Buschke-Lowenstein Tumors: A Review and Proposed Classification System

Abstract

Buschke-Lowenstein (B-L) tumors or giant condylomata are large fungating lesions that are caused by human papillomavirus (HPV) and develop in the anogenital region. Although uncommon, physicians and surgeons who treat sexually transmitted diseases or other diseases involving the anogenital area will encounter these patients. The purpose of this study is to review the current literature regarding these lesions. We evaluated every published study in PubMed and Embase from 1925 to 2020, concentrating on the clinical data included in each report, such as presentation and treatment. We also evaluated each work for any definition used and found that there is no accepted definition for these lesions. As such, we provide an inclusive, workable definition. In addition, there are many misconceptions about B-L that continue to be propogated as more case reports are published every year. After evaluating every published case, we refute the fact that these lesions have a high mortality or a high malignancy rate. Furthermore, we refute that these lesions are synonymous with verrucous carcinoma. In addition to a definition, we also propose a simple grading system that we hope can be used to assist in the study and management of these patients moving forward. Although the literature is very heterogenous regarding B-L, they are caused by HPV and are distinct from verrucous carcinoma. Because of the majority of information is based on case reports, the literature concentrates on treatment, but more work is clearly needed to delineate the association with specific HPV types and optimal management of this disease.

The Pathogenesis of Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor): An Overview

“…to recent studies, BLT and verrucous carcinoma should be recognized as two separate entities [29,30]. Indeed, BLTs are associated with low-risk HPV-6 or HPV-11 (see Section 3), whereas verrucous carcinomas are not usually HPV-driven [30,31].…”

“…Some authors consider BLT to be intermediate between condyloma acuminatum and SCC, whereas others classify it as an anogenital verrucous carcinoma (a well-differentiated type of SCC) [27,28]. According to recent studies, BLT and verrucous carcinoma should be recognized as two separate entities [29,30]. Indeed, BLTs are associated with low-risk HPV-6 or HPV-11 (see Section 3), whereas verrucous carcinomas are not usually HPV-driven [30,31].…”

“…Follow-up visits are necessary due to the high risk of recurrence (estimated at more than 60%) [26]. BLT-related mortality appears to be mostly associated with infectious complications [29]. The maintenance of good hygiene and the correct healing of postoperative wounds are, therefore, essential to reduce the risk of death.…”

Buschke – Löwenstein Tumor of the Vulva in a Patient with HIV-positive Status: General Information and Description of a Clinical Case

“…Считалось, что веррукозная карцинома представляет собой промежуточное состояние между остроконечными кондиломами и плоскоклеточным раком [13][14][15]. Согласно последним исследованиям, ОБЛ и веррукозная карцинома должны быть признаны двумя отдельными образованиями, поскольку ОБЛ связана с ВПЧ 6-го или 11-го типов, тогда как веррукозные карциномы обычно не связаны с ВПЧ-инфекцией [16][17][18].…”

“…Как правило, образование не реагирует на химиотерапию и лучевую терапию. Однако при обширных опухолях с целью уменьшения их объема может использоваться предоперационная химиотерапия или лучевая терапия [24,25].…”