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Buschke-Lowenstein Tumor

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.

Amyloidosis
  • 85 143 1843 Erythroderma 14 1907 215 1943 Section Five Vesiculobullous diseases 1953 Other vesiculobullous diseases Vesiculobullous and erosive diseases in the newborn Section Six Adnexal diseases 1959 Section Seven Rheumatologic diseases Mucinoses Amyloidosis[books.google.ro]
Poor Oral Hygiene
  • Factors that may influence its development include poor oral hygiene, fungal infections affecting the skin, and lichen planus Verrucous Squamous Cell Carcinoma of Skin may appear as nodules on skin, commonly in the extremities, genital areas, and oral[dovemed.com]
Dermatitis
  • Springer Science & Business Media, 6 Dec 2012 - Medical - 522 pages Patients with perianal diseases such as dermatitis do not just visit the dermatologist; they are seen by family doctors, internists, pediatricians, general surgeons, gynecologists, and[books.google.com]
Xanthoma
  • Verruciform xanthoma of the vulva: Case report. Genitourin Med 1989;65:252-4. Cheng SF. Seborrheic keratosis of penis. Urology 1974;3:595-7. Friedman SJ, Fox BJ, Albert HL. Seborrheic keratoses of penis. Urology 1987;29:204-6.[ijstd.org]
Follicular Plugging
  • Diagnosis becomes more difficult in the genital region as the features of distinct keratotic and follicular plugging, stuck-on appearance disappear because of the friction and maceration typical of this area.[ijstd.org]
Premature Ejaculation
  • Brand-new chapters and comprehensive updates throughout include new information on perioperative care in adults and children, premature ejaculation, retroperitoneal tumors, nocturia, and more![books.google.ro]
Nocturia
  • Brand-new chapters and comprehensive updates throughout include new information on perioperative care in adults and children, premature ejaculation, retroperitoneal tumors, nocturia, and more![books.google.ro]
Dysesthesia
  • […] 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 and dysesthesia[books.google.ro]

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

  • 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]
  • The evaluation, treatment, and role of preventative measures are reviewed.[ncbi.nlm.nih.gov]
  • In majority of the cases, the prognosis is excellent with appropriate treatment.[dovemed.com]
  • Treatment of these tumors begins with removal by surgery. Chemotherapy and radiation therapy have also been shown to be effective treatments for this tumor type.[diseaseinfosearch.org]

Prognosis

  • 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]
  • Prognosis is poor for this seemingly harmless-appearing white lesion of the oral mucosa. Copyright 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.[infectiousdiseaseadvisor.com]

Etiology

  • 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]
  • Its etiology is human pappiloma virus. It occurs more in men than women with a ratio of 2.7:1. Immunosuppresssion with HIV is the main risk factor but it has also been associated with pregnancy, diabetes, chronic steroid use and organ transplants.[ajol.info]
  • 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]
  • Human Papilloma Virus has been implicated as an etiologic agent for this tumor.[pacificejournals.com]

Epidemiology

  • PVL lacks specific histological criteria, so epidemiology, clinical presentation, and histopathology must all be taken into account for diagnosis.[infectiousdiseaseadvisor.com]
  • Epidemiology of mucosal human papillomavirus infection and associated diseases. Public Health Genomics 2009;12:291-307. 2. Aubin F, Prétet JL, Jacquard AC, Saunier M, Carcopino X, Jaroud F, et al. EDiTH Study Group.[idoj.in]
  • 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. Montaña N, Labra A, Schiappacasse G.[revista.fecolsog.org]
  • 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]
  • 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 2001;44:1878-1886.[karger.com]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • From the *Dermatology and Venereology Unit, Department of Pathophysiology and Organ Transplantation, University of Milan Medical School, Milan, Italy; †Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and ‡Divisions of Urology[journals.lww.com]

Prevention

  • The evaluation, treatment, and role of preventative measures are reviewed.[ncbi.nlm.nih.gov]
  • 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]
  • Immediate circumcision should be carried out in all males with phimotic foreskins who develop verruca acuminata in this area in order to prevent the development of this lesion.[jamanetwork.com]
  • This may dictate the course of the condition Please find comprehensive information on Verrucous Squamous Cell Carcinoma of Skin regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention[dovemed.com]

References

Article

  1. 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.
  2. 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.
  3. Martin JM, Molina I, Monteagudo C, Marti N, Lopez V, Jorda E. Buschke-Lowenstein tumor. J Dermatol Case Rep. 2008;2(4):60-62.
  4. Schwartz RA. Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol. 1995;32(1):1-21.
  5. 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.
  6. Agarwal S, Nirwal GK, Singh H. Buschke-Lowenstein tumour of glans penis. Int J Surg Case Rep. 2014;5(5):215-218
  7. 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.
  8. 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.
  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.
  10. 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.
  11. 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.
  12. 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.
  13. Pinto AR, Guedes-Martins L, Marques C, Cabral JM. Buschke-Lowenstein Tumor. Acta Med Port. 2012;25(5):345-347.
  14. 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.

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Last updated: 2018-06-21 22:55