Perianal Condyloma Acuminatum Research Articles

Effect of 5-Aminolevulinic Acid Photodynamic Therapy Combined with Carbon dioxide Laser on Condyloma Acuminatum

By comparing 5-aminolevulinic acid photodynamic therapy combined with carbon dioxide laser and carbon dioxide laser therapy only, to explore the therapeutic effect of 5-aminolevulinic acid photodynamic therapy combined with carbon dioxide laser on perianal and anal canal condyloma acuminatum. A total of 74 patients with perianal and anal canal condyloma acuminatum who were admitted to our hospital from January 2021 to December 2021 were selected as the research objects. They were randomly assigned to the observation group and the control group, with 37 cases in each group. The observation group was treated with 5-aminolevulinic acid photodynamic therapy combined with carbon dioxide laser and the control group was treated with carbon dioxide laser therapy. Both groups were treated once a week for 3 w. The therapeutic effect, recurrence rate and adverse reactions were compared between the two groups. The cure rate of condyloma acuminatum in the observation group was 86.48 %, which was higher than 54.05 % in the control group, with statistical significance (p<0.05). After follow-up, it was found that the recurrence rate of the observation group (13.51 %) was significantly lower than that of the control group (43.24 %), with statistical significance (p<0.05). The incidence of superficial scar and perianal pain in the observation group was 27.03 % and 21.62 % respectively, which was not significantly different from 35.14 % and 29.73 % in the control group. 5-aminolevulinic acid photodynamic therapy combined with carbon dioxide laser in the treatment of perianal and anal canal condyloma acuminatum has the advantages of good curative effect and low r ecurrence rate, which is worthy of clinical pr omotion.

Unusual Skin Ulcerations in a Patient With Hematochezia

Question: A 31-year-old Hispanic woman with a past medical history of systemic lupus erythematosus, perianal condyloma acuminatum, and chronic iron deficiency anemia who presented with 2 days of palpitations in the setting of 2 months of intermittent hematochezia and multiple painful anogenital and left inframammary skin ulcers. She reports associated chronic foul-smelling perianal discharge, but denies any fever, nausea, vomiting, abdominal or perianal pain, melena, or changes in bowel habits. She had undergone an upper endoscopy and colonoscopy as part of her iron deficiency anemia workup 3 years before presentation, which revealed a normal esophagus, stomach, and duodenum, but had multiple small rectal and sigmoid colon polyps as well as internal and external hemorrhoids.

Radical surgical management of perianal giant condyloma acuminatum of Buschke and Löwenstein: long-term results of 11 cases.

Perianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT. From November 2002 to June 2019, 11 patients (9 men) with a mean age of 33.45 years (range, 19-54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used. Two patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54 ± 1.34 cm (range, 10-26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45 ± 1.75 months (range, 10-196 months). In patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.

Clinical effect of interferon and imiquimod combined with multifunction electric ion in the treatment of perianal condyloma acuminatum

目的 探讨干扰素与咪喹莫特联合多功能电离子治疗肛周尖锐湿疣的临床疗效。 方法 选取华中科技大学同济黄州医院2017年1月至2018年1月收治的肛周尖锐湿疣患者80例为研究对象，采用随机数字表法分为两组。其中对照组40例采用咪喹莫特联合多功能电离子治疗，观察组40例在对照组基础上加用干扰素。治疗2个月后，比较两组患者的总满意率、治疗前后外周T淋巴细胞亚群变化及临床疗效。 结果 观察组患者的总满意率为95.0%(38/40)，高于对照组的82.5%(33/40)，差异有统计学意义(χ2＝6.23，P<0.05)。治疗后两组患者CD3＋、CD4＋及CD4＋/CD8＋等T淋巴细胞亚群均较治疗前改善，且观察组改善情况优于对照组，差异均有统计学意义(均P<0.05)。观察组患者的治愈率为92.5%(37/40)高于对照组的82.5%(33/40)，复发率为20.0%(8/40)低于对照组的32.5%(13/40)，差异均有统计学意义(χ2＝4.28、3.72，P＝0.031、0.028)。 结论 干扰素与咪喹莫特联合多功能电离子治疗肛周尖锐湿疣，可改善患者免疫功能，促进其临床康复，且复发率降低，值得临床借鉴。

Perianal Condyloma Acuminata: Factors that Contribute to the Recurrence

Introduction . Condyloma Acuminata (CA) is the most common sexually transmitted disease caused by HPV with high recurrence rate up to 70%. Factors contribute to the recurrence such as age, site of predilection, previous treatment, HIV infection and sexual behavior were noted in perianal CA. To date the correlation of these factors to the recurrence remains unknown. Method . A cross sectional study was conducted. Patients with history of CA managed in clinic of surgery during period of January 2010 to June 2015 were reviewed. Subject characteristics, i.e. age, infected site, previous treatment, HIV infection and sexual behavior and recurrence were the variables of the study. Data collected from medical record were statistically analyzed. Significant correlation found if p value <0.05. Results. There were 48 subjects with the history of CA. On the analysis, age variable has a significant correlation with the recurrence p = 0.008 (OR = 5.83; 95% CI 1.66–20.56;). The recurrence was higher in productive age compared to non–productive age. Previous anal CA and high risk negative sexual behavior showed a higher recurrence risk than previous non–anal CA and positive sexual behavior (OR = 1.89 and 2.14, respectively). Conclusion. There was significant correlation between age and CA recurrence, anal CA and negative sexual behavior showing 1.89 and 2.14 times, respectively more likely to have recurrence

Clinicopathological Characteristics of High-grade Squamous Intraepithelial Lesions Involving Condyloma Acuminatum.

Severe nuclear atypia can be associated with condyloma acuminatum. In this study, we investigated nine cases of perianal condyloma acuminatum with severe nuclear atypia and determined whether severe nuclear atypia is sufficient for the diagnosis of high-grade squamous intraepithelial lesion (HSIL). The clinical data and pathological features of the nine patients were collected. p16 Immunostaining and human papillomavirus genotyping were also performed. The resected specimens of six men infected with human immunodeficiency virus showed features suggestive of HSIL, including the expansion of basaloid cells, severe nuclear pleomorphism in the lower one-third, bizarre nuclei, mitotic figure in the upper two-thirds, atypical mitosis, block positivity for p16, and high-risk human papillomavirus infection. In contrast, the resected specimens of the remaining three patients did not show any of those HSIL features, even though there were several microscopic foci showing severe nuclear atypia in the upper two-thirds of the papillomatous epithelium. Our observation regarding the occurrence of HSIL involving perianal condyloma acuminatum in human immunodeficiency virus-infected patients suggests that active, complete surgical excision of perianal condyloma acuminatum and a thorough histopathological examination are necessary. The diagnosis of severe nuclear atypia involving the upper two-thirds of the epithelium should be made with great caution.

Efficacy in the use of local anesthesia in patients with surgical intervention for the resolution of anorectal pathologies

A prospective, comparative, longitudinal study was conducted in the period from April 2016 to January 2017 in order to determine the efficacy of local anesthesia for the surgical resolution of anorectal pathologies in surgically operated patients who attended the General University Hospital “Luis Gomez Lopez. Thus, the population was composed of patients with anorectal pathologies of low complexity, with no previous anorectal surgical history (Hemorrhoids, anal fissure, perianal fistula, hypertrophic anal papilla, perianal condyloma acuminata), which were agreed to be included in this study, without contraindications for use of local anesthesia. A non-probabilistic, intentional sample was made up of 30 patients and the anesthetic protocol was administered following an anesthetic protocol of perianal local anesthesia using anesthetic mixture (70% of 2% lidocaine+30% of 0.5% bupivacaine) quantifying pain tolerance during the intraoperative period on the first and fifth postoperative days, as well as any adverse effects. The results were expressed in absolute numbers and percentages; a good tolerance to pain was observed with some differences related to the sex of the individuals studied; no complications were observed.

2세 남아의 항문과 항문주위 첨형 콘딜로마 치험 1례

Abstract Anal and perianal condyloma acuminatum(CA), which is a large ca uliflower-like tumor, is a manifestation of human papillomavirus (HPV) infection. HPV may be acquired via sexual transmission, vertical transmission or nonsexual contact. It is an uncommon condition in children but the incidence in ch ildren has been increasing recently. There are many therapies for CA including chemical or physica l destruction, immunological therapy, or a surgical excision. All these procedures have some degree of limitations such as limited clearance rate, high recurrence rate, pain, bleeding, release of potentially infectious aerosols and scar. It may be traumatic mentally to the children as well as physically. Korean Medicine included herbal treatment and herba l ointment for CA is no pain, and it doesn't need an anesthesia. We present a case of anal and perianal CA in a 2 years old bo y that was treated successfully with Korean Medicine, with no recurrence during the follow up 3 months. Key words : anal and perianal; condyloma acuminatum; children; korean medic ine

Giant Condyloma Acuminatum of Buschke and Lowenstein

A 55-year-old man without HIV infection history, presented with neglected giant peri-anal condyloma acuminatum evolving for more than 10 years. Histologic findings revealed a condyloma acuminatum of Buschke and Lowenstein tumor without verrucous carcinoma. A patient was admitted for radiation therapy in our department. Clinical examination revealed a huge infected mass, cauliflower-like, infiltrating the left buttock and perineum.

Successful Treatment of Anal and Perianal Condyloma Acuminata with Imiquimod

Successful Treatment of Anal and Perianal Condyloma Acuminata with Imiquimod

Management of giant anal condyloma by wide local excision and anoplasty

Treatment of giant condyloma acuminatum, is controversial, especially in human immunodeficiency virus (HIV)-positive patients, owing to concern over wound healing, complications, risk of progression to carcinoma and a high recurrence rate. The aim of this study was to evaluate the outcome after extensive local excision with V-Y anoplasty. Nine patients were identified from a prospective database, six of whom were HIV positive. All patients had a giant perianal condyloma acuminatum extending into the anal canal and perianal region, which required wide excision with V-Y reconstruction. Postoperative complications, recurrence and continence were all determined. Nine patients were included (eight men, median age 40 years), six seropositive for HIV infection. A bilateral V-Y anoplasty was performed in six patients, and unilateral in two. There were no postoperative infections, graft failures or flap necrosis. The mean follow-up was 92 (2-137) months. One patient developed local recurrence treated with excision under local anaesthesia. Extensive local surgery of giant perianal condyloma with anoplastic reconstruction gives good results even in HIV-positive patients.

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.

Correlations between human papillomavirus types and recurrence of perianal and anal condyloma acuminatum among men who have sex with men

Objective To determine the genotypes of human papillomavirus (HPV) and to estimate their correlations with recurrence of perianal and anal condyloma acuminatum (CA) among men who have sex with men (MSM) in Shanghai.Methods Tissue specimens were obtained from the lesions of perianal or anal CA in 57 MSM.Flow-through hybridization and gene chip were used to determine the genotypes of HPV in these specimens.Follow-up was carried out to observe the recurrence of CA in these patients after CO2 laser treatment.Results Of the 57 specimens,56 (98.2％) were positive for HPV,and a total of 11 HPV subtypes were identified.The predominant genotypes were HPV 11 (42 cases,75％ ) and HPV 6 (30 cases,53.6％),sequentially followed by HPV 16 (8 cases,14.3％),HPV 18 (4 cases,7.1％),HPV 33 (2 cases,3.6％),HPV 59(2 cases,3.6％),HPV cp8304 (2 cases,3.6％),HPV 31 (1 case,1.8％) and HPV 35 (1 case,1.8％).Of the HPV-positive specimens,64.3％ (36/56) harbored low risk HPV types (11 and/or 6),and 35.7 ％ (20/56) harbored high risk HPV types.Among the 20 specimens positive for high risk HPV,17 (85％) harbored both low risk- and high risk-HPV genotypes.During the 6-month follow-up after CO2 laser treatment,recurrence was observed in 95％ of patients with high risk HPV and 66.7％ of patients with low risk HPV (P ＜ 0.05).Conclusions Among MSM with perianal and anal CA in Shanghai,the predominant genotypes of HPV are low risk types 11 and 6; high risk HPV infection is usually complicated by low risk HPV infection; the recurrence of CA is higher in patients with high risk HPV than in those with low risk HPV. Key words: Condylomata acuminata; Human papillomavirus; Homosexuality; Male

High resolution anoscopy in a recurrent perianal giant condyloma acuminata after renal transplantation: case report

High resolution anoscopy in a recurrent perianal giant condyloma acuminata after renal transplantation: case report

Treatment of Perianal Condyloma Acuminate with Topical ALA-PDT Combined with Curettage: Outcome and Safety

The purpose of this study was to evaluate the treatment outcome and safety of topical photodynamic therapy (PDT) with aminolevulinic acid (5-ALA) combined with surgical curettage for perianal condyloma acuminata. Condyloma acuminata is the most common sexually transmitted disease, with a high relapse rate, especially in the perianal area. The outcomes of many treatment methods for perianal genital warts are not satisfactory. In this study, 40 cases of perianal condyloma acuminata were treated with topical aminolevulinic acid photodynamic therapy (ALA-PDT) combined with curettage. First, the warts were removed with the patient under local anesthesia. The depth of the ablation and curettage reached the dermal layer. Then, the first session of PDT was performed after 2 days. Ten percent 5-ALA cream was applied to lesional skin with occlusive dressing for a 3-h incubation period and the lesions of warts were irradiated for 10 min by using a 635-nm laser beam of 177 mW/cm(2) intensity. The ALA-PDT was repeated after 1 and 3 weeks. Follow-up evaluation was performed at our outpatient clinic at 1 and 3 months after completion of therapy. Before treatment and at each follow-up visit, the lesions were photographed; the treatment outcome was evaluated as recurrence rate, and patient satisfaction was surveyed. After three PDT sessions following surgical curettage, all 40 patients were cured and there was no recurrence at 1 month off treatment. At 3 months off treatment, six cases relapsed, corresponding to a recurrent rate of 15%. The satisfaction rate of patients was 100% at 1 month and 95% at 3 months after treatment. Combination of surgical curettage and topical PDT has been proven to be a safe and effective procedure, and may offer a wide clinical application for the treatment of perianal condyloma acuminata.

Perianal ulcer - amebiasis cutis

© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2011 JDDG | 2011 (Band 9) Introduction The differential diagnosis of perianal ulcers includes infections, chronic inflammatory bowel diseases, malignancy, and, rarely, immune-related or factitious disorders. We describe a 35-year-old man who, after superficial removal of perianal condyloma acuminata, developed an ulcer at the treated site which progressively grew in size and penetration depth. There was no history of MSM intercourse or overseas travel. The results of a biopsy showed amebae which were identified as Entameba histolytica on PCR. Stool tests revealed the cyst form of the amebae as evidence of intestinal infection. Treatment with systemic and topical metronidazole led to rapid healing of the ulcer. Perianal ulcer – amebiasis cutis

Myiasis arising in condylomata acuminata: an unusual presentation

Myiasis is infestation of skin, mucosa, orifices or natural cavities of humans or animals by larvae of flying dipterous insects that, at least for a certain period of their life cycle, feed from live or necrotic tissue of the host. The distribution is worldwide with more cases being reported from tropical, subtropical and warm temperate areas. This report describes a rare case of perianal condylomata acuminata complicated with myiasis due to Chrysomya bezziana, seen in the presence of poor hygiene in a tropical country with a high fly population.

Randomized placebo-controlled trial on local applications of opioids after hemorrhoidectomy

Hemorrhoidectomy is associated with considerable postoperative pain. This study assessed whether a small dose of morphine or oxycodone administered in the embedded sponge set in the anus at the end of a hemorrhoidectomy intervention reduced postoperative pain. The presence of opioid receptors was assessed in the anal mucosa excised from ten patients with perianal condyloma acuminata and 19 patients with symptomatic third-fourth degree hemorrhoids. A double-blind prospective randomized placebo-controlled trial was then conducted in 135 patients with hemorrhoids. Hemorrhoidectomy patients were randomized to morphine (MG), oxycodone (OG), or control (CG) groups, each patient having an absorbable sponge dressing left in the anus embedded with 1 mg of morphine, 1 mg oxycodone, or vehicle, respectively. The mean time for the first dose of analgesic drugs, the use of analgesics, and the mean time to void bladder was evaluated. The presence of kappa- and delta-opioid receptor immunoreactivity was detected in the anal mucosa excised from patients with perianal condyloma acuminata and hemorrhoids. Furthermore, there was a significant (P < 0.001) upregulation of kappa receptor immunoreactive-like material in hemorrhoidectomy patients. The mean time for the first analgesic administration was significantly increased (P < 0.001) in MG versus CG. A further significant increase (P < 0.001) was observed in the OG patient group. The mean time for voiding was significantly higher in CG when compared to the MG and OG patient groups. The local administration of very low doses of kappa-opioid agonist decreased hemorrhoidectomy postoperative pain through the interaction with specific opioid receptors located on anal mucosa.

Giant Condyloma Acuminatum in an Infant

We report a 10-month-old boy who presented with a giant perianal condyloma acuminatum, and a similar lesion on the neck. These lesions were treated by surgical excision with satisfactory results. This size, extent, and early age of appearance make this case highly unusual.

A Surgical Approach to Anogenital Buschke Loewenstein Tumours (Giant Condyloma Acuminata)

Background: Condyloma acuminata are anogenital warts caused by human papillomavirus (HPV). Neglected giant peri-anal condyloma acuminata (Buschke Loewenstein Tumours) require major surgical procedures. This report reflects our experience concerning the aggressive surgical approach to this rarely presented type of condyloma acuminata.Methods: The medical records of five patients, who had been surgically treated following the diagnosis of giant perianal condyloma acuminata between April, 1996 and September, 2003 were reviewed and evaluated retrospectively. Full thickness tumour and skin excisions were performed followed by delayed split thickness skin graftings in all patients. Results: Five patients (3 men, 2 women) who suffered from giant condyloma acuminata lesions obliterating the anal canal were evaluated. The mean age was 36.5 years (range: 24–52). All patients underwent total surgical excisions. The wounds were left open for secondary healing, and following a mean time period of 35 days, split thickness skin graftings were performed. The histopathologic examinations of the specimens of these five patients did not reveal any malignant transformations. No recurrences were detected at the end of a mean follow-up period of 22 months and all patients were considered to be disease-free at the end of their long-term 5-year follow-up periods.Conclusions: Peri-anal condyloma acuminatum is usually a benign disease, but may grow locally to an excessive extent, developing into a Buschke Loewenstein Tumour, and may cause serious peri-anal hygiene problems. Even though the incidence of malignant transformation is rare, there is always a risk of this complication occurring. Transmission of the disease to other sexual partners is another point of concern. Therefore, this disease must be treated aggressively with total surgical excision. The results of our surgical treatment methods are satisfactory.