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Hsu FC, Yu DS, Pu TW, Wu MJ, Meng E. Unusual presentation of penile giant condyloma acuminatum with spontaneous prepuce perforation: A case report. World J Clin Cases 2023; 11:7107-7112. [PMID: 37946780 PMCID: PMC10631422 DOI: 10.12998/wjcc.v11.i29.7107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Giant condyloma acuminatum (GCA) is an uncommon condition affecting the anogenital area. CASE SUMMARY Here, we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft, pubis region, and groin as well as urine leakage along the distal penile shaft. Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base, which was initially suspected to be a urethral fistula. However, during surgery, it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening, with infection and high pressure causing subsequent skin perforation. He underwent circumcision and wide excision with electrocauterization of the warts. He was discharged after the surgery, and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil. CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.
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Affiliation(s)
- Fu-Chieh Hsu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - Min-Jui Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114024, Taiwan
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Mihailov R, Tatu AL, Niculet E, Olaru I, Manole C, Olaru F, Mihailov OM, Guliciuc M, Beznea A, Bușilă C, Candussi IL, Moroianu LA, Stănculea FC. Surgical Management of Perianal Giant Condyloma Acuminatum of Buschke and Löwenstein: Case Presentation. Life (Basel) 2023; 13:1916. [PMID: 37763319 PMCID: PMC10532963 DOI: 10.3390/life13091916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The Buschke-Löwenstein tumor (BLT) is an uncommon sexually transmitted ailment attributed to the human papillomavirus (HPV)-usually the 6 or 11 type (90%)-with male predominance and an overall infection rate of 0.1%. BLT or giant condyloma acuminatum is recognized as a tumor with localized aggressiveness, displaying distinctive features: the potential for destructive growth, benign histology, a rate of 56% malignant transformation, and a high rate of recurrence after surgical excision. There are several treatment choices which have been tried, including laser, cryotherapy, radiotherapy, electrocoagulation, immunotherapy, imiquimode, sincatechins, intralesional injection of 5-fluoruracil (5-FU), isolated perfusion, and local or systemic chemotherapy. In the case of an extensive tumor, preoperative chemotherapy or radiotherapy is used for tumor shrinkage, making the debulking procedure safer. HPV vaccines significantly decrease the incidence of genital warts, also decreasing the risk of BLT; HPV-6 and HPV-11 are included in these vaccines. MATERIALS AND METHODS We present a 53-year-old heterosexual man, hospitalized in our department in June 2021 with a typical cauliflower-like tumor mass involving the perianal region, which progressively increased in size for almost 7 years. The perianal mass was completely removed, ensuring negative surgical margins. The large perianal skin defect which occurred was reconstructed with fascio-cutaneous V-Y advancement flap. There was no need for protective stoma. The literature review extended from January 1980 and December 2022, utilizing Pubmed and Google Scholar as search platforms. RESULTS Due to the disease's proximity to the anal verge and the limited number of reported cases, arriving at a definitive and satisfactory treatment strategy becomes challenging. The optimal approach entails thorough surgical removal of the lesion, ensuring well-defined surgical margins and performing a wide excision to minimize the likelihood of recurrence. In order to repair the large wound defects, various rotation or advancement flaps can be used, resulting in reduced recovery time and a diminished likelihood of anal stricture or other complications. Our objective is to emphasize the significance of surgical excision in addressing BLT through the presentation of a case involving a substantial perianal condyloma acuminatum, managed successfully with complete surgical removal and the utilization of a V-Y advancement flap technique. In the present case, after 5 months post operation, the patient came back with a buttock abscess, which was incised and drained. After another 5 months, the patient returned for difficult defecation, with an anal stenosis being diagnosed. An anal dilatation and sphincterotomy were carried out, with good postoperative results. CONCLUSIONS The surgical management of Buschke-Löwenstein tumors needs a multidisciplinary team with specialized expertise. The reconstruction techniques involved can be challenging and may introduce additional complications. We consider aggressive surgery, which incorporates reconstructive procedures, as the standard treatment for Buschke-Löwenstein tumors. This approach aims to achieve optimal surgical outcomes and prevent any recurrence.
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Affiliation(s)
- Raul Mihailov
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Alin Laurențiu Tatu
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Dermatology Department, Saint Parascheva Infectious Diseases Clinical Hospital, 800179 Galați, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research Center (MICDIR), “Dunărea de Jos” University of Galați, 800201 Galați, Romania
| | - Elena Niculet
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Iulia Olaru
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Corina Manole
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Florin Olaru
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Oana Mariana Mihailov
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
| | - Mădălin Guliciuc
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Adrian Beznea
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- Clinical Emergency County Hospital Sf. Ap. Andrei, 800578 Galați, Romania; (I.O.); (F.O.)
| | - Camelia Bușilă
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Iuliana Laura Candussi
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
- ‘Sf. Ioan’ Clinical Hospital for Children, 800487 Galati, Romania
| | - Lavinia Alexandra Moroianu
- Faculty of Medicine and Pharmacy, Dunărea de Jos University, 800008 Galati, Romania; (R.M.); (A.L.T.); (E.N.); (A.B.); (C.B.); (I.L.C.); (L.A.M.)
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Riethmuller D, Buisson A, Thong Vanh C, Istasse F, Valmary-Degano S, Michy T, Hoffmann P. [Giant condyloma acuminatum in pregnancy]. ACTA ACUST UNITED AC 2021; 50:201-204. [PMID: 34403829 DOI: 10.1016/j.gofs.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Indexed: 10/20/2022]
Abstract
Buschke Lownestein's tumour is a giant acuminate condyloma characterised by its degenerative potential, its invasive nature and its recurrence after treatment. It is a rare condition, transmitted mainly by sexual transmission and induced by to the human papillomavirus (HPV). The discussion will be illustrated by a clinical case The treatment is still under discussion but surgery seems to be the best option. Management during pregnancy is more complex since it must take into account the mother and her fetus. The delivery route is still debated. The post-treatment evolution was satisfactory and without recurrence until the delivery which, due to the antecedent of 3 caesarean sections, was carried out by cesarean section. HPV vaccination, sex education and early treatment of condyloma lesions should prevent and in any case improve the prognosis of this disease.
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Affiliation(s)
- D Riethmuller
- Département de GO et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France.
| | - A Buisson
- Service d'anatomie et cytologie pathologique, département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France
| | - C Thong Vanh
- Service d'anatomie et cytologie pathologique, département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France
| | - F Istasse
- Service d'anatomie et cytologie pathologique, département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France
| | - S Valmary-Degano
- Service d'anatomie et cytologie pathologique, département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France
| | - T Michy
- Service d'anatomie et cytologie pathologique, département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France
| | - P Hoffmann
- Service d'anatomie et cytologie pathologique, département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble Alpes, 38700 La Tronche, France
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Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage. Infect Dis Obstet Gynecol 2021; 2021:9919446. [PMID: 34305393 PMCID: PMC8266468 DOI: 10.1155/2021/9919446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
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.
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Palma S, Gnambs T, Crevenna R, Jordakieva G. Airborne human papillomavirus (HPV) transmission risk during ablation procedures: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2021; 192:110437. [PMID: 33181134 DOI: 10.1016/j.envres.2020.110437] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Human Papillomavirus (HPV) is associated with development of oropharyngeal cancer. Aim of this review was to assess airborne transmission risk of infectious particles from HPV lesions to airway mucosa of medical staff during established ablation procedures. METHODS A systematic review of human and animal studies, published before 09/2020, relevant to airborne HPV transmission. Controlled studies reporting prevalence of HPV-associated upper airway (nasal/oral/pharyngeal) disease in staff performing ablation procedures (laser, loop electrosurgical excision [LEEP], cryosurgery) on HPV lesions were included in meta-analysis. Additionally, we aimed for a comprehensive systematic overview of studies regarding occupational risk of airborne HPV transmission and safety measures during ablation procedures. RESULTS A total of n = 30 original studies report outcomes related to HPV transmission risk in medical staff conducting ablation procedures. HPV DNA detection in ablation smoke (n = 7), matching HPV genotypes on ablated HPV lesions and face/airways of medical staff after ablation (n = 2), and evidence for infectivity of papillomavirus in ablation smoke (n = 3, animal models only) were reported. Three case reports describe occupational HPV disease of upper airway mucosa. Three controlled studies assessed warts (in CO2 laser-users only); when pooling all controls (general population, non-laser users), nasal/oral/pharyngeal lesion sites were more common amongst laser-users (OR = 5.75; 95%CI[1.55, 21.38]; p < .001). DISCUSSION Airborne HPV dispersal with matching "high-risk" HPV-genotypes in airways of medical staff after ablations (LEEP and CO2-laser) and cases of HPV-associated upper airways neoplasms based on exposure to laser and LEEP smoke are documented. Upper airway mucosa is a more common anatomical site for warts in CO2 laser users compared to controls. Simple safety measures greatly reduce HPV contamination and transmission risk.
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Affiliation(s)
- Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Timo Gnambs
- Leibniz Institute for Educational Trajectories, Wilhelmsplatz 3, 96047, Bamberg, Germany; Institute for Education and Psychology, Johannes Kepler University of Linz, Altenbergerstrasse 69, A-4040, Linz, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
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Vulvar Verrucous Carcinoma and Genital Condylomatosis. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:602-607. [PMID: 35444823 PMCID: PMC8987464 DOI: 10.12865/chsj.47.04.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/20/2021] [Indexed: 11/04/2022]
Abstract
Verrucous carcinoma is a histopathological type of well-differentiated squamous cell carcinoma, clinically characterized by slow and continuous growth, having a local destructive character, but low metastasis potential. Condyloma acuminatum is a sexually transmitted infection caused mainly by subtypes 6 and 11 of HPV, with subtypes 16, 18 being involved in malignant transformation. We present the case of a 70-year-old woman, hospitalized for a vulvar and perineal vegetative, ulcerated, bleeding tumor, with onset 20 years ago. The therapeutic option was surgical excision of the lesions and long-term oncological monitoring.
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Cui T, Huang J, Lv B, Yao Q. Giant condyloma acuminatum in pregnancy: A case report. Dermatol Ther 2019; 32:e12972. [PMID: 31141268 PMCID: PMC6771555 DOI: 10.1111/dth.12972] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 01/01/2023]
Abstract
The giant condyloma acuminatum (GCA), also known as Buschke-Löwenstein tumor (BLT), is a type of human papilloma virus-associated sexually transmitted infection. Treatment options for condyloma acuminatum remain controversial, but surgery seems to be the best option. The management of GCA during pregnancy is more complicated since one has to evaluate the condition of both the mother and the fetus. In this report, we presented a GCA case in a pregnant woman with giant masses that covered the perineal and perianal region. Considering the gestational age and the fetal neurological risk from the anticipated lengthy procedure of mass removal surgery for tumor of this size, we decided to resect the tumor 2 weeks after the infant was delivered via C-section.
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Affiliation(s)
- Tao Cui
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jingwen Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Bin Lv
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Qiang Yao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Meng X, Li Y, Luan H, Shi X. Therapeutic effect of photodynamic therapy combined with imiquimod in the treatment of anal condyloma acuminatum and its effect on immune function. Exp Ther Med 2018; 16:3909-3912. [PMID: 30344668 PMCID: PMC6176148 DOI: 10.3892/etm.2018.6676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/17/2018] [Indexed: 11/06/2022] Open
Abstract
Therapeutic effect of photodynamic therapy combined with imiquimod in the treatment of anal condyloma acuminatum (CA) was investigated to explore its effect on immune function. A total of 104 patients with anal CA were randomly divided into two groups: Patients in the study group were treated with photodynamic therapy combined with imiquimod, and ii) patients in the control group were treated with recombinant human interferon α-2b cream. Clinical efficacy and immune function related indicators were compared between the two groups. After treatment for 6 weeks, the cure rate and total effective rate of study group was 53.85 and 92.31%, respectively, which were significantly higher than those of the control group (30.77 and 75.00%, P<0.05). Recurrence rate of study group was 3.85% within 6 months after treatment, which was significantly lower than that of the control group (19.23%, P<0.05). After treatment, levels of CD4+, CD4+/CD8+ and IFN-γ in the study group were significantly higher than those in the control group, and levels of CD8+, IL-4 and IL-10 in the study group were significantly lower than those in the control group (P<0.05). Photodynamic therapy combined with imiquimod in the treatment of anus CA can regulate T lymphocyte subsets and cytokine levels, enhance immune function, improve clinical efficacy, reduce recurrence rate, and have almost no side effects. Therefore, this treatment should be popularized in clinical practice.
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Affiliation(s)
- Xianmin Meng
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.,Affiliated Hospital of Taishan Medical University, Tai'an, Shandong 271000, P.R. China
| | - Yongguo Li
- Affiliated Hospital of Taishan Medical University, Tai'an, Shandong 271000, P.R. China.,Department of Stomatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Hong Luan
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.,Affiliated Hospital of Taishan Medical University, Tai'an, Shandong 271000, P.R. China
| | - Xiuyan Shi
- Department of Dermatology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China.,Affiliated Hospital of Taishan Medical University, Tai'an, Shandong 271000, P.R. China
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Venter F, Heidari A, Viehweg M, Rivera M, Natarajan P, Cobos E. Giant Condylomata Acuminata of Buschke-Lowenstein Associated With Paraneoplastic Hypercalcemia. J Investig Med High Impact Case Rep 2018; 6:2324709618758348. [PMID: 29479542 PMCID: PMC5818086 DOI: 10.1177/2324709618758348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/13/2018] [Indexed: 01/22/2023] Open
Abstract
Low-risk human papillomavirus types 6 and 11 can manifest as giant condylomata acuminata (GCA) of Buschke-Lowenstein. Up to 50% of GCA can slowly progress over years to fungating, invasive tumors. The malignant potential is attributed to unique immune evading abilities of the human papillomavirus. A 42-year-old male presented with pain and foul-smelling discharge from his genital warts. The histopathological examination of the mass showed invasive squamous cell carcinoma, and it was associated with paraneoplastic hypercalcemia. The timely removal of long-standing GCA in order to prevent a carcinomatous transition is a priority.
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