ONLINE IMAGES
IN THE
MEDICAL SCIENCES
Buschke-Lowenstein Tumor René Rodríguez-Gutiérrez, MD,* Mario Rodarte-Shade, MD, Gloria González-Saldivar, MD and Jose Gerardo González-González, MD, PhD *Endocrinology Division, Internal Medicine Department, University Hospital, The Autonomous University of Nuevo León, Monterrey, México (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
CASE PRESENTATION
n 18-year-old man with a history of Human Immunodeficiency Virus infection presented to our clinic with a perianal mass. He was recently diagnosed with Human Immunodeficiency Virus and had never been on antiretroviral therapy. Physical examination revealed a foul-smelling 25 3 15 cm verrucous cauliflower-like ulcerated mass originating from the perianal skin (Figure 1). Wide surgical excision was performed. Histologic examination revealed squamous epithelial verrucous proliferation with marked papillomatosis and acanthosis. Tumor cells exhibited vacuolized cytoplasm with irregular and large nuclei consistent with koilocytes. No atypia or dysplasia was found at the histologic examination. These findings were consistent with a giant condyloma acuminata also known as Buschke-Lowenstein tumor. Adjuvant treatment with topical imiquimod was started with no evidence of recurrence at 6-month follow-up. First described in 1896, the Buschke-Lowenstein tumor is a very rare (less than 100 cases) giant condyloma acuminata, which usually appears at the anogenital region.1,2 One of the hallmarks of this disease is its invasive growth capacity with high recurrences rates after resection (66%) and an elevated incidence of malignant transformation (56%) into an invasive squamous cell carcinoma.3 Most commonly, it has been associated with human papillomavirus types 6 and 11 and less The American Journal of the Medical Sciences
frequently with types 16 and 18.4 The optimal strategy for this disease has not been completely defined; however, complete wide local excision remains the treatment of choice along with several therapeutic strategies such as topical agents (podophyllin, 5-fluorouracil, bleomycin, interferon and imiquimod) or systemic therapy with chemotherapy and/or radiotherapy.5 REFERENCES 1. Steffen C. The men behind the eponym—Abraham Buschke and Ludwig Lowenstein: giant condyloma (Buschke-Loewenstein). A J Dermatopathol 2006;28:526–36. 2. Buschke A. Condylomata acuminata in Neisser, A (ed): Stereoscopischer Medicinischer Atlas. Kassel, Germany, T Fischer, 1896, plate 61. 3. Lee PK, Wilkins KB. Condyloma and other infections including human immunodeficiency virus. Surg Clin North Am 2010;90:99–112. 4. Chu QD, Vezeridis MP, Libbey NP, et al. Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions: analysis of 42 cases. Dis Colon Rectum 1994;37:950. 5. Gholam P, Enk A, Hartschuh W. Succesful surgical management of giant condyloma acuminatum (Buschke-Lowenstein) in the genitoanal region: a case report and evaluation of current therapies. Dermatology 2009;218:56–9.
Volume 349, Number 1, January 2015
e1
IN THE
MEDICAL SCIENCES
Buschke-Lowenstein Tumor René Rodríguez-Gutiérrez, MD,* Mario Rodarte-Shade, MD, Gloria González-Saldivar, MD and Jose Gerardo González-González, MD, PhD *Endocrinology Division, Internal Medicine Department, University Hospital, The Autonomous University of Nuevo León, Monterrey, México (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
CASE PRESENTATION
n 18-year-old man with a history of Human Immunodeficiency Virus infection presented to our clinic with a perianal mass. He was recently diagnosed with Human Immunodeficiency Virus and had never been on antiretroviral therapy. Physical examination revealed a foul-smelling 25 3 15 cm verrucous cauliflower-like ulcerated mass originating from the perianal skin (Figure 1). Wide surgical excision was performed. Histologic examination revealed squamous epithelial verrucous proliferation with marked papillomatosis and acanthosis. Tumor cells exhibited vacuolized cytoplasm with irregular and large nuclei consistent with koilocytes. No atypia or dysplasia was found at the histologic examination. These findings were consistent with a giant condyloma acuminata also known as Buschke-Lowenstein tumor. Adjuvant treatment with topical imiquimod was started with no evidence of recurrence at 6-month follow-up. First described in 1896, the Buschke-Lowenstein tumor is a very rare (less than 100 cases) giant condyloma acuminata, which usually appears at the anogenital region.1,2 One of the hallmarks of this disease is its invasive growth capacity with high recurrences rates after resection (66%) and an elevated incidence of malignant transformation (56%) into an invasive squamous cell carcinoma.3 Most commonly, it has been associated with human papillomavirus types 6 and 11 and less The American Journal of the Medical Sciences
frequently with types 16 and 18.4 The optimal strategy for this disease has not been completely defined; however, complete wide local excision remains the treatment of choice along with several therapeutic strategies such as topical agents (podophyllin, 5-fluorouracil, bleomycin, interferon and imiquimod) or systemic therapy with chemotherapy and/or radiotherapy.5 REFERENCES 1. Steffen C. The men behind the eponym—Abraham Buschke and Ludwig Lowenstein: giant condyloma (Buschke-Loewenstein). A J Dermatopathol 2006;28:526–36. 2. Buschke A. Condylomata acuminata in Neisser, A (ed): Stereoscopischer Medicinischer Atlas. Kassel, Germany, T Fischer, 1896, plate 61. 3. Lee PK, Wilkins KB. Condyloma and other infections including human immunodeficiency virus. Surg Clin North Am 2010;90:99–112. 4. Chu QD, Vezeridis MP, Libbey NP, et al. Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions: analysis of 42 cases. Dis Colon Rectum 1994;37:950. 5. Gholam P, Enk A, Hartschuh W. Succesful surgical management of giant condyloma acuminatum (Buschke-Lowenstein) in the genitoanal region: a case report and evaluation of current therapies. Dermatology 2009;218:56–9.
Volume 349, Number 1, January 2015
e1
