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]

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.

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]

Treatment & Management

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

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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, 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 of Hematology, Medical Society of the State of New York, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Acknowledgements

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

Sections Giant Condylomata Acuminata of Buschke and Lowenstein
Overview
Presentation
DDx
Workup
Treatment
References

Giant Condylomata Acuminata of Buschke and Lowenstein Workup

Imaging Studies

Procedures

Histologic Findings

References

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