Giant Condyloma Acuminatum Research Articles

Buschke-Löwenstein Tumor (BLT): Successful Treatment of Human Papillomavirus (HPV)-Associated Squamous Cell Carcinoma With Radical Surgery and Chemotherapy

Buschke-Löwenstein Tumor (BLT): Successful Treatment of Human Papillomavirus (HPV)-Associated Squamous Cell Carcinoma With Radical Surgery and Chemotherapy

An extraordinary case of Buschke–Lowenstein tumor: multiple localization, malignant transformation, and clinical insights—a case presentation and literature review

BackgroundBuschke–Lowenstein (B–L) tumors are rare, aggressive warty lesions that can grow to enormous sizes and have a risk of malignant transformation despite their benign histology. These tumors are primarily caused by HPV types 6 and 11, with additional risk factors, including immunodeficiency, multiple sexual partners, poor hygiene, and a history of other genital infections. The typical treatments include topical medications, cryotherapy, chemotherapy, radiotherapy, and surgery. Surgery is considered the gold standard, particularly for extensive and infiltrative lesions, as demonstrated in our case.Case presentationWe report a case of a male patient with perianal and penopubic B–L tumors, who had multiple sexual partners and no history of homosexual relationships, presenting with refractory classic condyloma. The perianal tumor exhibited malignant transformation, while the penopubic tumor remained histopathologically benign. Upon admission, the patient showed unusual biochemical blood results, including hypercalcemia and anemia of chronic illness. The operation and postoperative period were managed by a multidisciplinary team. The patient was satisfied with both the cosmetic and functional outcomes. Histopathological examination confirmed the suprapubic lesion as a B–L tumor, whereas the perianal specimen revealed a small focus of squamous cell carcinoma arising from a B–L tumor.ConclusionsWith an experienced multidisciplinary team, excision of the tumor is still the standard treatment for BL tumor. Achieving a negative surgical margin for any SCC foci is of utmost importance to prevent recurrence. Close and careful follow-up is essential due to the high recurrence rate associated with these tumors. Further research is needed to clarify existing controversies and to enrich the literature on this rare phenomenon.

Clinicopathological Findings and Comprehensive Review of Buschke-Lowenstein Tumors Based on a Case Study.

The Buschke-Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is a rare, exophytic tumor, arising from pre-existing warty lesions associated with human papillomavirus (HPV) infection, particularly strains 6 and 11, which are considered to have low oncogenic potential. BLT presents as a large, cauliflower-like growth typically affecting the penis, vulva, vagina, perineum, scrotum, anus, and perianal area. Despite being a benign lesion, BLT is locally aggressive with a high recurrence rate, and can potentially undergo malignant transformation into squamous cell carcinoma, contributing to an overall mortality rate of 20-30%. The primary treatment is complete surgical excision with wide margins, frequently requiring complex reconstructive techniques for defect coverage. We report on a 68-year-old patient, with multiple comorbidities, who presented with a two-year history of a large exophytic tumor in the genital region, affecting the penis, along with progressive erectile dysfunction and urinary problems. The tumor was surgically excised with oncological safety margins, and reconstruction was performed using advancement and rotation flaps from the scrotum and intact penile skin. Histopathological examination confirmed the diagnosis of Giant Condyloma (Buschke-Löwenstein tumor), showing acanthosis, papillomatosis, parakeratosis, and koilocytic cell collections, with positive immunohistochemical staining for p16, p63, and ki67. Postoperatively, the patient had a good clinical outcome and a complete surgical cure. This case highlights the critical need for timely intervention and comprehensive management strategies in treating giant condyloma, given its potential for local invasion and substantial impacts on patient quality of life. Early diagnosis and thorough surgical excision are crucial for effective management and to reduce the high recurrence, morbidity and malignant transformation risk associated with this condition.

Buschke – Lowenstein Tumor. Case Report in a Patient with a History of Kidney Transplantation with Chronic Graft Rejection

Buschke-Lo wenstein tumor is a rare disease characterized by aggressive local infiltration in the perineal region, associated with human papillomavirus infection. It primarily affects immunocompromised patients, with surgical resection being the mainstay of treatment. We report the case of an adolescent with a history of chronic immunosuppression due to vasculitis and subsequent renal complications, including terminal chronic kidney disease and renal transplant failure. At 16 years old, she was diagnosed with Buschke-Lo wenstein tumor and underwent surgical treatment with complete lesion excision.

An Exasperating and Unusual Presentation of Buschke-Lowenstein Tumor in an Adolescent Girl: Case Report with Review of Literature

AbstractGiant condylomata acuminata of Buschke-Löwenstein (GCBL) is a benign condition with a high recurrence rate and a remote possibility of developing into cancer. It is characterized by excessive proliferation of verrucous lesions on the genitalia and/or perianal region, and is frequently linked to human papillomavirus (HPV) subtypes 6 and 11. With the exception of a few case series, case reports make up the majority of the literature. Despite the literature's support for surgical excision, the current evaluation reveals a lack of clarity regarding the disease's diagnosis and best course of action. Better assessment and management of these patients are necessary to prevent any progression/recurrence of disease.Here, we present a case of a GCBL of the vulva in an 18-year-old girl, who was effectively treated with a simple vulvectomy and split skin graft reconstruction. The reported case is one of the rarest presentations of Buschke-Löwenstein tumor as it is not associated with any of the HPV subtypes and is seen in an 18-year-old girl, one of the youngest patients reported till date. This case report is followed by a brief review of the literature on GCBL, which will add to our understanding of this entity and the most effective therapy to treat the disease.

Surgical treatment of perineal giant condylomata acuminata (Buschke Lowenstein tumor): Case series from a developing country

IntroductionGiant condylomata acuminatum (GCA) also referred to as Buschke-Lowenstein tumor (BLT) is a rare tumor primarily associated with low-risk HPV 6 and 11, which is believed to be a slow growing intermediate tumor with low potential to transform into invasive cancer. Case presentationWe presented our experience with three cases of BLT (one woman and two men). Clinical discussionThe three patients had surgical excision and two of them had reconstruction of the surgical defect with good clinical outcome. ConclusionWe highlighted the importance of early identification of symptoms, treatment options and risk of recurrence as well as primary preventive strategies.

Abstract A018: A case of Buschke-Löwenstein tumor with superimposed infection and associated urothelial carcinoma

Abstract The Giant Condyloma Acuminata (GCA), the Buschke-Löwenstein tumor, is a rare and challenging pathology with a less than 0.1% prevalence. This disease is often considered a transitional phase between condyloma acuminatum and squamous cell carcinoma, potentially representing a variant of verrucous carcinoma. Despite its initially benign histological presentation, GCA can evolve into expansive papillomatous proliferations that deeply invade underlying tissues. Studies indicate that GCA may transform into invasive squamous cell carcinoma in 8.5-23.8% of cases. The strong correlation between GCA and human papillomavirus (HPV) infections, particularly subtypes 6 and 11, underscores the role of viral factors in developing this condition. The presented case involves a 57-year-old male with pre-existing medical conditions, including hypertension and diabetes mellitus, who sought emergency care due to escalating suprapubic and penile discomfort. A biopsy of the genital warts identified condyloma acuminatum with an overlying bacterial infection of Proteus mirabilis. Concurrently, pathology identified anogenital squamous cell carcinoma. Notably, the patient had no associated sexually transmitted infections and no prior immunocompromised status. Imaging studies revealed a multilobulated soft tissue mass in the pelvis with prostatic invasion and enlarged lymph nodes. Further investigations, including a transurethral resection of bladder tumor (TURBT), revealed multiple tumor deposits in the bladder, penile lesion, and suprapubic papule. Pathological examinations indicated non-invasive and invasive papillary urothelial carcinoma as well as invasive squamous cell carcinoma in different locations. The tumor was staged as pathologic IIIB T2N3M0, and a collaborative decision between Urology and Oncology teams led to the initiation of neoadjuvant chemotherapy with TIP (cisplatin, ifosfamide, and paclitaxel). The patient underwent the initial chemotherapy cycle with subsequent cycles scheduled every three weeks. Management options for GCA include radiotherapy, cryosurgery, CO2 laser surgery, systemic chemotherapy, and radical surgical excision. While radiotherapy has shown successful outcomes, concerns about anaplastic transformations and post-treatment condylomas make its utilization contentious. The absence of unequivocal guidelines for radiotherapy dosage and fractionation has led to considerations of alternative modalities, but the primary approach remains radical surgical excision. The risk of recurrence remains high due to potential tumor cell spillage during surgery. In conclusion, this case report highlights an advanced manifestation of the Buschke-Löwenstein tumor coexisting with multiple HPV infections. The complexity of GCA and the lack of consensus on optimal therapeutic strategies emphasize the need for timely diagnosis and intervention to ensure favorable prognoses. Various treatment paradigms exist in medical literature, but their efficacy varies, reflecting the ongoing challenges in managing this rare and clinically intricate condition. Citation Format: Aliya M. Khan, Sophia Navajas, Mehmet Hepgur, Samuel A. Kareff. A case of Buschke-Löwenstein tumor with superimposed infection and associated urothelial carcinoma [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr A018.

Pedunculated Giant Condyloma Acuminatum of the Scrotum

The patient was a 71-year-old male whose chief complaint was a scrotum mass. The mass had gradually increased in size without any associated symptoms. The physical examination revealed a pedunculated, radish brown, and elastic soft tumor (4. 5×3. 5×3. 0 cm) in the right scrotum. Blood chemical analysis of HbA1c and squamous carcinoma antigen were 8. 3% and 38. 4 ng/ml (≦1. 5), respectively. This tumor was successfully treated with surgical resection. Histopathological examination showed condyloma acuminatum without malignant findings. Giant condyloma acuminatum commonly affects the genital and perianal areas. An immunocompromised state generally exists in the background of the patients.

Surgical Management of Giant Condyloma Acuminata Involving Vulva, Perineum and Perianal Area

Condyloma acuminata (CA), also known as anogenital warts, are benign proliferative epidermal and/or mucosal lesions usually caused by Human Papilloma Virus (HPV) type 6 and 11. They initially manifest as variable sized and shaped soft papules or plaques on anogenital skin. However, they can grow as a large, bulky, lobulated growth. Lesions are commonly multiple and multifocal, affecting the vulva, perianal, vaginal and cervical regions. They represent the most common sexually transmitted disease (STD) and are highly contagious. Further, the incidence of CA is 5-7fold higher in Human Immunodeficiency virus (HIV) positive patients compared to immunocompetent patients. The HIV infection reduces the local immune control of HPV infection thus favours the proliferation of the HPV which results into large sized CA. The giant condyloma acuminata (GCA) and giant condyloma of Buschke-Löwenstein (GCBL) are uncommon variants of classical condyloma acuminata (CCA) which can reach the size of 10 to 30 cm. The treatment of CA should be individualized and based upon the extent of disease and treatment availability. The small CA which present as papules or plaques can be treated by Podophyllin, Imiquimod, electrosurgical ablation or cryotherapy. However, GCA require excision with cold knife, electrosurgery or CO2 laser. When the base of GCA is narrow, surgical excision with minimal skin loss allows primary closure of the wound, whereas when the base is broad and relatively fixed, one must keep the differential diagnoses of GCA versus GCBL which require wide excision and reconstruction of the tissue. This case report illustrates the surgical management of GCA with broad base in a 44-year-old female patient with HIV infection. She was treated by wide surgical excision followed by reconstruction of the defect with fascio-cutaneous V-Y advancement flaps. Histology confirmed the diagnosis of condyloma acuminatum. Six months following surgery, she had recurrence of a perianal wart that was cauterized. On further 12 month follow up there was no new recurrence of any condylomatous lesion.

Fine scalpel surgery: preserving the dartos muscle in apatient with scrotal and perigenital giant Buschke-Löwenstein tumors.

Giant condyloma acuminatum (GCA), alternatively referred to as aBuschke-Löwenstein tumor (BLT), is an uncommon, benign, but locally aggressive form of verrucous carcinoma. The condition usually affects the male population under the age of50years; however, there have been rare reports of pediatric cases. Various risk factors such as smoking, diabetes, promiscuous behavior, poor hygiene, immunosuppression, and others are linked to the development of this condition. We present the case of a26-year-old male patient who came to the dermatology department with primary complaints of 10-year-old verrucous tumor formations located in the perigenital and perianal areas. Serological tests for AIDS, hepatitisB, hepatitisC, Chlamydia trachomatis, and syphilis were negative. The routine blood tests were slightly abnormal. Histological verification of condylomata acuminata of Buschke-Löwenstein was made. Given the sensitive areas, surgery was advised. With several fine undermining scalpel excisions, the lesions in the scrotal and perigenital areas were removed and the dartos muscle was preserved. Electrodissection and shave curettage were not performed. The postoperative period passed without complications and no recurrences in the perigenital area were reported. We believe that our case report represents the first documented surgical approach for scrotal Buschke-Löwenstein tumor using exclusively fine undermining scalpel surgery. Abrief literature review of the condition is presented, focusing on the currently available treatment options and highlighting the potential effectiveness of the surgical approach.

Tumor de Buschke-Löwenstein en el embarazo adolescente

Background: Buschke-Löwenstein tumor also called giant condyloma acuminatum is a rare condition due to the human papillomavirus with an incidence of 0.01% and just 6 cases reported in pregnancy. There is no consensus on the treatment, although surgery has been the most reported.

Anogenital warts-An update

With aprevalence of around 1% in the sexually active population anogenital warts are the most frequent human papillomavirus (HPV)-related disease. In the vast majority of cases the underlying cause of the infection is due to HPV types6 and11. The diagnosis can usually be clinically established but in certain cases a histopathological work-up can be useful. Buschke-Lowenstein tumors represent such a scenario. The current therapeutic armamentarium for anogenital warts ranges from surgical ablative procedures up to local immunomodulatory treatment. All procedures have different advantages and disadvantages and are relatively time-consuming and sometimes also unpleasant for the patient. Anogenital warts are also a possible expression of an incomplete immunological control of HPV. Therefore, it should be emphasized that for certain affected individuals, especially immunosuppressed patients, special attention should be given to ensuring that screening investigations for HPV-associated dysplasia is carried out according to the respective valid guidelines. The primary prophylaxis by vaccination of girls and boys prior to first HPV exposure represents a very effective option to drastically reduce the prevalence of anogenital warts and other HPV-related diseases.

Secondary Syphilis with Giant Condyloma Acuminatum in Pregnant Women: A Report from a Limited Resource Area

Introduction: This report shows a case of secondary syphilis in pregnancy with Giant Condyloma Acuminatum (GCA) co-infection DD/condyloma lata which was resolved with alternative treatment of syphilis. Case illustration: A 21-year-old, primigravid woman came to obstetrics outpatient clinic in rural SoE Hospital, East Nusa Tenggara, with a complaint of mass enlargement around vulva (minor and major labia) since 2 months before. Based on Last Menstrual Period (LMP), she was in 34 + 6 weeks of gestation. There were coin lesions in the palms. On genital examination, there was protruded mass sized around 15 x 10 cm, erythematous, and it easily bled on the center part which was suspected to be GCA. Treponema Pallidum rapid (TP-rapid) test using AIM© syphilis rapid test revealed positive results. The patient was diagnosed with secondary syphilis in pregnancy mixed with GCA with dd/condyloma lata and administered Ceftriaxone 1 g intramuscularly once daily for 14 days. She delivered at 41-42 weeks of gestation and a baby girl with 1,980 grams of body weight according to symmetric Intrauterine Growth Restriction (IUGR) was born. No clinical signs of congenital syphilis found. Discussion: Vertical transmission which occurs in each stage of syphilis is related to the presence of spirochetes in the blood circulation. Infants born from syphilis pregnant women consist of 56% of jaundice, 14% of hearing impairment, 8% of renal disease, 8% of mental retardation, and 6% of IUGR or Small for Gestational Age (SGA). Conclusion: Secondary syphilis coinfection with GCA in pregnancy is a rare case report. Syphilis is a significant public health problem globally, especially in Indonesia.

Secondary Syphilis with Giant Condyloma Acuminatum in Pregnant Women: A Report from a Limited Resource Area

Introduction: This report shows a case of secondary syphilis in pregnancy with Giant Condyloma Acuminatum (GCA) co-infection DD/condyloma lata which was resolved with alternative treatment of syphilis.Case illustration: A 21-year-old, primigravid woman came to obstetrics outpatient clinic in rural SoE Hospital, East Nusa Tenggara, with a complaint of mass enlargement around vulva (minor and major labia) since 2 months before. Based on Last Menstrual Period (LMP), she was in 34 + 6 weeks of gestation. There were coin lesions in the palms. On genital examination, there was protruded mass sized around 15 x 10 cm, erythematous, and it easily bled on the center part which was suspected to be GCA. Treponema Pallidum rapid (TP-rapid) test using AIM© syphilis rapid test revealed positive results. The patient was diagnosed with secondary syphilis in pregnancy mixed with GCA with dd/condyloma lata and administered Ceftriaxone 1 g intramuscularly once daily for 14 days. She delivered at 41-42 weeks of gestation and a baby girl with 1,980 grams of body weight according to symmetric Intrauterine Growth Restriction (IUGR) was born. No clinical signs of congenital syphilis found.Discussion: Vertical transmission which occurs in each stage of syphilis is related to the presence of spirochetes in the blood circulation. Infants born from syphilis pregnant women consist of 56% of jaundice, 14% of hearing impairment, 8% of renal disease, 8% of mental retardation, and 6% of IUGR or Small for Gestational Age (SGA).Conclusion: Secondary syphilis coinfection with GCA in pregnancy is a rare case report. Syphilis is a significant public health problem globally, especially in Indonesia.Sifilis Sekunder dengan Kondiloma Akuminata Besar pada Wanita Hamil: Sebuah Laporan dari Daerah dengan Keterbatasan Sumber DayaAbstrakPendahuluan: Kasus ini melaporkan sifilis sekunder pada kehamilan dengan kondiloma akuminatum besar dengan koinfeksi dd/kondiloma lata yang beresolusi setelah pemberian tatalaksana alternatif sifilis.Ilustrasi Kasus: Seorang wanita primigravida berusia 21 tahun datang ke poliklinik obstetrik di RSUD SoE, Nusa Tenggara Timur dengan pembesaran massa sekitar vulva (labia minor dan mayor) sejak 2 bulan sebelumnya. Berdasarkan Hari Pertama Haid Terakhir (HPHT), usia kehamilan 34 + 6 minggu. Terdapat lesi pada telapak tangan. Pada pemeriksaan genital, terdapat massa ukuran 15 x 10 cm, eritema, mudah berdarah pada bagian tengah dengan kecurigaan kondiloma akuminatum besar. Hasil tes rapid Treponema Pallidum menggunakan tes rapid sifilis (AIM©) menunjukkan hasil positif. Pasien didiagnosis mengidap sifilis sekunder pada kehamilan dengan kondiloma akuminatum besar dengan koinfeksi dd/ kondiloma lata dan diberikan terapi seftriakson 1 gram intramuscular setiap hari selama 14 hari. Pasien melahirkan saat usia kehamilan 41-42 minggu dan lahir bayi 1.980 gram sesuai dengan Pertumbuhan Janin Terhambat (PJT) simetrik. Tidak ada tanda klinis sifilis kongenital yang ditemukan. Diskusi: Transmisi vertikal dapat terjadi pada setiap tahap sifilis berkaitan dengan keberadaan spiroseta di sirkulasi darah. Bayi lahir dari wanita hamil sifilis biasanya menunjukkan tanda 56% kuning, 14% gangguan pendengaran, 8% gangguan ginjal, 8% retardasi mental, dan 6% PJT atau Kecil Masa Kehamilan (KMK).Kesimpulan: Sifilis sekunder koinfeksi kondiloma akuminatum besar merupakan kasus jarang. Sifilis masih menjadi perhatian kesehatan global, khususnya di Indonesia.Kata kunci: sifilis, koinfeksi, kondiloma akuminatum besar, pertumbuhan janin terhambat

Cutaneous Squamous Cell Carcinoma: A 7-year Review

Introduction: Cutaneous squamous cell carcinoma (SCC) is rare in sub-Saharan Africa. In Senegal, its prevalence was estimated at 0.09% in 2004. It occurs most frequently in pre-neoplastic acquired or genetic dermatoses. The aims of this study were to describe the epidemiological, clinical and therapeutic aspects of SCC, and to identify associated risk factors. Methodology: This was a descriptive cross-sectional study in the Oncology Department at the Joliot Curie Institute of the Aristide Le Dantec Hospital over a 7-year period (January 2015 to December 2021). We included all patients hospitalized and followed up for SCC. The diagnosis was confirmed by histopathology. Data entry and analysis were performed using epi-info software version 7.2.5.0 and Excel 365. Results: We recorded 189 cases of SCC, representing an incidence of 24 cases per year and a hospital frequency of 0.77%. The mean age was 51 and the sex ratio 1.28. The ulcero-budding form was predominant in 67.2% of cases. The majority of lesions were located on the lower limbs (30.6%) and 28.4% on the cephalic extremity. Squamous cell carcinoma was well-differentiated in 49.2%. Metastases were present in 40.2%. Pre-neoplastic dermatoses were noted in 28.6%. These were burn scars in 43%, chronic ulcer in 23.39%, discoid lupus in 2%, Buschke Lowenstein tumor in 4%. Geno dermatoses included albinism in 6 cases and xeroderma pigmentosum in one. Voluntary use of depigmenting cosmetics was noted in 11 cases. Patients underwent surgery in 32.3%, radiotherapy in 8.5% and chemotherapy in 32.8%. Favorable progression was in 20.6%. Recurrence was noted in 2 cases, metastasis in 3 and death in 5. Conclusion: Squamous cell carcinoma remains a serious tumor in Africa. There is a delay in diagnosis, with some tumors being very advanced. Early surgical management is the main factor in curing the cancer.

Unusual presentation of penile giant condyloma acuminatum with spontaneous prepuce perforation: A case report

Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways: Prediction and forecast. Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role. Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences. The time series analysis approach has the advantage of being easier to use (in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average). Still, it is limited in forecasting time, unlike the classical models such as Susceptible-Exposed-Infectious-Removed. Its applicability in forecasting comes from its better accuracy for short-term prediction. In its basic form, it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures (governments, companies, etc. ). Instead, it estimates from the data directly. Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread; be it school closures, emerging variants, etc. It can be used in mortality or hospital risk estimation from new cases, seroprevalence studies, assessing properties of emerging variants, and estimating excess mortality and its relationship with a pandemic.

SAT256 Buschke Loewenstein Tumor Presenting With Hypercalcemia

Abstract Disclosure: K. Jones: None. P. Krutilova: None. J.B. McGill: None. Introduction: Humoral hypercalcemia of malignancy is known to be associated with squamous cell carcinomas (SCC), although rarely seen in the setting of skin cancer. We present an interesting case of a young patient with giant condyloma acuminatum complicated by SCC presenting with severe hypercalcemia. Case Description: A 37-year-old man presented with pain and purulent drainage due to bacterial superinfection of genital warts. He had recurrent and locally advanced condylomas, first occurring more than 10 years ago. Skin lesions in the genital and perianal area never resolved and he required multiple surgical interventions including sigmoid colostomy placement due to Fournier gangrene. His laboratory evaluation this admission was notable for an elevated calcium level (13.0 mg/dL [8.5-10.3], albumin 3.4 g/dL [3.5-5.0]), phosphorus 3.9 mg/dL [2.3-4.5], and normal kidney function. He did not have history of hypercalcemia and was not taking any calcium supplements. Hypercalcemia prompted work-up including: PTH 4 pg/mL [15-65], 25-OH vitamin D 36 ng/mL [30-80], unremarkable SPEP/UPEP, TSH 0.91 mcIUnit/mL [0.3-4.2]. Initial differential diagnosis included hypercalcemia due to granulomatous process and increased production of calcitriol vs. PTH-related protein (PTHrP) mediated hypercalcemia. 1,25-OH vitamin D was normal (33 pg/mL [18-64]) and PTHrP was elevated (6.7 pmol/L [<4.2]). The patient subsequently underwent biopsy of groin lesions which demonstrated SCC in situ. PET/CT only demonstrated hypermetabolic changes in the perineum and groins bilaterally. Inguinal lymph node biopsy was negative for malignancy. His hypercalcemia persisted despite administration of IV fluids and he was treated with IV zolendronic acid. Calcium level subsequently normalized (9.1 mg/dL). He underwent extensive excision of the tumor involving the right gracilis muscle, left testicle, portions of the perineum, and penile shaft skin. Discussion: While cases of hypercalcemia in malignancy are common, this is an unusual case of giant condyloma acuminata (GCA) heralding development of SCC by elevated calcium levels. GCA also known as Buschke-Loewenstein tumor is a rare disease with estimated incidence of 0.1% in the general population and a male-to-female ratio of 2.7:1, typically associated with human papilloma virus subtypes 6 and 11. It is a locally aggressive tumor with a potential for destructive growth and malignant transformation (estimated rate up to 56%), very high rate of recurrence after excision (66%), and overall mortality of approximately 20%. Early recognition and treatment of GCA is essential in order to prevent devastating complications. Purzycka-Bohdan D, Nowicki RJ, Herms F, et al. The Pathogenesis of Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor): An Overview. Int J Mol Sci. 2022;23(9):4547. Published 2022 Apr 20. doi:10.3390/ijms23094547 Presentation: Saturday, June 17, 2023

"Free-Floating Anus": A Flap-Free Approach for Definitive Excision of Circumferential Giant Condyloma Acuminata.

Giant condyloma acuminata (GCA), or Buschke-Löwenstein tumor, is a rare exophytic cauliflower-like growth in the anogenital region. The spectrum of treatment options is wide, ranging from the application of topical ointments to the performance of an abdominoperineal resection. Currently, wide local excision is the most common approach and may entail the creation of a protective loop ileostomy or implementation of flaps or grafts that facilitate closure. We describe a unique surgical approach for the management of circumferential GCA void of the use a protective loop ileostomy, flaps, or grafts. Our report highlights that the implementation of a radical, circumferential, wide excision resulting in "free-floating anus" and healing via secondary intention can ultimately lead to excellent functional and cosmetic results and therefore may be considered a minimally invasive surgical option for patients afflicted with a large, circumferential GCA.

Buschke-Lowenstein Tumor and its Medical-Surgical Approach

Buschke-Lowenstein tumor is a benign lesion of the skin and mucosa that occurs most commonly in the genital and perianal region of sexually active men and women. It is associated with human papillomavirus (HPV) and is treated with surgery in most cases. In addition, patients with immunodeficiency have a higher incidence of TBL. The initial clinical evaluation should include a detailed history, a careful physical examination, and an assessment of risk factors, including sexual activity, immunosuppression, and HPV exposure. The diagnosis of TBL is based on clinical presentation, histopathology and HPV detection. Histopathologic examination is necessary to confirm the diagnosis of TBL and to rule out other similar conditions. In addition, HPV detection is important to establish the risk of progression to malignant lesions and guide the management of TBL.

Buschke-Lowenstein Tumor and its Medical-Surgical Approach

Buschke-Lowenstein Tumor and its Medical-Surgical Approach