Buschke-Löwenstein Tumor in HIV-Positive Patient, Surgically Treated by V-Y Advancement Flap, Case Report and Review of the Literature
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Abstract
Introduction: Buschke-Löwenstein tumor (BLT), known as giant condyloma acuminatum, is a sexually transmitted disease associated with human papillomavirus (HPV), mainly genotypes 6 and 11. The frequency of occurrence is rare and it is mainly located in the external genitalia and perineal region.
Among the risk factors associated with this tumor are immunosuppression, alcoholism, smoking, the presence of genital infections, among others. Histologically, the distinctive feature of BLT is the lack of involvement of the basement membrane; however, it is said that this tumor presents mixed characteristics of squamous cell carcinoma and condyloma acuminatum.
Clinically it manifests as a slow growing tumor, pain, itching and tends to present ulcerations, fistulas or bleeding as well as high risk of recurrence. Surgical resection with free margins and reconstruction is the gold standard of treatment, however there are multiple options and treatment must be individualized, taking into account the risk of recurrence and cancerous progression to squamous cell carcinoma.
Case presentation: We present the case of a 24 year old male patient, HIV positive, with a giant condyloma acuminatum in the perianal region, affecting the anal canal and gluteal folds. Surgical resection of the tumor was performed with bilateral V-Y advancement flap reconstruction in both gluteal folds. The postoperative period was managed without serious complications and the patient showed a favorable evolution.
Conclusion: Although surgical resection with reconstruction is the gold standard for the treatment of Buschke-Löwenstein tumor, treatment must be individualized due to the rarity of this pathology, especially in immunocompromised patients. In our case, the patient was treated by resection and V-Y advancement flap, achieving recovery without major complications.
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References
I. Purzycka-Bohdan D, Nowicki RJ, Herms F, Casanova JL, Fouéré S, Béziat V. The Pathogenesis of Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor): An Overview. Int J Mol Sci. 2022 Apr 20;23(9):4547.
II. Sandoval I, Hernández R, Torres E, Yanque O. Giant condylomata acuminata of Buschke-Lowenstein. J Obstet Gynaecol (Lahore). 2020 May 18;40(4):582-3.
III. Squamous cell carcinoma of perineal area developed from the Buschke-Löwenstein tumor. Folia Med Cracov. 2023 Oct 23;
IV. Taskin OC, Pehlivanoglu B, Reid MD, Friedman T, Lee M, Tadros TS, et al. Löwenstein-buschke: clinicopathologic analysis of 78 cases of large and giant condyloma acuminata of the anus. Turkish Journal of Pathology. 2020;
V. Kowo M, Nzoume Nsope Mengang JM, Simeni Njonnou SR, Kouotou EA, Atangana PJA, Ankouane Andoulo F. Giant anogenital tumor of Buschke-Löwenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report. J Med Case Rep. 2022 Dec 18;16(1):116.
VI. Monteiro D, Varejão AM, Sampaio J, Rodrigues M. Vulvar condyloma of Buschke and Löwenstein: an unusual tumour in developed countries. BMJ Case Rep. 2022 Jun 7;15(6):e250273.
VII. Kabila B, Imrani K, Kaddouri S, Boujida I, Zouaidia F, Billah NM, et al. Buschke-Lowenstein tumor in the penis and anorectal region: case report. Oxf Med Case Reports. 2024 Apr 1;2024(4).
VIII. Kordeva S, Pidakev I, Tchernev G. Fine scalpel surgery: preserving the dartos muscle in a patient with scrotal and perigenital giant Buschke-Löwenstein tumors. Wien Med Wochenschr. 2024 Apr 8;
IX. Ajagbe OA, Ayandipo OO, Afuwape OO, Idowu OK, Adeleye AO, Ogundiran TO. Surgical treatment of perineal giant condylomata acuminata (Buschke Lowenstein tumor): Case series from a developing country. Int J Surg Case Rep. 2024 Aug;121:109994.
X. Mihailov R, Tatu AL, Niculet E, Olaru I, Manole C, Olaru F, et al. Surgical Management of Perianal Giant Condyloma Acuminatum of Buschke and Löwenstein: Case Presentation. Life (Basel). 2023 Sep 15;13(9).
XI. Manlubatan SIT, Onglao MAS, Tampo MMT, Lopez MPJ. Outcomes of surgical management of buschke-lowenstein tumor in a Philippine tertiary hospital. Ann Coloproctol. 2022 Feb 28;38(1):82-7.
XII. Yildiz A, Leventoglu S, Yildiz A, Inan A, Mentes BB. Radical surgical management of perianal giant condyloma acuminatum of Buschke and Löwenstein: long-term results of 11 cases. Ann Coloproctol. 2023 Jun;39(3):204-9.
XIII. Govindaraj R, Govindaraj S. A perianal conundrum and its management: chondyloma versus carcinoma. Int J Surg Case Rep. 2023 Feb;103:107864.
XIV. Arwini B, Tam IS, Al-Agha O, Lee JS. Clinical Conundrum: A Case of Cervical Giant Condyloma Acuminatum. J Obstet Gynaecol Can. 2022 Mar;44(3):294-7.
XV. Balogh N, Kolozsi P, Tóth D. A rare malignancy: A case report of early progression of anal Buschke-Löwenstein tumor into squamous cell carcinoma in an immunocompetent patient. Int J Surg Case Rep. 2024 Jun;119:109715.
XVI. Purzycka-Bohdan D, Szczerkowska-Dobosz A, Swiatecka-Czaj J, Peksa R, Urban M, Szczypior M, et al. Buschke-Löwenstein tumour associated with low-risk human papillomavirus genotypes successfully treated surgically. Advances in Dermatology and Allergology. 2019;36(1):112-4.
XVII. Nieves-Condoy JF, Acuña-Pinzón CL, Chavarría-Chavira JL, Hinojosa-Ugarte D, Zúñiga-Vázquez LA. Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage. Infect Dis Obstet Gynecol. 2021 Jun 30;2021:1-5.
XVIII. Boda D, Cutoiu A, Bratu D, Bejinariu N, Crutescu R. BuschkeLöwenstein tumors: A series of 7 case reports. Exp Ther Med. 2022 Apr 13;23(6):393.
XIX. Labon M, Czajkowski M, Matuszewski M. Penile Buschke-Lowenstein tumor in HCV patient. Urol Case Rep. 2024 Jul;55:102758.
XX. Costa Almeida CE, Azevedo J, Botelho I, Vilaça J. Buschke-Löwenstein tumour: a rare and challenging entity. BMJ Case Rep. 2021 Sep 16;14(9):e244192.
XXI. Davis KG, Barton JS, Orangio G, Bivin W, Krane S. Buschke-Lowenstein Tumors: A Review and Proposed Classification System. Sex Transm Dis. 2021 Dec;48(12):e263-8.
XXII. McBride AA. Human papillomaviruses: diversity, infection and host interactions. Nat Rev Microbiol. 2022 Feb 14;20(2):95-108.
XXIII. Yuan Y, Cai X, Shen F, Ma F. HPV post-infection microenvironment and cervical cancer. Cancer Lett. 2021 Jan;497:243-54.
XXIV. Ajila V, Shetty H, Babu S, Shetty V, Hegde S. Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck. J Sex Transm Dis. 2015 Sep 21;2015:1-5.
XXV. Akinboro AO, Onayemi O, Mejiuni AD. Frequency, pattern, and extent of skin diseases in relation to CD 4+ cell count among adults with human immunodeficiency virus infection or acquired immunodeficiency syndrome in Osogbo, southwestern Nigeria. Int J Dermatol. 2014 Apr 29;53(4):416-24.