Grosu-Bularda Andreea, Hariga Cristian-Sorin, Dumitru Catalina-Stefania, Calcaianu Nicolae, Creanga Cosmin-Antoniu, Enache Valentin, Tache Silvia-Elena, Bordeanu-Diaconescu Eliza-Maria, Ratoiu Vladut-Alin, Teodoreanu Razvan-Nicolae, Lascar Ioan
Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.
Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.
J Pers Med. 2024 Aug 22;14(8):887. doi: 10.3390/jpm14080887.
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-Löwenstein瘤（BLT），也称为巨大尖锐湿疣，是一种罕见的外生性肿瘤，由先前存在的与人类乳头瘤病毒（HPV）感染相关的疣状病变引起，尤其是6型和11型毒株，它们被认为致癌潜力较低。BLT表现为巨大的菜花状肿物，通常累及阴茎、外阴、阴道、会阴、阴囊、肛门和肛周区域。尽管是良性病变，但BLT具有局部侵袭性且复发率高，并可能恶变为鳞状细胞癌，总体死亡率为20%-30%。主要治疗方法是广泛切缘的完整手术切除，常常需要复杂的重建技术来覆盖缺损。我们报告了一名68岁、有多种合并症的患者，其生殖器区域有一个巨大外生性肿瘤，累及阴茎，病史两年，伴有进行性勃起功能障碍和排尿问题。肿瘤在保证肿瘤学安全切缘的情况下进行了手术切除，并使用阴囊和完整阴茎皮肤的推进皮瓣和旋转皮瓣进行了重建。组织病理学检查确诊为巨大尖锐湿疣（Buschke-Löwenstein瘤），表现为棘层肥厚、乳头瘤样增生、角化不全和凹空细胞聚集，p16、p63和ki67免疫组化染色呈阳性。术后，患者临床结局良好，实现了手术完全治愈。鉴于巨大尖锐湿疣有局部侵袭的可能性并对患者生活质量有重大影响，该病例突出了对其进行及时干预和综合管理策略的迫切需求。早期诊断和彻底的手术切除对于有效管理以及降低与此病相关的高复发率、发病率和恶变风险至关重要。
