Giant Condyloma Accuminatum Bushke Lowenstein Tumor

Condyloma acuminata are warty, exophytic growths which can affect any part of the anogenital region and are generally considered benign. On the penis, lesions typically occur around the coronal sulcus and frenulum, but can also be found as flat lesions on the penile shaft. They can occasionally extend into the anterior urethra, but extension into the posterior urethra and bladder is usually only seen in immuno-compromised patients.22 They are due to infection with low-risk HPV types 6 and 11.23,24 In keeping with BP, these lesions typically occur in sexually active men in their third decade. Small lesions can be treated with topical podophyllin or trichlo-roacetic acid. Alternative topical treatment options include imiquimod cream. Laser therapy and cryotherapy can also be used for lesions on the glans. Occasionally the lesions are intraurethral and small lesions can be managed using 5-FU inserted into the urethra. Larger lesions may require resection using a pediatric resectoscope.

Despite the extensive lesion which destroyed the glans penis and distal urethra, the corpus cavernosum was

Fig. 5.4 Giant condylomata acuminata in a 51-year-old patient from Eastern Europe. Presentation only occurred following voiding difficulties.

spared

Despite the extensive lesion which destroyed the glans penis and distal urethra, the corpus cavernosum was

Fig. 5.4 Giant condylomata acuminata in a 51-year-old patient from Eastern Europe. Presentation only occurred following voiding difficulties.

Confluence of lesions can lead to the development of large, exophytic, cauliflower- like growths known as giant condyloma acuminate (GCA) or Bushke-Lowenstein tumors, after the original description of the condition by the authors in 1925.25 (Fig. 5.4). Risk factors for the development of GCA include immunosuppression, chronic irritation, and poor hygiene,26 and consequently they are more common in uncircumcised men. Although histologically their appearance is benign, these lesions can behave in a malignant fashion, invading adjacent structures.1 Due to their behavior, they are often considered to be an intermediary lesion somewhere between benign condylomas and invasive SCC.27

GCA is at risk of malignant transformation into invasive SCC, with reported rates between 30% and 56%.26,28,29 These tumors were previously classified as verrucous carcinomas, but recently there has been a move away from this based on the pathogenic HPV elements involved with GCA which are not seen with verrucous tumors.

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