  4. Papiu HS, Dumnici A, Olariu T, Onita M, Hornung E, Goldis D, et al. Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature. Chirurgia (Bucur). Jul-Aug 2011;106(4):535-9. [Medline].

  5. Crespo R, Puig F, Lanzon A, Borell A. Buschke-Lowenstein tumor and pregnancy: a case report. Eur J Gynaecol Oncol. 2007;28(4):328-9. [Medline].

  6. Trombetta LJ, Place RJ. Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. Dis Colon Rectum. Dec 2001;44(12):1878-86. [Medline].

  7. Takezawa Y, Shimizu N, Kurokawa K, Suzuki K, Yamanaka H. Appearance on magnetic resonance imaging of Buschke-Lowenstein tumour. Br J Urol. Aug 1996;78(2):308-9. [Medline].

  8. Renzi A, Giordano P, Renzi G, Landolfi V, Del Genio A, Weiss EG. Buschke-Lowenstein tumor successful treatment by surgical excision alone: a case report. Surg Innov. Mar 2006;13(1):69-72. [Medline].

  9. Ambriz-González G, Escobedo-Zavala LC, Carrillo de la Mora F, Ortiz-Arriaga A, Cordero-Zamora A, Corona-Nakamura A, et al. Buschke-Löwenstein tumor in childhood: a case report. J Pediatr Surg. Sep 2005;40(9):e25-7. [Medline].

  10. Hengge UR, Tietze G. Successful treatment of recalcitrant condyloma with topical cidofovir. Sex Transm Infect. Apr 2000;76(2):143. [Medline].

  11. Toro JR, Sanchez S, Turiansky G, Blauvelt A. Topical cidofovir for the treatment of dermatologic conditions: verruca, condyloma, intraepithelial neoplasia, herpes simplex and its potential use in smallpox. Dermatol Clin. Apr 2003;21(2):301-9. [Medline].

  12. Geusau A, Heinz-Peer G, Volc-Platzer B, Stingl G, Kirnbauer R. Regression of deeply infiltrating giant condyloma (Buschke-Löwenstein tumor) following long-term intralesional interferon alfa therapy. Arch Dermatol. Jun 2000;136(6):707-10. [Medline].

  13. Heinzerling LM, Kempf W, Kamarashev J, Hafner J, Nestle FO. Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology. 2003;207(1):119-22. [Medline].

  14. Ilkay AK, Chodak GW, Vogelzang NJ, Gerber GS. Buschke-Lowenstein tumor: therapeutic options including systemic chemotherapy. Urology. Nov 1993;42(5):599-602. [Medline].

  15. Butler TW, Gefter J, Kleto D, Shuck EH 3rd, Ruffner BW. Squamous-cell carcinoma of the anus in condyloma acuminatum. Successful treatment with preoperative chemotherapy and radiation. Dis Colon Rectum. Apr 1987;30(4):293-5. [Medline].

  16. Sobrado CW, Mester M, Nadalin W, Nahas SC, Bocchini SF, Habr-Gama A. Radiation-induced total regression of a highly recurrent giant perianal condyloma: report of case. Dis Colon Rectum. Feb 2000;43(2):257-60. [Medline].

  17. Wiltz OH, Torregrosa M, Wiltz O. Autogenous vaccine: the best therapy for perianal condyloma acuminata?. Dis Colon Rectum. Aug 1995;38(8):838-41. [Medline].

  18. Hatzichristou DG, Apostolidis A, Tzortzis V, Hatzimouratidis K, Ioannides E, Yannakoyorgos K. Glansectomy: an alternative surgical treatment for Buschke-Löwenstein tumors of the penis. Urology. May 2001;57(5):966-9. [Medline].

  19. Talwar A, Puri N, Singh M. Giant condyloma acuminatum of Buschke and Lowenstein: successful surgical treatment. Int J STD AIDS. Jun 2010;21(6):446-8. [Medline].

  20. Renzi A, Brusciano L, Giordano P, Rossetti G, Izzo D, Del Genio A. Buschke-Löwenstein tumor. Successful treatment by surgical electrocautery excision alone: a case report. Chir Ital. Mar-Apr 2004;56(2):297-300. [Medline].

  21. Perniola G, d'Itri F, Di Donato V, Achilli C, Lo Prete E, Panici PB. Recurrent Buschke-Löwenstein tumor treated using CO(2) laser vaporization. J Minim Invasive Gynecol. Sep-Oct 2010;17(5):662-4. [Medline].

  22. Bertram P, Treutner KH, Rübben A, Hauptmann S, Schumpelick V. Invasive squamous-cell carcinoma in giant anorectal condyloma (Buschke-Löwenstein tumor). Langenbecks Arch Chir. 1995;380(2):115-8. [Medline].

  23. Chao MW, Gibbs P. Squamous cell carcinoma arising in a giant condyloma acuminatum (Buschke-Lowenstein tumour). Asian J Surg. Jul 2005;28(3):238-40. [Medline].

  24. Chu QD, Vezeridis MP, Libbey NP, Wanebo HJ. Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions. Analysis of 42 cases. Dis Colon Rectum. Sep 1994;37(9):950-7. [Medline].

  25. Elliot MS, Werner ID, Immelman EJ, Harrison AC. Giant condyloma (Buschke--Loewenstein tumor) of the anorectum. Dis Colon Rectum. Oct 1979;22(7):497-500. [Medline].

  26. Kanik AB, Lee J, Wax F, Bhawan J. Penile verrucous carcinoma in a 37-year-old circumcised man. J Am Acad Dermatol. Aug 1997;37(2 Pt 2):329-31. [Medline].

  27. Loewenstein L. Carcinoma-like condylomata acuminata of the penis. Med Clin North Am. 1939;23:789-95.

  28. Lowe D, McKee PH. Verrucous carcinoma of the penis (Buschke-Lowenstein tumour): a clinico- pathological study. Br J Urol. Aug 1983;55(4):427-9. [Medline].

  29. Majewski S, Jablonska S. Human papillomavirus-associated tumors of the skin and mucosa. J Am Acad Dermatol. May 1997;36(5 Pt 1):659-85; quiz 686-8. [Medline].

  30. Micali G, Innocenzi D, Nasca MR, Musumeci ML, Ferrau F, Greco M. Squamous cell carcinoma of the penis. J Am Acad Dermatol. Sep 1996;35(3 Pt 1):432-51. [Medline].

  31. Mistrangelo M, Mobiglia A, Cassoni P, Castellano I, Maass J, Martina MC, et al. [Verrucous carcinoma of the anus or Buschke-Lowenstein tumor of the anus: staging and treatment. Report of 3 cases]. Suppl Tumori. May-Jun 2005;4(3):S29-30. [Medline].

  32. Rübben A, Beaudenon S, Favre M, Schmitz W, Spelten B, Grussendorf-Conen EI. Rearrangements of the upstream regulatory region of human papillomavirus type 6 can be found in both Buschke-Lowenstein tumours and in condylomata acuminata. J Gen Virol. Dec 1992;73 (Pt 12):3147-53. [Medline].

  33. Schwartz RA. Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol. Jan 1995;32(1):1-21; quiz 22-4. [Medline].

 
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Giant condylomata acuminata of Buschke and Löwenstein of the perianal region, consisting of a slow-growing, ulcerated, cauliflowerlike mass.
 
 
 
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