Buschke - Loewenstein tumor resection with simultaneous reconstruction of extensive tissue losses: case report

Abstract

BackgroundGiant condyloma acuminatum or Buschke - Loewenstein tumor is a very rare disease usually located in the genital, anorectal, and perianal regions. It is locally invasive but in mostly cases displays a benign cytology on preoperative tissue sampling. Because of its low incidence little is known about treatment outcomes. Complete surgical excision is the treatment of choice. Different surgical methods have been applied to reach curability. To our knowledge such an advanced sized tumors in this localization has only been reported few times before with different surgical techniques being applied.Case presentationWe describe a case of 56 years old female with 20 years persisting condyloma acuminatum progressing to a very huge dimensions perianal Buschke-Lowenstein tumor with one of the widest excision in the literature without the need for diverting stoma. The tumor size and its location determined the choice of treatment option and suspected prognosis for the patient outcome. Treatment was impeded by patient’s malnutrition. The giant Buschke - Loewenstein tumor was resected from the anus, perineum and gluteal areas. The large tissue losses were simultaneously covered with rotational skin and fatty subcutaneous tissue flaps, mobilized from neighboring gluteal and femoral areas. The circumferential part of the anal canal was covered with skin grafted from the mentioned flaps and it was attached to the anal mucosa. No protective stoma was formed. Despite temporary problems with healing of the covering skin flaps, full permanent coverage of the resection site has been achieved. Anal canal function has also improved within the time.ConclusionThe patient with BLT must be very carefully clinical and imagistic investigated in order to detect the tumor visceral invasion and to establish the extension of the surgical procedure. There exists an extensive and time-consuming surgical procedure which allows to remove the giant anorectal Buschke - Loewenstein tumors with good function of the anorectum and without the necessity of diverting stoma creation.

Successful treatment of giant condyloma in a pediatric heart transplant recipient with topical cidofovir

“…6,13 However, topical therapies are associated with high rates of recurrence, and surgical excision can lead to significant morbidity due to poor wound healing, fecal contamination, and extensive tissue loss. [14][15][16] Other modalities for treatment, including intralesional administration of bleomycin sulfate, interferon alfa-2b, and systemic administration of cisplatin, fluorouracil, ribavirin, mitomycin-C, and methotrexate have been associated with significant toxicities or mixed results. 1,17,18 Cidofovir is a nucleotide analog and antiviral agent approved and neutropenia.…”

“…Recommendations for the treatment of external genital warts among SOT recipients include the use of topical solutions such as podophyllin, imiquimod or trichloroacetic acid, or local interventions such as cryotherapy, with referral to gynecology for surgical excision in cases of failed therapy . However, topical therapies are associated with high rates of recurrence, and surgical excision can lead to significant morbidity due to poor wound healing, fecal contamination, and extensive tissue loss . Other modalities for treatment, including intralesional administration of bleomycin sulfate, interferon alfa‐2b, and systemic administration of cisplatin, fluorouracil, ribavirin, mitomycin‐C, and methotrexate have been associated with significant toxicities or mixed results …”

Condiloma gigante de Buschke-Lowenstein: um relato de caso

“…Esse tumor epitelial é caracterizado por uma alta taxa de recorrência e um grande potencial de transformação maligna, 10 entre 40 e 60% dos casos, 11 como ocorreu com o paciente em questão, inicialmente diagnosticado com condiloma gigante que evoluiu para CEC.…”

“…Isso faz com que a excisão cirúrgica completa seja o tratamento de escolha, 7,9,11,12 ressaltando-se que a radioterapia e a quimioterapia também podem ser empregadas para evitar que o cancro se estenda para o canal anal. Em um estudo de seguimento realizado por 21 anos em 24 pacientes diagnosticados com CEC anal e tratados, 8 pacientes foram tratados com ampla excisão local e nesses não foram detectadas nem recorrência, nem mortalidade, dado consistente com a literatura.…”

“…9 Ressalta-se que não há dados disponíveis suficientes para recomendar o tratamento como radioterapia, quimioterapia ou interferon, sendo esses apenas paliativos. 11 Todavia, no caso descrito, apesar de tratamento com ampla excisão cirúrgica em poucos meses de pós-operató-rio, observou-se recorrência.…”