Gonçalves Raquel, Garrido Isabel, Coelho Rosa, Coelho Rita, Lopes José, Macedo Guilherme
Gastroenterology Department, São João Local Health Center, Porto, Portugal.
World Gastroenterology Organization Training Center, Porto, Portugal.
GE Port J Gastroenterol. 2025 Jun 10. doi: 10.1159/000546859.
Giant condyloma acuminatum, known as Buschke-Löwenstein tumor, is a rare benign tumor. Several risk factors are described, including immunosuppression, diabetes, tobacco use, and multiple sexual partners. About 90% of cases are associated with human papillomavirus infection. Given the rarity of this lesion, there are still no established guidelines for the assessment and treatment of this tumor. The most reported and consensus approach described in the literature is surgical intervention.
We report a case of a 32-year-old man who was immunosuppressed following a lung transplant due to cystic fibrosis. He also had stage IV chronic kidney disease and chronic pancreatitis. The patient was evaluated in a proctology consultation due to complaints of itching, perianal pain, and constipation with a 4-month history. Clinical examination showed a cauliflower-like, papillomatous tumor measuring 9 cm along the perianal area with other surrounding smaller lesions. The evaluation of immunodeficiency virus, hepatitis C virus, hepatitis B virus and syphilis was negative. The patient denied engaging in receptive anal sex and other risky sexual behaviors. A macro biopsy of the lesion was performed, and the histopathological examination revealed an anal condyloma acuminatum, with no signs of malignancy. Therapy with imiquimod was initiated for several weeks, with no significant reduction in lesion size. In a multidisciplinary discussion, it was decided to start neoadjuvant chemoradiotherapy with capecitabine and mitomycin. After 5 months of treatment, a significant reduction in lesion size was observed with significant clinical improvement. Currently, the patient has no proctological symptoms and no need for analgesia.
巨大尖锐湿疣，即Buschke-Löwenstein肿瘤，是一种罕见的良性肿瘤。已描述了多种危险因素，包括免疫抑制、糖尿病、吸烟和多个性伴侣。约90%的病例与人乳头瘤病毒感染有关。鉴于这种病变的罕见性，目前仍没有针对该肿瘤评估和治疗的既定指南。文献中报道最多且达成共识的方法是手术干预。
我们报告一例32岁男性病例，该患者因囊性纤维化接受肺移植后出现免疫抑制。他还患有IV期慢性肾病和慢性胰腺炎。患者因瘙痒、肛周疼痛和便秘4个月的主诉接受了直肠科会诊评估。临床检查显示沿肛周区域有一个菜花状、乳头状肿瘤，大小为9厘米，周围还有其他较小的病变。免疫缺陷病毒、丙型肝炎病毒、乙型肝炎病毒和梅毒的评估均为阴性。患者否认有接受肛交及其他危险性行为。对病变进行了大块活检，组织病理学检查显示为肛门尖锐湿疣，无恶性迹象。开始使用咪喹莫特治疗数周，病变大小无明显缩小。在多学科讨论后，决定开始使用卡培他滨和丝裂霉素进行新辅助放化疗。治疗5个月后，观察到病变大小显著缩小，临床症状明显改善。目前，患者无直肠科症状，无需止痛。
