While the physical exam may reveal that the patient has a cauliflower-like mass with fistulization, the cause is difficult to know with certainty without proper histopathological and imaging studies. The cause of such a mass may be a myriad of lesions, including condyloma acuminatum, cutaneous SCC (including papillary carcinoma, warty carcinoma, and carcinoma cuniculatum), primary rectal adenocarcinoma, Bowenoid papulosis, and lymphangiomas. These patients may exhibit non-specific signs and symptoms such as pain, bleeding, abscesses, and a penile/anogenital mass. Giant condylomata acuminata of Bushke-Löwenstein (GCBL) frequently poses a diagnostic dilemma. Īutologous vaccination therapy as a treatment for GCBL has also shown promising results. Radiation therapy, in spite of its neoadjuvant application in a limited number of GCBL cases, has largely been avoided, mostly because of the fear of causing further anaplastic transformations. Chemotherapy alone, however, has not shown promising results. Topical, intralesional, or oral chemotherapy with fluorouracil (5-FU), podophyllin, cidofovir, interferon, and imiquimod, as well as systemic chemotherapeutic drugs e.g., bleomycin, cisplatin, and leucovorin have been used as neoadjuvant or adjuvant therapy and for treating tumor recurrences after surgery. Carbon dioxide/argon laser resection has also been used for recurrences. In most cases, GCBL recurrences are dealt with by radical surgery. If necessary, surgical defects can later be surgically reconstructed e.g., by using delayed split-thickness grafts. According to most experts, Mohs surgery is the preferred technique as it allows tissue sparing while simultaneously enabling the surgeon to ensure tumor-free margins and spotting any SCC foci. Broadly speaking, a wide surgical excision is the treatment of choice for GCBL. įactors like lesion size, number and location, immune status of the patient, personal preferences of the patient, and the type of treatment available at a particular healthcare facility dictate the chosen treatment. In immunocompromised and pregnant patients, GCBL proliferates at a much more rapid pace compared to the proliferation rates seen in immunocompetent and nonpregnant individuals. Perianal growth is normally circumferential, starting from the transitional zone between the anal mucosa and the cutaneous surface and slowly growing outwards, involving the anal canal in most cases. In the case of perianal GCBL, the first presenting symptoms are usually in the form of a painful mass, bleeding, fistulations, or abscesses. Although lymphadenopathy (usually regional) is seen with this tumor, it is most often caused by secondary spread and not because of metastasis of the tumor, which is very uncommon. When found on the penis, it can extend into the penile urethra or the corpus cavernous and produce fistulas. The tumorous growth often forms ulcers or horns and is usually malodorous. In immunocompetent individuals, GCBL will normally start as a small, often keratotic, plaque usually on the foreskin of the penis and will gradually, over up to twenty years, change into a structure typically described as a ‘cauliflower-like growth’ approximately twenty centimeters in size.
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