Abstract:Anogenital warts, also known as condylomata acuminata caused by human papillomavirus constitute the most common sexually transmitted infection. Rarely, the disease may evolve into a huge cauliflower-like growth called giant condyloma acuminatum or Buschke–Löwenstein tumor (BLT). In contrast with normal anogenital warts, BLT displays local invasion, lack of spontaneous resolution, posttreatment recurrence, and potential for malignant transformation. Although radical excision with split-thickness skin grafting i… Show more
“…Treatment with a trichloroacetic acid solution of 80%-90% or podophyllotoxin solution of 0.5%, radiotherapy, chemotherapy, immunotherapy, or cryotherapy, has been suggested but also criticized [5][6][7][8][9][10]26]. A few studies also put forward imiquimod as an effective treatment option for BLT [27,28]. Although complete clearance of common warts has been observed in 45%-56% of the patients treated with the imiquimod, its efficacy in the treatment of BLT is questionable [29].…”
Perianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT. Methods: From November 2002 to June 2019, 11 patients (9 males) with a mean age of 33.45 years (range, 19-54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used. Results: Two patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54 ± 1.34 cm (range, 10-26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45 ± 1.75 months (range, 10-196 months). Conclusion: In patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.
“…Treatment with a trichloroacetic acid solution of 80%-90% or podophyllotoxin solution of 0.5%, radiotherapy, chemotherapy, immunotherapy, or cryotherapy, has been suggested but also criticized [5][6][7][8][9][10]26]. A few studies also put forward imiquimod as an effective treatment option for BLT [27,28]. Although complete clearance of common warts has been observed in 45%-56% of the patients treated with the imiquimod, its efficacy in the treatment of BLT is questionable [29].…”
Perianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT. Methods: From November 2002 to June 2019, 11 patients (9 males) with a mean age of 33.45 years (range, 19-54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used. Results: Two patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54 ± 1.34 cm (range, 10-26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45 ± 1.75 months (range, 10-196 months). Conclusion: In patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.
“…After the excision, the wound may be left open to granulate or reconstructive surgery with flaps or grafts may be performed, taking into account the size and location of the lesion 14 16–19. Recently, immunotherapy with imiquimod has had success in treating large lesions 20 21…”
“…Sonthalia et al [ 32 ] described a total regression of penile GCA in a 35-year-old man, with negative HIV serology and evidence of HPV subtype 6. They use imiquimod cream 5%, which was maintained for 12 hours, five days per week for 16 weeks, it was well tolerated, and there was a significant regression at week 12 of treatment, with a recurrence-free period of 5 years.…”
Giant condyloma acuminatum (GCA) or Buschke-Loewenstein tumor is a rare disease, with an estimated prevalence of 0.1%. It was initially described in 1896 by Buschke and later in 1925 by Buschke and Loewenstein. Classic condyloma acuminata (CCA) and squamous cell carcinoma (SCC) were initially described as different entities. These three entities are currently considered to correspond to the same spectrum of different but not exclusive malignant transformations, associated with multiple risk factors such infection by human papilloma virus (HPV), immunodeficiencies, poor hygiene, multiple sexual partners, and chronic genital infections. HPV subtypes 6 and 11 are associated with 90% of GCA. It presents as a cauliflower-like tumor in the genital region with bad odor, bleeding, and local infection, differential diagnosis with multiple conditions should be considered, and sexually transmitted diseases should always be investigated. GCA has a higher rate of malignant transformation than CCA and tends to infiltrate adjacent soft tissues. The therapeutic approach is controversial but is considered that the resection with free edges is the gold standard and can be combined with adjuncts. The recurrence rate is high. Overall mortality is 21% and is associated with morbidity caused by recurrences. Imiquimod cream 5% has recently shown good results as monotherapy and in combination with ablative and surgical treatments. The quality of life is diminished in patients with this condition. In this review, we address the different aspects of this rare entity including the therapeutic approach.
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