Giant Condylomata Acuminata of Buschke and Lowenstein Workup

Updated: Oct 16, 2018
  • Author: Catharine Lisa Kauffman, MD, FACP; Chief Editor: Dirk M Elston, MD  more...
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Workup

Imaging Studies

 Giant condyloma of Buschke and Löwenstein (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. [14]

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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. Because the distinction of GCBL from verrucous carcinoma can be difficult, GCBL has been regarded by some as a variant of verrucous carcinoma. [15]

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