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2.1
Anal Buschke-Lowenstein Tumor

Presentation

He presented two months later with overwhelming sepsis and died despite maximal medical therapy. 1. [ncbi.nlm.nih.gov]

[…] a benign biological behavior and histological characteristics despite being clinically presented by large lesions. [surgicalcosmetic.org.br]

Rectal Involvement of Recurrent Buschke-Lowenstein Tumor Causing Subileus: a Case Report Abstract We present a 48-year-old caucasian woman presenting with anal pain, discharge and difficulty in defecation due to recurrent Buschke-Lowenstein tumor with [gastrores.org]

The purpose of this paper is to present the case that reached huge dimensions in the perianal region and that was treated with wide resection in the literature. 1. [hindawi.com]

Pathol 2012;25:1354, Histopathology 2017;70:938, WHO Classification of Tumours Editorial Board: Digestive System Tumours, 5th Edition, 2019) Essential features Condylomatous squamous lesion without high grade dysplasia, with only low risk HPV types present [pathologyoutlines.com]

Entire Body System

  • Pathologist

    […] below the pectinate line Tumor invasion Not identified Examined sections 05 blocks Lymph nodes, # sampled 10 Lymph nodes, # involved 0 Ancillary study result p16 Ki67 Patchy, 5% of cells Restricted to parabasal layers Reference: College of American Pathologists [pathologyoutlines.com]

Gastrointestinal

  • Perianal Ulcer

    Full size image Case two A 56-year-old homosexual HIV positive man was admitted complaining of anal pain and bleeding, mucopurulent perianal discharge and severe incontinence for six months due to a large perianal ulcerated lesion. [wjso.biomedcentral.com]

Skin

  • Papule

    Table 1:: The course of treatment Time Course of the disease Physical examinations Diagnosis Treatment Perianal area Anal canal 20110905 6 months ago Papules and plaques Unclear Perianal CA Four times laser resection 20120307 Day 1 Papules and plaques [ijdvl.com]

  • Pruritus

    11 A few cases reported with Netherton syndrome (Pediatr Dermatol 2017;34:e328, J Plast Reconstr Aesthet Surg 2011;64:1533) Clinical features Presenting symptoms: perianal exophytic and cauliflower-like mass with or without abscess, fistula, pain, pruritus [pathologyoutlines.com]

Psychiatrical

  • Suggestibility

    This suggests that good viroimmunological control may be insufficient for controlling the HPV infections. [ncbi.nlm.nih.gov]

    […] with HPV genotypes 6 or 11, suggesting a role in pathogenesis. [ascopubs.org]

    Most of the authorities suggest a temporary loop colostomy to be opened to prevent fecal contamination in the wound before wide surgical excision [7]. [hindawi.com]

    Condylomas that are >10 cm seemed to occur in older patients, suggesting a slower growing process. Our findings suggest that Löwenstein-Buschke lesions are mega versions of conventional condyloma. [turkjpath.org]

    Laser-mediated photodynamic therapy with 5-aminolevulinic acid is an emerging approach for treating genital HPV infection.5 Several studies have suggested the administration of topical aminolevulinic acid along with photodynamic therapy is an effective [ijdvl.com]

Neurologic

  • Burning Sensation

    The patient only reported intense burning sensation during laser application, and no other complications were observed. The course of the treatment is presented in Table 1. [ijdvl.com]

Treatment

The course of the treatment is presented in Table 1. [ijdvl.com]

Treatment with concomitant radiochemotherapy may be the exclusive curative treatment, or represent a neoadjuvant treatment to achieve and facilitate subsequent surgery. [exp-oncology.com.ua]

The most important treatment method is the excision of the mass. [hindawi.com]

facilitating operative treatment, and avoiding complications caused by healing. [surgicalcosmetic.org.br]

Other treatment modalities include cryotherapy, photodynamic therapy, topical treatment with podophyllin, 5-fluorouracil, and systemic interferon. [ncbi.nlm.nih.gov]

Prognosis

Prognosis depends on the size of tumor on presentation and factors like immunosuppression and secondary infection. [ncbi.nlm.nih.gov]

Despite the combination of several therapies, the prognosis of this tumor remains poor, given the risk of recurrence, locoregional aggressiveness, infection, degeneration into a “frankly” malignant tumor, and mortality exceeding 20% [9, 12]. [exp-oncology.com.ua]

Extensive pelvic infiltration of tumor Pelvic structures infiltrated by tumor Tumor expands along the endopelvis Tumor involves the inguinal area Prognostic factors Overall mortality: 10.5 - 20% (Virchows Arch 2020;476:543, Dis Colon Rectum 1994;37:950) Prognosis [pathologyoutlines.com]

Etiology

[…] carcinoma Recent studies and WHO 2019 have suggested that Buschke-Löwenstein tumors and verrucous carcinoma are 2 separate entities; while Buschke-Löwenstein tumors are associated with low risk HPV types (6,11), verrucous carcinomas usually have a non-HPV etiology [pathologyoutlines.com]

As regards its etiology, the HPV-6 and HPV-11 are the most common types identified but HPV-16 and HPV-18 are also detected especially in cases with foci of SCC [8, 10]. In our patients, we identified HPV-6 in two patients and HPV-18 in one patient. [wjso.biomedcentral.com]

Epidemiology

Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. Trombetta LJ, Place RJ. Trombetta LJ, et al. Dis Colon Rectum. 2001 Dec;44(12):1878-86. doi: 10.1007/BF02234473. [pubmed.ncbi.nlm.nih.gov]

Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. Dis Colon Rectum. 2001;44:1878-86. 4. Hull MT, Eble JN, Priest JB, Mulcahy JJ. [surgicalcosmetic.org.br]

We report here a new case of anal margin BLT with a review of the literature; we will try to identify the epidemiological, clinical, therapeutic and evolutionary aspects of this tumor. Case report We report the case of a 47-year-old patient. [exp-oncology.com.ua]

[…] cm Terminology Preferred term: Buschke-Löwenstein tumor (MeSH: Buschke-Lowenstein Tumor [Accessed 18 November 2020]) Also called giant condyloma acuminatum, giant condyloma of Buschke and Löwenstein ICD coding ICD-O: None ICD-11: 1A95.0 - Anal warts Epidemiology [pathologyoutlines.com]

Article CAS PubMed Google Scholar Trombetta LJ, Place RJ: Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. [wjso.biomedcentral.com]

Pathophysiology

[…] raise the suspicion of sexual abuse, though this association is not well established (Am J Dis Child 1982;136:704, Arch Pediatr 2019;26:473) Sites Anogenital region (involves both inside and outside of anal canal) Urinary bladder, genitalia, oropharynx Pathophysiology [pathologyoutlines.com]

Prevention

Conclusion Early surgical resection in the treatment of condyloma acuminatum prevents the development of BLT. [hindawi.com]

Prophylactic HPV vaccination has been shown to reduce HPV6/11 infection and anogenital condylomata and thus is expected to prevent this tumor [2]. 2. [ncbi.nlm.nih.gov]

With our previous experiences in treating and preventing the recurrence of cervical condyloma accuminatum, we prescribed topical 5% imiquimod cream on both perianal skin and anal canal for the patient weekly for latent lesions.7 Since week 16, no recurrences [ijdvl.com]

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