Buschke-Lowenstein tumor in a patient with decompensated cirrhosis.

Abstract

Sir, A 57-year-old Caucasian male presented with continuous oozing of blood from a large exophytic growth over the abdomen and penile shaft. The patient reported a slowly enlarging exophytic growth over his penis [Figure 1a] and abdomen [Figure 1b] for past 35 years. He never sought medical attention for these; however, for the past 2 weeks, he was continuously oozing blood from these growths, requiring him to change clothes and bed sheets several times a day. Past medical history was significant for end-stage liver disease from untreated hepatitis C. At presentation, his hemoglobin was 6.6 and INR 1.9. During the course of hospitalization, patient was transfused as needed with reversal of coagulopathy; however the bleeding continued. Biopsy from both abdominal and penile growth showed increased mitosis and atypia, causing push effect, but lacked basement membrane invasion, [Figure ​[Figure2a2a and ​andb]b] consistent with diagnosis of Buschke-Lowenstein tumor (BLT). Our patient failed radiotherapy and surgery was not an option because of decompensated cirrhosis with irreversible coagulopathy. Figure 1 (a) Large, exophytic lesions over the penile shaft and scrotum; (b) Large, exophytic lesions on the abdomen Figure 2 (a and b) Histopathology of lesions illustrates papillomatosis, acanthosis, and keratin pearls with increased mitosis and atypia