Abstract
Treatment of anorectal Buschke-Löwenstein tumor (BLT) with squamous cell carcinoma (SCC) transformation is not univocal given the rarity of the disease. BLT is characterized by its large size and tendency to infiltrate into underlying tissues. Malignant transformation can occur and it is important to identify the presence of neoplastic foci to decide the proper treatment. Our aim was to assess the effectiveness of neo-adjuvant chemo-radiation therapy (CRT) and local excision in order to avoid abdomino-perineal resection (APR). Three cases of anorectal BLT with SCC transformation are presented. All patients were HIV positive and treated with antiretroviral drugs. They underwent preoperative endoanal ultrasound, biopsies, total body tomography and anal brushing. Treatment consisted of neo-adjuvant chemo-radiation therapy (45 Gy to the pelvis plus a boost with 14.40 Gy to the primary tumor for a total of 59.40 Gy, and mitomycin-C in bolus on the first day, plus 5-fluorouracil by continuous infusion in the first and in the sixth week) and subsequent local surgical excision. During the follow-up, patients were subjected to the same preoperative diagnostic investigations and high resolution anoscopy. All patients showed a complete regression of the lesion after CRT and were treated by local surgical excision, thus avoiding permanent colostomy. In conclusion neo-adjuvant chemo-radiation therapy with local surgical excision could be considered an effective therapy in the treatment of anorectal BLT with SCC transformation to avoid APR.
Highlights
The Buschke-Löwenstein tumor (BLT) or giant condyloma acuminatum (GCA) is a large, exophytic, cauliflower lesion of the anogenital region, correlated to Human papillomavirus (HPV) infection [1]
We present three cases of BLT with squamous cell carcinoma (SCC) transformation treated with chemo-radiation therapy and local surgical excision
We identified HPV-6 in two patients and HPV-18 in one patient
Summary
The Buschke-Löwenstein tumor (BLT) or giant condyloma acuminatum (GCA) is a large, exophytic, cauliflower lesion of the anogenital region, correlated to HPV infection [1]. It is histologically benign and when it is diagnosed at an early stage can be treated with wide local excision [2,3]. Malignant transformation in squamous cell carcinoma (SCC) can occur and if not detected early it is no longer distinguishable from an invasive carcinoma [5]. Endoanal ultrasound examination (EUS) showed anal canal invasion (uT1N0). Histological examination on multiple biopsies specimens showed a characteristic GCA with SCC transformation. The patient underwent EUS and high resolution anoscopy (HRA) twice a year and, after three years, is disease free
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