A Case of the Giant Buschke — Loewenstein Tumour

Introduction. The Buschke — Loewenstein tumour was described for the first time in 1925 as a rare giant condyloma. The main cause of this pathology is the human papillomavirus, which is introduced into the body under certain conditions. This pathogen can be transmitted sexually. The neoplasm is usually localised in the anogenital region. Malignant transformation and its spread to the penis are even more rare.

Aims. The Buschke — Loewenstein tumour is a rare pathology, whose course and treatment features are of considerable interest to urologists.

Materials and methods. This article presents a clinical case of the malignant giant Buschke — Loewenstein tumour with primary localisation on the anterior abdominal wall and spreading to the genitals of a 42-year-old man without accompanying immunodeficiency or urogenital infections. The anamnesis of the gradually progressive disease in the absence of any treatment was more than 10 years. When preoperative cytological examination of the biopsy did not reveal signs of malignant transformation, the patient underwent simultaneous removal of all neoplasm foci and reconstructive plastic surgery using skin grafts.

Results and Discussion. The foci of the tumour were removed entirely without disturbing surgical boundaries. A postoperative histological examination revealed small foci of squamous cell carcinoma in remote tissues. A postoperative observation conducted six months following surgery revealed no signs of recurrence of the disease.

Conclusion. Buschke-Loewenstein tumours are rarely accompanied by malignancy. Nevertheless, oncological vigilance forms a necessary element of postoperative procedures. Following removal of a large neoplasm, the choice of reconstructive plastic surgery is of particular significance for postoperative quality of life. For the prevention of relapse, it is advisable to conduct immunotherapy in the postoperative period.

1. Spinu D., Rădulescu A., Bratu O., Checheriţă I.A., Ranetti A.E., Mischianu D. Giant condyloma acuminatum — Buschke — Lowenstein disease — a literature review. Chirurgia (Bucur). 2014;109(4): 445–50. PMID: 25149605

2. Agarwal S., Nirwal G.K., Singh H. Buschke — Lowenstein tumour of glans penis. Int J Surg Case Rep. 2014;5(5):215–8. DOI: 10.1016/j.ijscr.2014.01.023

3. Indinnimeo M., Impagnatiello A., D’Ettorre G., Bernardi G., Moschella C.M., Gozzo P. et al. Buschke — Lowenstein tumor with squamous cell carcinoma treated with chemo-radiation therapy and local surgical excision: report of three cases. World J Surg Oncol. 2013;11:231. DOI: 10.1186/1477-7819-11-231

4. Buschke A., Lowstein L. Uber carcinomahnliche condylomata acuminata des penis. Klin Wochenschr. 1925;4:1726–8. DOI: 10.1007/BF01728480

5. Safi F., Bekdache O., Al-Salam S., Alashari M., Mazen T., El-Salhat H. Management of peri-anal giant condyloma acuminatum — a case report and literature review. Asian J Surg. 2013;36(1):43–52. DOI: 10.1016/j.asjsur.2012.06.013

6. Kim H.G., Kesey J.E., Griswold J.A. Giant anorectal condyloma acuminatum of Buschke — Löwenstein presents difficult management decisions. J Surg Case Rep. 2018;2018(4):rjy058. DOI: 10.1093/jscr/rjy05

7. Papapanagiotou I.K., Migklis K., Ioannidou G., Xesfyngi D., Kalles V., Mariolis-Sapsakos T. et al. Giant condyloma acuminatum-malignant transformation. Clin Case Rep. 2017;5(4):537–8. DOI: 10.1002/ccr3.863

8. Sporkert M., Rubben A. Buschke — Lowenstein tumor. Hautarzt. 2017;68(3):199–203. DOI: 10.1007/s00105-016-3924-x

9. Fukunaga M., Yokoi K., Miyazawa Y., Harada T., Ushigome S. Penile verrucous carcinoma with anaplastic transformation following radiotherapy: a case report with human papillomavirus typing and flow cytometric DNA studies. Am J Surg Pathol. 1994;18(5):501–5. PMID: 8172323

10. Sandhu R., Min Z., Bhanot N. A gigantic anogenital lesion: Buschke — Loewenstein tumor. Case Rep Dermatol Med. 2014;2014:650714. DOI: 10.1155/2014/650714

11. Safi F., Bekdache O., Al-Salam S., Alashari M., Mazen T. Giant condyloma acuminatum of Buschke — Lowenstein tumour: Disease development between 2000 and 2010. Surg Pract. 2014;18(1):27–36. DOI: 10.1111/1744-1633.12047