Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage.

Jefferson F Nieves-Condoy,Camilo L Acuña-Pinzón,Diego Hinojosa-Ugarte,Luis A Zúñiga-Vázquez,José L Chavarría-Chavira,Faustino R Perez-Lopez

doi:10.1155/2021/9919446

Abstract

Giant condyloma acuminatum (GCA) or Buschke-Loewenstein tumor is a rare disease, with an estimated prevalence of 0.1%. It was initially described in 1896 by Buschke and later in 1925 by Buschke and Loewenstein. Classic condyloma acuminata (CCA) and squamous cell carcinoma (SCC) were initially described as different entities. These three entities are currently considered to correspond to the same spectrum of different but not exclusive malignant transformations, associated with multiple risk factors such infection by human papilloma virus (HPV), immunodeficiencies, poor hygiene, multiple sexual partners, and chronic genital infections. HPV subtypes 6 and 11 are associated with 90% of GCA. It presents as a cauliflower-like tumor in the genital region with bad odor, bleeding, and local infection, differential diagnosis with multiple conditions should be considered, and sexually transmitted diseases should always be investigated. GCA has a higher rate of malignant transformation than CCA and tends to infiltrate adjacent soft tissues. The therapeutic approach is controversial but is considered that the resection with free edges is the gold standard and can be combined with adjuncts. The recurrence rate is high. Overall mortality is 21% and is associated with morbidity caused by recurrences. Imiquimod cream 5% has recently shown good results as monotherapy and in combination with ablative and surgical treatments. The quality of life is diminished in patients with this condition. In this review, we address the different aspects of this rare entity including the therapeutic approach.

Highlights

Giant condyloma is a rare entity characterized by an exophytic cauliflower-like growth lesion with tendency to infiltrate adjacent tissues, high rate of recurrence, and potential for malignant transformation [1]
Giant condyloma acuminatum (GCA) differs from squamous cell carcinoma by an intact basement membrane, preservation of polarity, and absence of lymphatic invasion or metastasis in the lymph nodes
The main agent related to GCA is the human papilloma virus (HPV), been associated with HPV subtypes 6 and 11 in more than 90% of cases in patients without other comorbidities and in patients with immunosuppression conditions [12], and cases of multiple subtypes have been reported in the same patient

Summary

Introduction

Giant condyloma is a rare entity characterized by an exophytic cauliflower-like growth lesion with tendency to infiltrate adjacent tissues, high rate of recurrence, and potential for malignant transformation [1]. It has been suggested that CCA and GCA are different entities histologically due to their biological behavior. It is considered that the CCA, GCA, and SCC correspond to entities of the same continuous but not mandatory spectrum of potentially malignant lesions [5]. There are few series of cases of this disease, and those are compilations of reports of previous cases and analyses of the characteristics described in them, and this limits the knowledge about this entity and the appropriate therapeutic approach. Several therapeutic alternatives and combinations of them have been described in the case reports [6], but due to the infrequency of the disease, a high level of evidence of the results of the different therapeutic regimens is not available. The following review aims to review the literature that describes the characteristics of this disease and to guide the approach to it

Epidemiology and Risk Factors

Clinical Presentation

Clinical Management

Clinical Evolution

Findings

Conclusions