Case Of Giant Condyloma Acuminatum Research Articles

Giant condyloma acuminatum of vulva

In this paper, A 23 year old married woman who was diagnosed as a case of giant condyloma acuminatum of vulva measuring about 15 x 8 x 3 cm, irregular surface with multiple projections, oval in shape, firm to hard in consistency, mildly tender, exophytic, cauliflower like growth involving the whole vulva (lower part of mons pubis, labia, vestibule, clitoris, around vaginal opening). Another multiple small lesions were present at perineal region but there was no inguinal lymphadenopathy. She underwent a combined electro cauterization and cryotherapy for small to moderate size multiple primary and recurrent warty lesions and wide surgical excision with fasciocutaneous advancement flaps procedure for a giant lesions in the vulva. Excisional biopsies were performed to detect potential malignancy but malignancy was not found histologically. The patient was advised to first follow-up 1 month after operation when multiple small warty lesions were developed and treated and the subsequent follow-ups for 3 months.

Giant Condyloma Acuminatum in a Woman with AIDS

Objective: To describe a case of Giant Condyloma Acuminatum with aspect of HIV and some concerns about the CD4.
 
 Result: We describe 2 cases, the first case is a giant Condyloma in HIV patient and the second case is a giant Condyloma in pregnant woman. The patient in the first case was a 40-year-old woman with AIDS (CD4 is 290) who was undergoing anti-retroviral therapy. She was found to have a giant condyloma acuminatum of the vulva. Electrocautery excision was performed, and afterwards the quality of life has improved significantly. The second case patient is a 30-year-old G4P3A0 woman with a giant condyloma acuminatum. She was 30 weeks pregnant with a single fetus. On the external genitalia there was a giant condyloma mass on the vulva extending towards the
 peri-anal area, obstructing the introitus. The electrocautery excision was performed. She was discharged from the hospital on the second day in good condition. She had a spontaneous delivery after reaching
 full term.
 
 Conclusion: Although the giant Condyloma Acuminatum is combined with HIV, but it’s not as difficult as imagined because the tumor’s base is not wide, but shaped like inverted mushroom and it is not necessary to do local flap reconstruction.
 [Indones J Obstet Gynecol 2012; 36-4: 206-10]
 
 Keywords: electrocautery excision, giant condyloma acuminatum, surgery in AIDS

Giant condyloma acuminatum of vulva treated by surgical excision and reconstruction of defect

Giant condyloma acuminatum (GCA) is a rare sexually transmitted disease caused by Human papilloma virus (HPV) and characterised by invasive growth. Very few cases of GCA of vulva have been reported till now in the English literature [1–3]. We report a case of 34-year-old lady with GCA of vulva who was successfully treated by simple vulvectomy and reconstruction of the defect by ‘‘four-flap technique’’. A 34-year-old, married woman presented with complaints of growth on her vulva for the last 8 months. The patient was 6 months pregnant when she first noted the lesion and did not seek any medical help. Two months after her caesarean delivery, she underwent cryosurgery, but with no improvement. She denied any history of sexual promiscuity. On examination there was a 14 cm 9 10 cm 9 6 cm friable, foul smelling growth on her vulva involving both labia majora, extending anteriorly to mons pubis and posteriorly to perianal region (Fig. 1a). There were a few satellite lesions on labia minora and perianal region. Clitoris, urethra and external anal sphincter were not involved. Colposcopic, proctoscopic and oropharyngeal examinations were normal. The patient and her partner were screened negative for sexually transmitted diseases and high-risk HPV DNA. Incisional biopsy showed squamous cell papilloma with koilocytic changes and it was positive for HPV DNA type 6. A simple vulvectomy, achieving wide margins, was performed. Small lesions in perianal area and labia minora were also excised. Reconstruction of vulva was performed using ‘four flap technique’ (personal communication by Dr. Prakash V, Department of plastic surgery, Safdarjung Hospital, New Delhi). In this technique, four random pattern flaps in the dimension of 1:1 or 1:2 were raised adjacent to the defect and advanced medially to resurface the defect. This resulted in defect being transferred laterally, but this defect was smaller than the original defect and could be closed primarily (Fig. 1b). Final histopathology report confirmed the diagnosis of condyloma acuminatum with mild degree of dysplasia. Functional outcome was good with no sexual complaints. She remained free of recurrence at 12 months of follow-up (Fig. 1c). Many treatment strategies have been documented in the literature for management of GCA, but mainly in the form of case reports. Complete surgical excision with histologically clear margins, with or without adjuvants, is the mainstay of the treatment for GCA, including that of vulva [1, 3]. Other modalities include combined radiotherapy and chemotherapy, topical agents (e.g. podophyllin, 5-FU, imiquimod, bleomycin) and intralesional injections of interferons [4–6]. The skin defects created after excision of GCA in the peri-anal region can be managed with mesh skin grafting, flaps and even healing by secondary intention [1, 7–9]. Flaps have been shown to give better results for reconstruction of vulva [8, 9]. The additional advantage of our ‘four flap technique is that the scars do not extend over the perineum or thighs. In our patient, the postoperative period P. Mittal (&) R. Gupta R. Dewan S. Singhal J. Suri Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi 110029, India e-mail: drpratima@hotmail.com

Management of peri-anal giant condyloma acuminatum—A case report and literature review

Giant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity; however, malignant transformation to frankly invasive squamous-cell carcinoma has been described in about one-third of patients. In addition, malignant transformation has been reported in patients with "ordinary" condylomata acuminata. Human papillomavirus, known to cause condylomata acuminata, is also known to induce these tumors and was found in 96% of 63 cases reviewed in the last 10 years. These lesions have a propensity for recurrence and a likelihood of malignant transformation, and lead to significant mortality. Therefore, early and radical R0 excision, along with vigilant follow-up, provides the hope for cure. Conservative and/or multimodal therapy has been reported in a few cases, but its effect is not yet proved. The authors report one case of GCA; in addition, they reviewed the literature over the last 10 years and compared with previous reviews.

Determination of human papillomavirus types in giant condyloma acuminatum

Objective To determine the genotypes of human papillomavirus (HPV) in patients with giant condyloma acuminatum.Methods Sixty-seven outpatients with giant condyloma acuminatum collected from January 2007 to January 2010 were included in this study.Lesional specimens were obtained from these patients.The genotypes of HPV were determined by flow-through hybridization and gene chip assay.Results Of the 67 cases of giant condyloma acuminatum,63 (94.02％) were positive for HPV DNA.Among the HPV DNA-positive specimens,84 (60.87％) harbored low risk types of HPV,54 (39.13％) high risk types of HPV.Type 6 and 11were the predominant low risk HPV types,while type 16 and 18 were the major high risk HPV types. Key words: Conclusion There is an elevated prevalence of high risk HPV types 16 and 18 in patients with giant condyloma acuminatum.

Giant condyloma acuminata of Buschke-Löwenstein: successful treatment with a combination of surgical excision, oral acitretin and topical imiquimod

Human papillomavirus (HPV) is the most common sexually transmitted disorder in young, sexually active populations in the USA and Europe. Giant condyloma acuminatum (GCA) is a unique variant of condyloma acuminata, characterized by local aggressive behaviour despite benign histology. It carries a substantial risk of squamous cell carcinoma. Various treatments have been used, but response is often poor and recurrence rates high. We present a case of GCA successfully treated with a combination of surgical excision, oral acitretin and topical imiquimod. The diagnosis was based on histological examination, immunohistochemical analysis and in situ hybridization for HPV 6 and 11. We recommend a trial of oral retinoid and topical imiquimod in selected cases of GCA.

Squamous Cell Carcinoma Arising in a Giant Condyloma Acuminatum (Buschke-Lowenstein Tumour)

Giant condyloma acuminatum (GCA) is a tumour that primarily affects the genital and perianal areas. Despite the histologically benign appearance, it behaves in a malignant fashion, destroying adjacent tissues, and is regarded as an entity intermediate between an ordinary condyloma acuminatum and squamous cell carcinoma. Primary anorectal lesions account for only a small number of GCA cases and, as with squamous cell carcinoma, the human papilloma virus is the causative agent. The hallmark of GCA is the high rate of local recurrence and transformation into squamous cell carcinoma. We describe a case of GCA complicated by malignant transformation, where locoregional control was achieved with combined chemoradiotherapy.

Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions

Giant condyloma acuminatum or Buschke-Loewenstein tumor of the anorectal and perianal regions is an uncommon entity that has not been extensively reviewed. We analyzed 42 known cases of giant condyloma acuminatum in the English literature and reviewed their behavior and management. All reported cases of giant condyloma acuminatum in the English literature were selected. The relevant clinicopathologic features of this uncommon entity were examined and discussed. These tumors are generally large with the propensity to ulcerate and infiltrate into deeper tissues. The hallmark of the disease is the high rate of recurrence (66 percent) and malignant transformation (56 percent). No distant metastases have been reported. The overall mortality was 20 percent, all occurring in patients with recurrences. Fifty percent of the patients who were initially treated with radical surgery developed recurrences. The average duration of disease was longer in patients with recurrences than in patients without recurrences (9.6 years vs. 2.8 years). The median number of recurrences was two (range, one to seven) recurrences, and the median time before first recurrence was ten months. Recurrences were treated by radical surgery in 17 patients and chemoradiotherapy +/- local excision in 5 patients. Follow-up information for the remaining five patients was not available. The cure rate in the radical surgery group was 61 percent compared with 25 percent in the chemoradiotherapy +/- local excision group. Giant condyloma acuminatum of the anorectal and perianal regions is a highly aggressive tumor with the propensity for recurrences and malignant transformation, but without metastatic potential. A high rate of recurrence is seen in patients with long duration of the disease. Salvage of patients with recurrences can be achieved successfully with radical surgery.

Giant condyloma acuminatum (Buschke-Loewenstein tumour) of the scrotum

A case of giant condyloma acuminatum of the scrotum is reported. It was initially diagnosed as a low grade squamous carcinoma. This neoplasm is closely related to Human Papillomavirus, mainly HPV 6 and HPV 11, and may be clinically indistinguishable from squamous carcinoma. The histological appearance is benign, however, its clinical behaviour is similar to verrucous carcinoma. A review of previously reported cases has been undertaken. The true significance of this lesion and management are discussed. Early aggressive therapy is recommended.

Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor) Involving a Pilonidal Sinus: A Case Report and Review of the Literature

Giant condyloma acuminatum or Buschke-Lowenstein tumor has been reported to involve many areas about the perineum. The majority of previous documentations have implicated the coronal sulcus, prepuce, and fossa navicularis of the penis as the most likely foci to support growth. Authors have contributed multiple cases of perianal and rectal involvement as well as rare reports of inguinal, bladder, and endocervix-low uterine segment tumors. A case of giant condyloma acuminatum involving a chronic pilonidal sinus overlying the sacrum is described. Wide surgical extirpation was found to be a curative means of management.