Giant Condyloma Acuminatum (GCA; Buschke-Löwenstein Tumor) is a rare sexually transmitted human-papillomavirus (HPV)-induced, large, exophytic, and cauliflower-like lesion of the anogenital region with a potentially fatal course. We report a case on a 57-year-old male with a 9-year history of a large slow-growing right inguinal/abdominal wall giant condyloma acuminatum.
The patient is a 57 year-old obese Caucasian male who presented with a nine-year history of a slow-growing right inguinal/ abdominal wall mass. The patient stated that the mass originally started as a “pimple” and over the course of the following 9 years the lesion grew to its present size. The mass had occasionally been followed by local family physician but the patient had refused previous treatment. The last few months he noted a progressive increase in pain, foul smell and occasional bleeding.
In the reported literature there seems to be a predominance of GCA in males and a recent trend toward a younger age at presentation. The most common presenting symptoms are anogenital mass, pain, abscess, fistula, bleeding, foul odor, weight loss, and pruritus. The overwhelming majority of cases have been reported on the penis and perianal locations.
Ordinary condylomas and GCA share many similarites. Histiologically they include koilocytosis (clear vacuolization of prickle cells in the superficial layer of the epidermis), infrequent mitosis, superficial hyperkeratosis, and acanthosis (epidermal thickening). GCA and simple condyloma acuminatum (anogenital warts) can be differentiated because GCA tends to affect the underlying tissue by characteristically “pushing” and displacing rather than “infiltrating” the basement membrane. Histiologically GCA is also differentiated from common anogenital warts by its marked papillomatosis, thicker stratum corneum, and thickened rete ridges .
It is reasonable when evaluating a patient for GCA to obtain a generous biopsy to see the broad, blunt, and deeply penetrating rete pegs and other histiologic features to help differentiate from condyloma, VC or SCC. In perianal disease with rectal involvement evaluation of rectum by proctoscope or flexible sigmoidoscopy should be used to rule out more proximal disease. If concerned about the extent of the tumor within the pelvis or to identify possible lymphadenopathy, a CT or MRI may be used . GCA has a high recurrence rate , therefore vigilant follow up after treatment should occur.
In the literature many treatment strategies have been published (e.g. chemotherapy, excision, radiation) . Most authors recommend complete surgical resection with histologically clear margins with or without adjunct chemotherapy . Early radical surgical excision has been suggested due to the clinical, pathologic and malignant potential of GCA . When there is involvement of the external anal sphincter, abdominoperineal resection should be considered . Resections with carbon dioxide and argon lasers have also been shown to be an alternative first-line treatment. There have also been reports of tumor destruction using cryotherapy or electrocauterization . No further treatment is necessary if the margins are free of tumor, but vigilant follow-up is necessary due to its malignant potential and high recurrence rate.
GCA can be defined as an unusual, humanpapillomavirus (HPV)-induced, large, exophytic, and cauliflower like lesion of the anogenital region with a potentially fatal course. Adjuvant therapy may include chemotherapy, radiotherapy or immunotherapy. Controlled, prospective, multi-institutional studies are necessary to further understand and define the nature and treatment of this rare disease.