A 46-year-old woman Gravida: 1 Para: 1 presented with a huge mass on her external genitalia unresponsive to local medical treatments including podophyllin solution and trichloroacetic acid. Her physician had recommended surgical resection but she refused initially.
She had pemphigus vulgaris and diabetes mellitus and was under treatment with prednisolone and glybenclamide.
Examination revealed a 20 × 15 cm cauliflower-like tumor mass involving the mons pubic, the labia majors, the perineum and medial aspect of left thigh (Fig. 1).
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Treponema pallidum hemagglutination assay and test for antibody to human immunodeficiency virus and hepatitis B virus antigen were negative.
She was treated with intravenous cefazolin and metronidazole for infection.
Multiple biopsies detected ordinary condyloma accuminatum, and neither malignancy nor cytological atypia was detected. HPV DNA analysis by polymerase chain reaction revealed HPV type 6.
Wide surgical excision was performed. Histopathologic examination showed multiple papillary structures covered by stratified keratinized squamous epithelium and koilocytic changes with fibrovascular core and infiltration of predominantly mononuclear inflammatory cells into the vascular core. No significant squamous atypia was seen and verrucous carcinoma was excluded. The histopathology was typical for a condyloma. The postoperative course was uneventful and the cosmetic result was satisfactory
Giant condyloma has a benign histologic appearance. It resembles that of condyloma accuminatum, and it may be difficult to distinguish them from each other.1
A large representative biopsy specimen is important to judge the structure of the lesion in order to establish the diagnosis and to exclude foci of verrucous carcinoma. Giant condyloma invades by expansion rather than by infiltration, leaving basement membrane intact, and shows a well-stratified epithelium with minimal cellular dysplasia or atypical cells.2
Giant condyloma has been treated by a variety of modalities. However, literature consists mainly of case reports and lacks controlled studies.3 and 4 A study on 42 published cases concluded that the only consistently effective therapy is wide surgical excision of tumor with clear margins with or without adjuvant chemotherapy.5
Radiation therapy is controversial and should only be considered in patients with non-resectable tumors as anaplastic transformation may be induced
Patients with extensive lesions may require systemic chemotherapy with a variety of combinations of methotrexate, 5-fluorouracil, bleomycin, mitomycin C, cisplatin, and leucovorin.9
References
1 H. Yag, M. Igawa and H. Shiina et al., A study of growth pattern in giant condyloma acuminatum, Urol Int 61 (1998), pp. 188–191.
2 A. Geusau, G. Heinz-peer and B. Volc-platzer, Regression of deeply infiltrating giant condyloma (Buschke–Lowenstein tumor) following long term intralesional interferon alfa therapy, Arch Dermatol 136 (2000), pp. 707–710. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (15)
3 L. Zhao, F. Fang and F. Carey et al., A case of condyloma acuminate with giant and multiple lesions on the vulva and breast: successfully treated with surgical operations, Int J STD AIDS 15 (Mar 2004) (3), pp. 199–201.
4 F.C. Antony, M. Ardern-Jones and A.V. Evans et al., Giant condyloma of Buschke–Loewenstein in association with erythroderma, Clin Exp Dermatol 28 (2003), pp. 46–49. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (6)
5 Q.D. Chu, M.P. Vezeridis and P.N. Libbey et al., Giant condyloma acuminatum (Buschke–Loewenstein tumor) of the anorectal and perianal regions: analysis of 42 cases, Dis colon Rectum 37 (1994), pp. 950–957. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (40)
6 C.W. Sobrado, M. Mester and W. Nadalin et al., Radiation-induced total regression of a highly recurrent giant perianal condyloma, Dis colon Rectum 43 (2000), pp. 257–260. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (13)
7 K. Uchida, H. Safani and T. Okuno et al., Two cases of giant condyloma of the penis treated with penis-sparing methods, Hinyokika Kiyo 42 (1996), pp. 605–608. View Record in Scopus | Cited By in Scopus (2)
8 D.G. Hatzichristou, A. Apostolidis and V. Tzotzis et al., Glansectomy: an alternative surgical treatment for Buschke–Lowenstein tumor of penis, Urology 57 (2001), pp. 966–969. SummaryPlus | Full Text + Links | PDF (246 K) | View Record in Scopus | Cited By in Scopus (16)
9 G. Persson, K. Andersson and I. Krantz, Symptomatic genital papilomavirus infection in a community B incidence and clinical picture, Acta Obstet Gynecol Scand 75 (1996), pp. 287–290. View Record in Scopus | Cited By in Scopus (21)