Buschke-Löwenstein Tumor: Case Report And Review With Focus On Therapeutic And Psychological Aspects

Abstract

Buschke-Lowenstein tumor (BLT) is a rare entity and less than 100 cases have been reported. These are slow-growing, cauliflower-like, destructive lesions that histologically have benign appearance. One of the hallmarks of the disease is the high rate of recurrence and malignant transformation. Human papillomavirus has been identified as contributory to its development as well as immunosuppressive factors. We report a new case of BLT and review current knowledge about the disease, emphasizing in therapeutic but also in psychological aspects, which have never been previously analyzed. Surgery is the only treatment with curative potential and adjuvant interpheron should be considered due to the high rate of recurrence. In unresectable cases, preoperative systemic treatment is warranted. Participation of a psychologist and/or psychiatrist in the management of these patients is essential to fully understand and adequately manage mechanisms that frequently lead to a negligent attitude that can interfere with adaptation and treatment adherence. Introduction In 1896 Buschke 1 described a disease as “verrucous carcinoma” for the first time. It consisted in a giant condyloma that microscopically had a differentiated squamous epithelium with papillary growing. Despite a benign histological appearance its local behavior was aggressive with infiltration and destruction of surrounding tissue due to compression. This disease is known today as BuschkeLowenstein tumor (BLT). To our knowledge, less than 100 cases have been reported up to today in the English literature. Usually located in perineal region it has also been reported in oral cavity, larynx and nasal cavity, characterized by slow growth with major local inflammation 2. Sexually transmitted human papillomavirus DNA subtypes 6 and 11 is regularly found in these lesions, strongly suggesting its etiopathogenic role in tumor development. Still today, it is unknown which viral factor(s) or hostess features promote the replication of these generally indolent viruses leading to the progression of a plaque to a cawliflowerlike mass and later even to a carcinoma in about 30-50% of the cases 3,4,5. Although surgical resection is potentially curative, the extension of these tumors usually limits its indications and makes radical treatment impossible. For that reason, immunotherapy, chemotherapy and/or radiotherapy are frequently considered. Psychological features in these patients have not been assessed in the cases published up to now. It constitutes an extremely relevant aspect in the evaluation of this pathology that requires long-term treatments, mutilative surgeries and which involves the possibility of malignant transformation and death. Getting to know the psychological profile of these patients would help physicians to promote treatment adherence and, furthermore, get patients to consult in earlier stages of the disease. In this paper we review the most noticeable clinical features of BLT on the base of a case report and emphasize the psychological features that have not been previously analyzed in medical literature.