Surgical Management of Perianal Giant Condyloma Acuminatum (Buschke-Löwenstein Tumor)

Abstract

Giant condyloma acuminatum (GCA) is a slow-growing, large, cauliflower-like tumor located in the anogenital region. This tumor has a locally destructive behavior, a high recurrence rate and occasional transformation to squamous cell carcinoma. Risk factors include anoreceptive intercourse, HIV and immunosuppression. There is no general agreement on the choice of treatment for this tumor. Wide radical excision with plastic reconstruction of skin defects seems to be the best treatment, while adjuvant therapies, such as radiotherapy and immunotherapy, may achieve good results, but their effectiveness is still uncertain. Loop colostomy, considered mandatory by several authors in order to minimize wound contamination risk, does not appear to be necessary (except in cases of anal canal involvement beyond the dentate line) if a combination of bowel cleansing, non-fiber diet and loperamide can be administered. The authors report 3 cases of perianal GCA treated by radical local excision and reconstruction by S-plasty grafts, without performing loop colostomy.

Effective management of extensive tissue loss after abdominoperineal resection for Buschke-Loewenstein tumor

“…We performed a radical sphincter-preserving resection because it allows a complete pathological examination with evaluation of the margins and prevalence of carcinomatous foci (14). In fact the pathological examination in our case, reported a well differentiated squamous cell carcinoma, and therefore, we chose to perform the radicalization of the surgical procedure with an abdominal perineal resection in agreement with several Authors (15).…”

Should the Surgical Management of Buschke-Lowenstein Tumors Be Aggressive? About 10 Cases

“…Its diagnosis is often delayed, even after several years of local treatment [2,8,15] . The prognosis of these tumors is conditioned by the incidence of local recurrence (60-70%) and the risk of malignant transformation (30-50%) [2,7,8,12,13] . To our knowledge, predictive factors of malignant transformation have not been identified in previously published observations and cohorts.…”

“…Histological examination of BLT shows a benign appearance as it is a pseudo-epitheliomatous proliferation characterized by exo-and endophytic hyperpapillomatosis with epithelial hyperplasia, hyperacanthosis and koilocytosis; transition toward squamous epithelial cancer does not appear with distinctive pathological characteristics [1,3,4,7,9,12,15] . Moreover, those tumors behave malignantly by destroying adjacent tissues.…”

Colostomía previa a escisión quirúrgica de un tumor de Buschke-Löwenteim en la infancia

“…La aplicación de podofi lina al 25% o ácido tricloroacético, puede estar indicada en caso de lesiones de pequeño tamaño, con una tasa de recidiva del 25%. El tratamiento de elección descrito en la literatura del TBL es la exéresis quirúrgica 7 , con o sin quimioterapia adyuvante. Otros tratamientos sistémicos son el 5-fl uorouracilo o bleomicina, combinadas con el cisplatino o metrotexate.…”