Giant condyloma (Buschke-Lowenstein tumor) occurs both in young and in old age. Most often it is observed in men and is located on the penis. Less commonly, the development of condyloma is noted on the genitals of women. Extragenital localization may occur.
Buschke-Lowenstein tumor along with Bowen’s disease, bovenoid papulesis, Keir’s disease, Xeroderma pigmentosa and cutaneous horn belong to the precancerous tumors of the skin. Its transformation into skin cancer can be promoted by poor personal hygiene, reduced immunity, and long-term irritant effects of external factors.
Causes of the giant warts Buschke-Lowenstein
The appearance of the giant warts Buschke-Lowenstein is caused by the human papillomavirus (HPV). Predisposing factors are considered to be:
- excessive sweating,
- sexually transmitted infections (ureaplasmosis, chlamydia, cytomegaly).
In venereology, there have been isolated cases of development of the giant warts Bushke-Levenshtein against lichen planus and scleroatrophic lichen.
Symptoms of the giant Buschke-Lowenstein condyloma
The disease begins with the appearance on the skin of small formations similar to papillomas, warts or genital warts. These elements quickly increase in size and merge with each other, forming a single lesion area – the giant warlock Buschke-Lowenstein. It has a broad base, covered with villous growths and neoplasm, separated by pronounced grooves.
On the periphery of the formation, isolated genital warts are observed. Over time, condylomas grow, become covered with scales of the cornified epithelium and macerate. In between the grooves between them accumulates discharge, which has an unpleasant smell. Often there is an infection, as a result of which the discharge becomes purulent.
Most often, the giant warts is localized on the penis in the area of its head or coronary sulcus. It may appear in the anorectal region, around the anus, in the groin, on the skin of the labia and the clitoris in women, on the face (on the cheeks, around the mouth, in the eyelids or nose), on the oral mucosa or urinary organs.
Giant Buschke-Lowenstein tumor is slow, steadily progressive growth and a tendency to recur. Together with the pronounced exophytic growth of the giant warlock Buschke-Lowenstein, leading to its growth in the type of “cauliflower”, pronounced germination is observed in the surrounding tissues.
The progressive growth of education can lead to the destruction of the foreskin, the introduction of the tumor into the cavernous body, the germination of the surrounding tissue with the formation of fistulas and ulcerations. Possible malignancy of the giant warts with its transition to squamous cell carcinoma of the skin.
Diagnosis of giant Bushke-Levenshteyna condyloma
The diagnosis of giant warts establishes venereologist. To do this, he conducts an examination of the formation and its differential diagnosis with similar diseases:
- acute condylomas,
- widespread warts characteristic of secondary syphilis,
- oral papillomatosis,
- anogenital condyloma,
- and squamous cell carcinoma of the skin.
Additionally carry out PCR studies on HPV.
The final diagnosis of the giant Buschke-Lowenstein tumor allow only the histology of material removed during surgical treatment. To exclude malignant transformation of condyloma, a study is conducted with several tissue samples taken from different parts of the tumor.
The histological picture in case of the giant Buschke-Lowenstein tumor resembles the picture of the usual genital warts and differs only in a greater degree of manifestation of pathological changes. There is a marked increase in the thickness of the stratum corneum of the epidermis and germination of the warts in the deep layers of the dermis. A sign of malignant transformation is the detection of areas of tumor tissue corresponding to the histological pattern of cancer in situ.
Treatment of giant condyloma (Buschke-Lowenstein tumor)
Given the invasive and rapid growth of the giant warts, the possibility of its transformation into cancer, its wide surgical excision is recommended. The operation should be carried out as soon as a tumor is detected. For the prevention of postoperative recurrence of the Buschke-Lowenstein condyloma, additional cryodestruction of the base of the tumor is recommended.
Surgical treatment is combined with systemic antiviral and fortifying therapy. A number of authors indicate the feasibility of local administration of interferons, their inducers and bleomycin in the postoperative period.
Radiotherapy of the giant warts is contraindicated, as it can give impetus to the cancer transformation of the tumor.
The forecast for the Buschke-Lowenstein tumor
Despite the complete and absolutely correctly carried out treatment, the giant warlock Bushke-Levenshtein can give relapses. Its malignant transformation occurs within 2 to 12 years after the onset of the disease.