Buschke-Lowenstein tumor, or giant condyloma acuminatum, is a rare, slow-growing tumor occurring in the anogenital area. It is a version of verrucous carcinoma. It is destructive and invasive locally but does not become metastatic.
Presentation
Buschke-Lowenstein tumor is also called giant condyloma acuminatum or giant condyloma of Buschke and Lowenstein. The tumor generally appears in the anogenital region, mostly on the penis, but it can be localized in the perianal area, or be found on the scrotum, perineum, vulva, vagina or bladder. A case of its occurrence in the urethra with the bladder unaffected has also been described in a female patient [1]. Some authors regard it a version of wart-like, verrucous carcinoma, which is itself a variant of squamous cell carcinoma. Others [2] consider it an intermediate between condyloma acuminatum (genital warts caused by human papillomavirus) and squamous-cell carcinoma.
Its appearance is usually described as a cauliflower-like, exophytic growth, although it infiltrates local tissues and therefore sometimes shows exo-endophytic growth pattern [3]. It is a slow growing tumor, but if not treated, can grow to a large size and ulcerate the penis; if it involves the perianal region, it can cause bleeding and abscesses. Growth may be faster in immunocompromised patients.
The appearance of the tumor may suggest an aggressive nature; however, the histologic pattern is benign [3]. Nevertheless, the tumor needs careful attention because of its large size and the high probability of recurrence [4] [5]. There is also a marked tendency for malignant transformation to squamous cell carcinoma [2] [5] [6] [7], although metastases are very infrequent. Thus, removal of the Buschke-Lowenstein tumor is regarded as imperative to avoid the above risks [8]. Regular follow-up is also necessary.
Several investigators have reported an association between the presence of human papillomavirus (HPV) types 6 and 11, which have a low potential for malignant transformation, and Buschke-Lowenstein tumor [9] [10] [11] [12]. Some investigators believe the association may indicate a causal relationship [6], others regard this as unsubstantiated [10], yet others suggest possible roles for coinfecting HPV viruses 16 and 18 which have higher oncogenic potential [9]. Thus, the role of HPV in Buschke-Lowenstein tumor has not been resolved.
Entire Body System
- Hodgkin Lymphoma
The patient’s medical history was as follows: cervical cancer diagnosed 25 years before, treated successfully with radiotherapy, and a non-Hodgkin lymphoma diagnosed 11 years before, treated with chemotherapy for one year. [hindawi.com]
Immune System
- Inguinal Lymphadenopathy
In many cases, peripheral clinical signs such as inguinal lymphadenopathy have also been observed. The tumor often forms an ulcerating mass with abscesses and necrotic tissue [ 1 ]. [omicsonline.org]
Cardiovascular
- Hypertension
[…] usually slow growing and sometimes malignant neuroma - any tumor derived from cells of the nervous system phaeochromocytoma, pheochromocytoma - a vascular tumor of the adrenal gland; hypersecretion of epinephrine results in intermittent or sustained hypertension [thefreedictionary.com]
Delivery Models Health Care Economics, Insurance, Payment Health Care Policy Health Care Quality Health Care Reform Health Care Safety Health Care Workforce Health Disparities Health Informatics Health Policy Hematology History of Medicine Humanities Hypertension [jamanetwork.com]
Skin
- Pruritus
Genetic basis of cutaneous diseases Arne Kanig and Rudolf Happle Ichthyoses erythrokeratodermas and related disorders Keratodermas Kro Dariers disease and HaileyHailey disease Daniel Hohl Theodora Mauro and leanPhilippe Gorog Mosaicism and linear lesions Pruritus [books.google.ro]
Clinical manifestations typically include a palpable mass, pain, bleeding, fistulas, or pruritus 1. [scielo.br]
A 37 year old Para 2+0, HIV-infected woman on Highly Active Antiretroviral Therapy (HAART) for the past eight years, presented with a seven year history of progressive vulval growths and a five year history of per vaginal discharge and pruritus. [ajol.info]
Others include fistulas, abscess, bleeding, weight loss, pruritus, and anemia. It represents a stage of intermediacy with common wart at one end and invasive squamous cell cancer (verrucous carcinoma) at the other. [idoj.in]
Neurologic
- Irritability
Other factors implicated in this disease include poor hygiene, chronic irritation, promiscuity, and cellular immunocompromised states. It rarely occurs in children. [ncbi.nlm.nih.gov]
Chronic irritation, produced by a perianal fistula and ulcerative colitis, has been implicated as a causative factor. Immunosuppression secondary to HIV disease or due to immunosuppressive medication may be a predisposing factor. [dermaamin.com]
Risk factors include immunosuppression, chronic irritation, and poor personal hygiene. 3,9,10 Chronic irritation from perianal fistulas and ulcerative colitis have been implicated in anal occurrences of this tumor. 7,8 The risk of recurrence after excision [mdmag.com]
Urogenital
- Penile Lesion
Physical examination revealed several confluent penile lesions of exophytic morphology including the prepuce, glans and coronal sulcus (Fig. 1). [afju.springeropen.com]
Buschke Löwenstein Tumor of the Right Lower Abdominal Wall: Case Report and Review of the Literature Abstract Buschke-Löwenstein tumor (BLT), known as giant condyloma acuminatum (GCA), is a very rare disease that typically appears as a penile lesion but [lifescienceglobal.com]
Keratin cysts [Figure 4], are present consistent with SK Penile lesion: Section shows papillomatosis with hyperkeratosis and acanthosis. A few horn cysts are present consistent with SK. There is no evidence of malignancy in any of the three lesions. [ijstd.org]
Introduction It was first described as a penile lesion by Abraham Buschke in 1896, then in 1925, Buschke and his assistant, Löwenstein reported on giant condyloma acuminatum (GCA) as benign carcinoma-like condyloma acuminatum [1]. [file.scirp.org]
It was first described a HPV-induced penile tumour which clinically resembled both a squamous cell carcinoma and condyloma acuminatum, often arising from a pre-existing warty lesion. [pubfacts.com]
Workup
A biopsy is essential for diagnosis. The biopsy must be wide and deep to allow for finding possible squamous cell carcinoma foci and to assess the extent of infiltration into an underlying tissue. The base of the tumor displays blunt-shaped tumor cell aggregates that extend deeply into the dermis. It is this deep endophytic growth and the thick stratum corneum that distinguishes the Buschke-Lowenstein tumor (BLT) from condyloma acuminatum. Vacuole formation occurs in both diseases [13].
Further characteristics of BLT are hyperkeratosis, parakeratosis, papillomatosis, acanthosis, and koilocytosis. The tumor may show infiltration by lymphocytes [6]. Displacement of tissues by the tumor is also a frequent feature of BLT. Most of these traits also occur in verrucous carcinoma; thus, distinguishing BLT from verrucous carcinoma is difficult [13]. Magnetic resonance imaging using gadolinium-diethylenetriamine pentaacetic acid (DTPA) contrast is helpful in establishing the boundaries of the tumor. Computed tomography scan has been used to examine local invasion by BLT [13].
Sentinel lymph node biopsy should be performed if there is a need for its examination. Human papillomavirus has been identified by in situ hybridization, polymerase chain reaction and restriction fragment length polymorphism [9] [12] [13] [14].
Treatment
It is a rare viral disease, essentially transmitted by sexual intercourse, characterized by a potential for malignant transformation, invasion and recurrence after treatment. We report a case of BLT associated with perinea-scrotal melanoma. [unboundmedicine.com]
He tolerated the treatment well. The perianal GCA did not disappear completely after treatment, and was removed by wide local excision (Figure 4 ). [wjso.biomedcentral.com]
Bottom, After 12 months of treatment, the internal obturator muscle is again well defined (arrow). Figure 3. [jamanetwork.com]
Early diagnosis and treatment are advised and the choice of treatment is crucial. We present a case of a 31-year-old pregnant woman with myasthenia gravis affected by Buschke-Lowenstein tumor. [ncbi.nlm.nih.gov]
Others treatments proposed are radiotherapy, chemotherapy, interferon, iniquimod and so on. Other studies are requested to value the best treatment. [iris.unito.it]
Prognosis
Patients with oral verrucous carcinoma may be at greater risk of a second oral squamous cell carcinoma, for which the prognosis is worse. [morebooks.de]
In majority of the cases, the prognosis is excellent with appropriate treatment. [dovemed.com]
Giant condylomata acuminata (Buschke-Lowenstein tumor) of the penis resembles carcinoma in some respects but has a favorable prognosis. [jamanetwork.com]
Appropriate treatment of GCA provides very good prognosis and low rate of recurrence. Prognosis is specifically considered good with adequate surgical excision [ 10 ]. [omicsonline.org]
Etiology
Human Papilloma Virus has been implicated as an etiologic agent for this tumor. [pacificejournals.com]
A viral etiology suggests it should be more common in the immunocompromised; however, few reports exist in the literature. The evaluation, treatment, and role of preventative measures are reviewed. [ncbi.nlm.nih.gov]
Viruses, unclean sanitation and cytotoxic immune reaction have been proposed as the etiology of the tumor. However, among all the causes, recent studies have emphasized on the associaton of the tumor and human papilloma virus (HPV). [synapse.koreamed.org]
Epidemiology
Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]
Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology Network ISSN (Electronic): 1937-8688 Publication date (Electronic): 05 September 2020 Publication [scienceopen.com]
[…] and Natural History 482 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia 486 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia 493 Retropubic and Suprapubic Open Prostatectomy 496 Epidemiology Etiology [books.google.de]
PVL lacks specific histological criteria, so epidemiology, clinical presentation, and histopathology must all be taken into account for diagnosis. [infectiousdiseaseadvisor.com]
Pathophysiology
Urology 1993 nov ; 42 (5) : 599-602 - Ferenczy A. epidemiology and clinical pathophysiology of condylomata acuminata. Am. J. obstet. Gynecol. 1995 apr ; 172 (4 pt 2) 1331-9 - El Mansouri A. [revue-uroandro.org]
Etiology Pathophysiology VC is a low-grade well-differentiated variant of squamous cell carcinoma of the mucosa and skin that was first described by Ackerman in 1948. [infectiousdiseaseadvisor.com]
Cutaneous Continent Urinary Diversion 459 Orthotopic Urinary Diversion 465 Genital and Lower Urinary Tract Trauma 468 Lower Urinary Tract Calculi 471 Development Molecular Biology and Physiology of the Prostate 476 Benign Prostatic Hyperplasia Etiology Pathophysiology [books.google.de]
[…] 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
Find out the causes, diagnosis, risk factors, treatment and preventive steps from this article Are you looking to overcome a cancer diagnosis without toxic drugs or surgery? Ruby Lathon talks to Jonathan Landsman about how to heal the body naturally. [pinterest.de]
The evaluation, treatment, and role of preventative measures are reviewed. A report and discussion of rare scrotal Buschke-Lowenstein tumor in the immunocompromised patient. The evaluation, treatment, and potential role of prevention are discussed. [journals.lww.com]
The evaluation, treatment, and role of preventative measures are reviewed. [ncbi.nlm.nih.gov]
While vaccination is an effective method for preventing anogenital warts, early and adequate treatment of condyloma acuminata could prevent its potential growth into an extensive verrucous tumor. [academic.oup.com]
References
- Nordsiek M, Ross C, Metro M. Successful Surgical Management of Giant Condyloma Acuminatum (Buschke Lowenstein Tumor) in the Urethra of a Female Patient: A Case Report. Curr Urol. 2015;8(1):49-52.
- Creasman C1, Haas PA, Fox TA Jr, Balazs M. Malignant transformation of anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor). Dis Colon Rectum. 1989;32(6):481-487.
- Martin JM, Molina I, Monteagudo C, Marti N, Lopez V, Jorda E. Buschke-Lowenstein tumor. J Dermatol Case Rep. 2008;2(4):60-62.
- Schwartz RA. Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol. 1995;32(1):1-21.
- 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. 1994;37 (9):950-7.
- Agarwal S, Nirwal GK, Singh H. Buschke-Lowenstein tumour of glans penis. Int J Surg Case Rep. 2014;5(5):215-218
- Valenzuela N, Barnadas MA, Matias-Guiu X, Curell R, de Andres L, Alomar A. Lethal perianal Buschke–Loewenstein tumor in a female patients with AIDS. Dermatology 2004;208:349–350.
- Papiu HS, Dumnici A, Olariu T, et al. Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature. Chirurgia (Bucur). 2011;106(4):535-9.
- Braga JC, Nadal SR, Stiepcich M, Framil VM, Muller H. Buschke -Loewenstein tumor: identification of HPV type 6 and 11. An Bras Dermatol. 2012;87(1):131-134.
- del Pino M, Bleeker MC, Quint WG, Snijders PJ, Meijer CJ, Steenbergen RD. Comprehensive analysis of human papillomavirus prevalence and the potential role of low-risk types in verrucous carcinoma. Mod Pathol. 2012;25(10):1354-1363.
- Tripoli M, Cordova A, Maggì F, Moschella F. Giant condylomata (Buschke-Löwenstein tumours): our case load in surgical treatment and review of the current therapies. Eur Rev Med Pharmacol Sci. 2012;16(6):747-751.
- Wells M, Robertson S, Lewis F, Dixon MF. Squamous carcinoma arising in a giant peri-anal condyloma associated with human papillomavirus types 6 and 11. Histopathology. 1988;12(3):319-323.
- Pinto AR, Guedes-Martins L, Marques C, Cabral JM. Buschke-Lowenstein Tumor. Acta Med Port. 2012;25(5):345-347.
- Asato Y, Taira K, Yamamoto Y, Uezato H. Detection of human papillomavirus type 11 in a case of Buschke-Löwenstein tumor. Eur J Dermatol. 2008;18(3):329-331.