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.
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 . Some authors regard it a version of wart-like, verrucous carcinoma, which is itself a variant of squamous cell carcinoma. Others  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 . 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 . Nevertheless, the tumor needs careful attention because of its large size and the high probability of recurrence  . There is also a marked tendency for malignant transformation to squamous cell carcinoma    , although metastases are very infrequent. Thus, removal of the Buschke-Lowenstein tumor is regarded as imperative to avoid the above risks . 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    . Some investigators believe the association may indicate a causal relationship , others regard this as unsubstantiated , yet others suggest possible roles for coinfecting HPV viruses 16 and 18 which have higher oncogenic potential . Thus, the role of HPV in Buschke-Lowenstein tumor has not been resolved.
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]
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 .
Further characteristics of BLT are hyperkeratosis, parakeratosis, papillomatosis, acanthosis, and koilocytosis. The tumor may show infiltration by lymphocytes . 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 . 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 .
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    .
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]
Without well-defined treatment protocol for BLT, many treatment options can be found in the literature with very different results. [ijdvl.com]
Post-treatment clinical monitoring is highly recommended. [omicsonline.org]
Bottom, After 12 months of treatment, the internal obturator muscle is again well defined (arrow). Figure 3. [jamanetwork.com]
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]
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]
The prognosis of these tumors is conditioned by the incidence of local recurrence (60–70%) and the risk of malignant transformation . The principal differential diagnosis is epithelioma spinocellular which can lead to dark prognosis . [scidoc.org]
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]
Human Papilloma Virus has been implicated as an etiologic agent for this tumor. [pacificejournals.com]
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]
PVL lacks specific histological criteria, so epidemiology, clinical presentation, and histopathology must all be taken into account for diagnosis. [infectiousdiseaseadvisor.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]
Terminology Also called Buschke-Löwenstein tumor Also called verrucous carcinoma by some authors but most authors consider them to be separate entities Epidemiology Patients tend to be older than those with condyloma acuminatum Sites Usually involves [pathologyoutlines.com]
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]
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]
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]
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]
- 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.