LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 222-223
Buschke–Lowenstein tumor: An intermediate between condyloma acuminata and verrucous carcinoma
Yogindher Singh1, Sheela Kuruvila1, Manjiri Phansalkar2
1 Department of Dermatology, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
|Date of Submission||23-Jul-2022|
|Date of Decision||26-Jul-2022|
|Date of Acceptance||30-Jul-2022|
|Date of Web Publication||17-Nov-2022|
Dr. Sheela Kuruvila
Department of Dermatology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh Y, Kuruvila S, Phansalkar M. Buschke–Lowenstein tumor: An intermediate between condyloma acuminata and verrucous carcinoma. Indian J Sex Transm Dis 2022;43:222-3
|How to cite this URL:|
Singh Y, Kuruvila S, Phansalkar M. Buschke–Lowenstein tumor: An intermediate between condyloma acuminata and verrucous carcinoma. Indian J Sex Transm Dis [serial online] 2022 [cited 2022 Nov 28];43:222-3. Available from: https://www.ijstd.org/text.asp?2022/43/2/222/361330
Buschke and Lowenstein tumor or giant condylomata acuminata is an uncommon, slow-growing verrucous tumor of the anogenital region. It was first described by Buschke and Lowenstein in 1925, who named the first case as “condyloma acuminate carcinoma-like.”
This tumor is a controversial entity, often histopathologically benign but clinically malignant and sometimes showing true malignant transformation with histological features of verrucous carcinoma.
A 20-year-old unmarried, promiscuous, heterosexual male came to the dermatology outpatient with complaints of raised lesions over the shaft of the penis for 6 months, with a rapid increase in size for 1 month, and occasional bleeding.
Clinical examination revealed an exophytic verrucous growth involving the entire glans penis measuring 4 cm × 4 cm. There were a few verrucous papules seen over the inner aspect of the prepuce.[Figure 1](a) & [Figure 1](b).
|Figure 1: (a) Exophytic verrucous growth seen over the glans penis. (b) Few verrucous papules seen over inner aspect of prepuce. (c) Marked acanthosis and papillomatosis seen (H and E, ×10). (d): Multiple koilocytes are noted (H and E, ×40)|
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Histopathological examination confirmed the diagnosis of condyloma acuminata, showed koilocytic change, and showed no malignant transformation. [Figure 1(c)]&[Figure 1](d).
Giant condyloma acuminata of Buschke–Lowenstein occurs more often in men, and the common sites of occurrence are the glans penis, prepuce, and perianal regions. It has also been reported in the vulva, vagina, urinary bladder, and rarely from the axilla., It is sexually transmitted with an incidence of about 0.1% in the general population. The incidence of this tumor is more in homosexual or bisexual men. Low-risk human papillomavirus (HPV) types 6 and 11 are said to be associated with this tumor. Other predisposing factors include phimosis, poor penile hygiene, especially in the uncircumcised, immunosuppression, diabetes, and smoking.
It is not clear whether the viral or host risk factors are responsible for the malignant transformation. A better understanding of its etiopathogenesis may help in deciding treatment options. It is well known that viral warts become larger and more resistant to treatment when there is altered immunity in the host in inherited conditions, such as DOCK8 and SPINK5 deficiencies, as well as in acquired disorders such as HIV infection. The genome of HPV 6 and 11 encode for DNA sequences that translate to produce E6 and E7, which are tumor suppressors and inactivate p53, resulting in unchecked replication of epithelial cells, finally leading to abnormal growth. It is also believed that the release of free oxygen radicals by activated inflammatory cells may induce genetic damage and neoplastic transformation.
Clinically, they present as cauliflower-like masses which are exophytic in appearance and may reach a diameter of 20 cm. The tumor is characterized by a slow and locally invasive growth pattern. It typically has a benign histopathological appearance with plenty of koilocytes in the epidermis. In the early stages, the histopathological findings are indistinguishable from condyloma acuminata. The tumor later shows bulldozing, endophytic intrusion, and locally destructive behavior, thereby undergoing malignant transformation into verrucous carcinoma. Therefore, it is considered, by some authors, an intermediate lesion between condyloma acuminata and squamous cell carcinoma. Careful histopathological evaluation is essential to identify malignant transformation. The lesion may show evidence of a well-differentiated squamous cell carcinoma with minimal cellular atypia and a low mitotic rate. Ulceration as well as infiltration into deep tissues can occur. It has been reported to have a high recurrence rate of 66% with malignant transformation in 56% and overall mortality of 20%.
There are no standard treatment guidelines for this uncommon entity. Different modalities employed include topical agents such as podophyllin, imiquimod, and 5-fluorouracil, as well as destructive procedures such as cryotherapy, CO2 laser therapy, and surgical excision. Wide surgical excision by Mohs technique has been found to be beneficial. Chemotherapy and radiotherapy have been used when there was malignant transformation. Intra-arterial methotrexate has been used in verrucous carcinoma of different parts of the body, including the anogenital region.
Our patient was managed by wide excision of the tumor and advised regular follow-up. This case has been reported in view of its rarity and to be aware of the malignant potential of the same.
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Conflicts of interest
There are no conflicts of interest.
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