Anal carcinoma in giant anal condyloma, multidisciplinary approach necessary for optimal outcome: Two case reports and review of literature

Abstract

BACKGROUNDAnal cancers are caused by human papilloma virus (HPV). Buschke-Lowenstein tumor also known as giant anal condyloma (GCA) is a variant of giant neglected anal tumors arising from warts caused by HPV infection. HPV are a family of double-stranded DNA viruses and primarily cause sexually transmitted disease of the genitalia and oropharyngeal mucosa. These tumors are slow growing; locally destructive large verrucous masses.CASE SUMMARYWe present a series of two cases with large anal tumors harboring invasive cancers and highlight their presentation and management. Tumors with high risk HPV subtypes (HPV 16, 18, 31, 33) may progress into invasive squamous cell carcinoma (SCC). Untreated GCA can attain enormous size and extend into the pelvic organs and bony structures. Some tumors show malignant degeneration into SCC and are often difficult to diagnose given the large size of the tumors. Complete surgical excision with negative margins is the treatment of choice and necessary to prevent recurrence. This is often not feasible and leaves large surgical wounds with tissue defects with delay in healing and increases post-operative morbidity. Pelvic reconstructive techniques including muscle flaps and grafts are often necessary to close the defects. Human immunodeficiency virus and immunocompromised patients generally do poorly with standard treatments.CONCLUSIONA multidisciplinary team of colorectal and plastic surgeons, medical and radiation oncologists along with combination treatment modalities are necessary when malignant transformation occurs in GCA, for optimal outcomes.

Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn’s disease—a unique case report

“…Radical surgical excision with negative margins is the therapy of choice for VC [ 7 , 12 , 13 ]. Due to severe inflammation with multiple abscesses of the perianal and perineal region, abdominoperineal resection with wide tumor excision was the only curative treatment option for the patient (Figs.…”

Giant anogenital tumor of Buschke–Löwenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report

“…These treatments are not very effective in BLT despite some case descriptions. A multidisciplinary approach, as adopted for this patient, is recommended in most cases [ 12 , 21 – 23 ]. However, coinfected HPV–HIV patients have a greater risk of failure or recurrence [ 18 ].…”

Anal human papilloma viral infection and squamous cell carcinoma: Need objective biomarkers for risk assessment and surveillance guidelines

“…However frequent anal exams and surgical biopsies have their own risks and limitations. Complications are infrequent but may include chronic pain, bleeding, and peri-anal scarring with resulting anal stenosis or incontinence due to anal sphincter injury and sepsis[ 8 , 23 ]. The therapy of these complications may require further operations and leads to significant morbidity and increased cost.…”

“…Further there is risk of surgery and the morbidity associated with repeated anal procedures and may be debilitating. Frequent complications include chronic pain, bleeding, peri-anal scarring with rare severe complications such as anal stenosis or incontinence due to anal sphincter injury and sepsis[ 6 - 8 ]. One way to reduce the HPV burden in the community is to mandate immunization before the onset of sexual intercourse and exposure to HPV.…”

“…This will assist us in identifying useful biomarkers for anal cancer. HPV targets actively proliferating basal cells in the anogenital mucosa and promotes events that are fundamental to neoplastic transformation including early viral oncogene expression and viral persistence[ 8 ]. E6 and E7 are two HPV viral oncogenes which up-regulate cellular proliferation, increasing the numbers of infected cells and infectious virions[ 2 ].…”