Skip to main content
SpringerLink
Log in

Fine scalpel surgery: preserving the dartos muscle in a patient with scrotal and perigenital giant Buschke–Löwenstein tumors

Operieren mit feinem Skalpell: Erhalt der Tunica dartos bei einem Patienten mit perigenitalen großen Buschke-Löwenstein-Tumoren

  • case report
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

Summary

Giant condyloma acuminatum (GCA), alternatively referred to as a Buschke–Löwenstein tumor (BLT), is an uncommon, benign, but locally aggressive form of verrucous carcinoma. The condition usually affects the male population under the age of 50 years; however, there have been rare reports of pediatric cases. Various risk factors such as smoking, diabetes, promiscuous behavior, poor hygiene, immunosuppression, and others are linked to the development of this condition. We present the case of a 26-year-old male patient who came to the dermatology department with primary complaints of 10-year-old verrucous tumor formations located in the perigenital and perianal areas. Serological tests for AIDS, hepatitis B, hepatitis C, Chlamydia trachomatis, and syphilis were negative. The routine blood tests were slightly abnormal. Histological verification of condylomata acuminata of Buschke–Löwenstein was made. Given the sensitive areas, surgery was advised. With several fine undermining scalpel excisions, the lesions in the scrotal and perigenital areas were removed and the dartos muscle was preserved. Electrodissection and shave curettage were not performed. The postoperative period passed without complications and no recurrences in the perigenital area were reported. We believe that our case report represents the first documented surgical approach for scrotal Buschke–Löwenstein tumor using exclusively fine undermining scalpel surgery. A brief literature review of the condition is presented, focusing on the currently available treatment options and highlighting the potential effectiveness of the surgical approach.

Zusammenfassung

Das Condyloma acuminatum giganteum („giant condyloma acuminatum“, GCA), auch Buschke-Löwenstein-Tumor (BLT) genannt, ist eine seltene, gutartige, aber lokal aggressive Form des verrukösen Karzinoms. Die Krankheit betrifft i. d. R. die männliche Bevölkerungsgruppe unter 50 Jahren, es liegen jedoch auch seltene Berichte über Fälle bei Kindern vor. Verschiedene Risikofaktoren wie Rauchen, Diabetes, promiskuitives Verhalten, mangelnde Hygiene, Immunsuppression und andere werden mit der Entstehung dieser Krankheit in Verbindung gebracht. Hier wird der Fall eines 26-jährigen männlichen Patienten vorgestellt, der mit primären Beschwerden über verruköse Tumorbildungen im perigenitalen und perianalen Bereich in die dermatologische Abteilung kam. Serologische Tests für AIDS, Hepatitis B, Hepatitis C, Chlamydia trachomatis und Syphilis waren negativ. Routinemäßige Blutuntersuchungen waren leicht abnormal. Es wurde eine histologische Untersuchung der Buschke-Löwenstein-Condylomata acuminata durchgeführt. Aufgrund der empfindlichen Bereiche wurde eine Operation empfohlen. Mehrere feine unterminierende Skalpellexzisionen wurden durchgeführt, um skrotale und perigenitale Läsionen zu entfernen und die Tunica dartos zu erhalten. Elektrodissektion und Shave-Kürettage wurden nicht durchgeführt. Die postoperative Phase verlief ereignislos, und es wurden keine Rezidive im Perigenitalbereich angegeben. Nach Kenntnis der Autoren handelt es sich bei diesem Fallbericht um den ersten dokumentierten chirurgischen Ansatz zur Behandlung des skrotalen Buschke-Löwenstein-Tumors, bei dem nur eine feine unterminierende Skalpelloperation zum Einsatz kommt. Es wird eine kurze Literaturübersicht über die Erkrankung durchgeführt, wobei der Schwerpunkt auf den derzeit verfügbaren Behandlungsoptionen liegt und die potenzielle Wirksamkeit des chirurgischen Ansatzes hervorgehoben wird.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kadouri Y, Nouini Y. La tumeur de Buschke-Löwenstein. Pan Afr Med J. 2020;36:359. https://doi.org/10.11604/pamj.2020.36.359.13292.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Elsayed AG, Sola-Rufai ST, Griswold D, Pacioles T. Verrucous carcinoma arising in a long standing Buschke-Löwenstein tumor. Clin Case Rep. 2019;7(4):836–8. https://doi.org/10.1002/ccr3.2029.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chao MW, Gibbs P. Squamous cell carcinoma arising in a giant condyloma acuminatum (Buschke-Lowenstein tumour). Asian J Surg. 2005;28(3):238–40. https://doi.org/10.1016/S1015-9584(09)60352-3.

    Article  PubMed  Google Scholar 

  4. Lévy A, Lebbe C. Prise en charge des tumeurs de Buschke-Löwenstein. Ann Urol. 2006;40(3):175–8. https://doi.org/10.1016/j.anuro.2006.02.002.

    Article  Google Scholar 

  5. Buschke A. Neisser’s Stereokopischer Atlas. New York: Fischer; 1896.

    Google Scholar 

  6. Buschke A, Löwenstein L. Über carcinomähnliche condylomata accuminata des Penis. Klin Wochenschr. 1925;7:1726–8. https://doi.org/10.1007/BF01728480.

    Article  Google Scholar 

  7. Sabuncuoglu MZ, Sabuncuoglu A, Celik G, Sozen I, Cetin R. Moist secret mass; Buschke-Lowenste in tumor: a report of three cases. Case Rep Clin Med. 2014;3:474–8. https://doi.org/10.4236/crcm.2014.38104.

    Article  Google Scholar 

  8. Zidar N, Langner C, Odar K, Hošnjak L, Kamarádová K, Daum O, Pollheimer MJ, Košorok P, Poljak M. Anal verrucous carcinoma is not related to infection with human papillomaviruses and should be distinguished from giant condyloma (Buschke-Löwenstein tumour). Histopathology. 2017;70(6):938–45. https://doi.org/10.1111/his.13158.

    Article  PubMed  Google Scholar 

  9. Wiedemann A, Diekmann WP, Holtmann G, Kracht H. Report of a case with giant condyloma (Buschke-Löwenstein tumor) localized in the bladder. J Urol. 1995;153(4):1222–4.

    Article  CAS  PubMed  Google Scholar 

  10. Irshad U, Puckett Y. Giant condylomata acuminata of Buschke and Lowenstein. Treasure Island (FL): StatPearls; 2023.

    Google Scholar 

  11. Chu QD, Vezeridis MP, Libbey NP, Wanebo HJ. Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions. Analysis of 42 cases. Dis Colon Rectum. 1994;37(9):950–7. https://doi.org/10.1007/BF02052606.

    Article  CAS  PubMed  Google Scholar 

  12. Nambudiri VE, Mutyambizi K, Walls AC, Fisher DC, Bleday R, Saavedra AP. Successful treatment of perianal giant condyloma acuminatum in an immunocompromised host with systemic interleukin 2 and topical cidofovir. JAMA Dermatol. 2013;149(9):1068–70. https://doi.org/10.1001/jamadermatol.2013.5160.

    Article  PubMed  Google Scholar 

  13. Wells M, Robertson S, Lewis F, Dixon MF. Squamous carcinoma arising in a giant peri-anal condyloma associated with human papillomavirus types 6 and 11. Histopathology. 1988;12(3):319–23. https://doi.org/10.1111/j.1365-2559.1988.tb01946.x.

    Article  CAS  PubMed  Google Scholar 

  14. Boda D, Cutoiu A, Bratu D, Bejinariu N, Crutescu R. Buschke-Löwenstein tumors: a series of 7 case reports. Exp Ther Med. 2022;23(6):393. https://doi.org/10.3892/etm.2022.11320.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bastola S, Halalau A, Kc O, Adhikari A. A gigantic anal mass: Buschke-Löwenstein tumor in a patient with controlled HIV infection with fatal outcome. Case Rep Infect Dis. 2018;2018:7267213. https://doi.org/10.1155/2018/7267213.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Elfatoiki FZ, Hali F, Baghad B, Marnissi F, Chiheb S. Giant perianal condyloma acuminatum in an infant without sexual abuse. Arch Pediatr. 2019;26(8):473–4. https://doi.org/10.1016/j.arcped.2019.09.003.

    Article  CAS  PubMed  Google Scholar 

  17. Leto MD, Santos Júnior GF, Porro AM, Tomimori J. Human papillomavirus infection: etiopathogenesis, molecular biology and clinical manifestations. An Bras Dermatol. 2011;86(2):306–17. https://doi.org/10.1590/s0365-05962011000200014.

    Article  PubMed  Google Scholar 

  18. Kidd LC, Chaing S, Chipollini J, Giuliano AR, Spiess PE, Sharma P. Relationship between human papillomavirus and penile cancer-implications for prevention and treatment. Transl Androl Urol. 2017;6(5):791–802. https://doi.org/10.21037/tau.2017.06.27.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang D, Gonzalez RS, Feely M, Umrau K, Lee H, Allende DS, Karamchandani DM, Zaleski M, Lin J, Westerhoff M, Zhang X, Alpert L, Liao X, Lai J, Liu X. Clinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases. Virchows Arch. 2020;476(4):543–50. https://doi.org/10.1007/s00428-019-02680-z.

    Article  CAS  PubMed  Google Scholar 

  20. Ingles DJ, Pierre Campbell CM, Messina JA, Stoler MH, Lin HY, Fulp WJ, Abrahamsen M, Sirak BA, O’Keefe MT, Papenfuss M, Gage C, Carvalho da Silva R, Gonzalez Sosa R, Rojas Juarez O, Villa LL, Lazcano Ponce E, Giuliano AR. Human papillomavirus virus (HPV) genotype- and age-specific analyses of external genital lesions among men in the HPV Infection in men (HIM) study. J Infect Dis. 2015;211(7):1060–7. https://doi.org/10.1093/infdis/jiu587.

    Article  PubMed  Google Scholar 

  21. Cornall AM, Roberts JM, Garland SM, Hillman RJ, Grulich AE, Tabrizi SN. Anal and perianal squamous carcinomas and high-grade intraepithelial lesions exclusively associated with “low-risk” HPV genotypes 6 and 11. Int J Cancer. 2013;133(9):2253–8. https://doi.org/10.1002/ijc.28228.

    Article  CAS  PubMed  Google Scholar 

  22. Antonsson A, Green AC, Mallitt KA, O’Rourke PK, Pandeya N, Pawlita M, Waterboer T, Neale RE. Prevalence and stability of antibodies to 37 human papillomavirus types—a population-based longitudinal study. Virology. 2010;407(1):26–32. https://doi.org/10.1016/j.virol.2010.07.046.

    Article  CAS  PubMed  Google Scholar 

  23. Rahman S, Pierce Campbell CM, Waterboer T, Rollison DE, Ingles DJ, Torres BN, Michel A, Sudenga SL, Pawlita M, Villa LL, Lazcano Ponce E, Borenstein AR, Wang W, Giuliano AR. Seroprevalence of cutaneous human papillomaviruses (HPVs) among men in the multinational HPV Infection in men study. J Gen Virol. 2016;97(12):3291–301. https://doi.org/10.1099/jgv.0.000620.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. de Sanjosé S, Bruni L, Alemany L. HPV in genital cancers (at the exception of cervical cancer) and anal cancers. Presse Med. 2014;43(12):e423–8. https://doi.org/10.1016/j.lpm.2014.10.001.

    Article  PubMed  Google Scholar 

  25. Ahsaini M, Tahiri Y, Tazi MF, Elammari J, Mellas S, Khallouk A, El Fassi MJ, Farih MH, Elfatmi H, Amarti A, Stuurman-Wieringa RE. Verrucous carcinoma arising in an extended giant condyloma acuminatum (Buschke-Löwenstein tumor): a case report and review of the literature. J Med Case Rep. 2013;7:273. https://doi.org/10.1186/1752-1947-7-273.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jorgaqi E, Jafferany M. Giant condyloma acuminatum (Buschke-Lowenstein tumor): combined treatment with surgery and chemotherapy. Dermatol Ther. 2020;33(1):e13193. https://doi.org/10.1111/dth.13193.

    Article  PubMed  Google Scholar 

  27. Abbass MA, Valente MA. Premalignant and malignant perianal lesions. Clin Colon Rectal Surg. 2019;32(5):386–93. https://doi.org/10.1055/s-0039-1687835.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Indinnimeo M, Impagnatiello A, D’Ettorre G, Bernardi G, Moschella CM, Gozzo P, Ciardi A, Bangrazi C, De Felice F, Musio D, Tombolini V. Buschke-Löwenstein 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. https://doi.org/10.1186/1477-7819-11-231.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Costa Almeida CE, Azevedo J, Botelho I, Vilaça J. Buschke-Löwenstein tumour: a rare and challenging entity. BMJ Case Rep. 2021;14(9):e244192. https://doi.org/10.1136/bcr-2021-244192.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hicheri J, Jaber K, Dhaoui MR, Youssef S, Bouziani A, Doss N. Giant condyloma (Buschke-Löwenstein tumor). A case report. Acta Dermatovenerol Alp Pannonica Adriat. 2006;15(4):181–3.

    PubMed  Google Scholar 

  31. Neagu M, Caruntu C, Constantin C, Boda D, Zurac S, Spandidos DA, Tsatsakis AM. Chemically induced skin carcinogenesis: updates in experimental models (review). Oncol Rep. 2016;35(5):2516–28. https://doi.org/10.3892/or.2016.4683.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Tripoli M, Cordova A, Maggì F, Moschella F. Giant condylomata (Buschke-Löwenstein tumours): our case load in surgical treatment and review of the current therapies. Eur Rev Med Pharmacol Sci. 2012;16(6):747–51.

    CAS  PubMed  Google Scholar 

  33. Purzycka-Bohdan D, Szczerkowska-Dobosz A, Swiatecka-Czaj J, Peksa R, Urban M, Szczypior M, Nowicki RJ. Buschke-Löwenstein tumour associated with low-risk human papillomavirus genotypes successfully treated surgically. Postepy Dermatol Alergol. 2019;36(1):112–4. https://doi.org/10.5114/ada.2019.82831.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Papiu HS, Dumnici A, Olariu T, Onita M, Hornung E, Goldis D, Aiordachioae G, Vasca V. Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature. Chirurgia. 2011;106(4):535–9.

    CAS  PubMed  Google Scholar 

  35. Li AL, Walsh S, McKay DR. Surgical management of a giant condyloma of Buschke-Löwenstein in a patient with Netherton syndrome using the pedicled anterolateral thigh flap—a case report. J Plast Reconstr Aesthet Surg. 2011;64(11):1533–6. https://doi.org/10.1016/j.bjps.2011.03.013.

    Article  PubMed  Google Scholar 

  36. Spinu D, Rădulescu A, Bratu O, Checheriţă IA, Ranetti AE, Mischianu D. Giant condyloma acuminatum—Buschke-Lowenstein disease—a literature review. Chirurgia. 2014;109(4):445–50.

    CAS  PubMed  Google Scholar 

  37. Afouba AGN, Abessolo HA, Mukam GAM, Noa SAA, Edinga-Melenge BE, Sando Z. Scrotal Buschke-Löwenstein tumor in a teenager: a case study. J Dermatol Res Ther. 2022;5(1):1–5.

    Google Scholar 

  38. Patel AP. Anatomy and physiology of chronic scrotal pain. Transl Androl Urol. 2017;6(1):S51–S6. https://doi.org/10.21037/tau.2017.05.32.

    Article  PubMed  PubMed Central  Google Scholar 

  39. El Khoury A, Jensen JC, Pacioles T. Neoadjuvant chemotherapy and penile conservation in the management of Buschke-Lowenstein tumor, a case report. Urol Case Rep. 2019;29:101111. https://doi.org/10.1016/j.eucr.2019.101111.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Boda D, Negrei C, Arsene AL, Caruntu C, Lupuleasa D, Ion RM. Spectral and photochemical properties of hyperbranched nanostructures based on gardiquimod and TPPS4. Farmacia. 2015;63:218–23.

    CAS  Google Scholar 

  41. Iorga L, Marcu R, Diaconu C, Stanescu A, Pantea A, Mischianu D, Surcel M, Bungau S, Constantin T, Boda D, Fekete L, Bratu O. Penile carcinoma and HPV infection (Review). Exp Ther Med. 2020;20(1):91–6. https://doi.org/10.3892/etm.2019.8181.

    Article  CAS  PubMed  Google Scholar 

  42. Kim HG, Kesey JE, Griswold JA. Giant anorectal condyloma acuminatum of Buschke-Löwenstein presents difficult management decisions. J Surg Case Rep. 2018;2018(4):rjy58. https://doi.org/10.1093/jscr/rjy058.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wu CF, Chen CM, Shen YS, Huang IY, Chen CH, Chen CY, Shieh TY, Sheen MC. Effective eradication of oral verrucous carcinoma with continuous intraarterial infusion chemotherapy. Head Neck. 2008;30(5):611–7. https://doi.org/10.1002/hed.20751.

    Article  PubMed  Google Scholar 

  44. 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. https://doi.org/10.1097/00000478-199405000-00010.

    Article  CAS  PubMed  Google Scholar 

  45. Combaud V, Verhaeghe C, El Hachem H, Legendre G, Descamps P, Martin L, Bouet PE. Giant condyloma acuminatum of the vulva: successful management with imiquimod. JAAD Case Rep. 2018;4(7):692–4. https://doi.org/10.1016/j.jdcr.2018.04.007.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Heinzerling LM, Kempf W, Kamarashev J, Hafner J, Nestle FO. Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology. 2003;207(1):119–22. https://doi.org/10.1159/000070963.

    Article  CAS  PubMed  Google Scholar 

  47. Dinleyici M, Saracoglu N, Eren M, Kiliç Ö, Ciftci E, Dinleyici EC, Sag C, Kara A. Giant condyloma acuminate due to human papillomavirus type 16 in an infant successfully treated with topical Imiquimod therapy. Dermatol Reports. 2015;7(3):6134. https://doi.org/10.4081/dr.2015.6134.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Masuko T, Fuchigami T, Inadomi T, Inamo Y, Hashimoto K. Effectiveness of imiquimod 5 % cream for treatment of perianal warts in a 28-month-old child. Pediatr Int. 2011;53(5):764–6. https://doi.org/10.1111/j.1442-200X.2010.03277.x.

    Article  CAS  PubMed  Google Scholar 

  49. Lee CN, Hsu CK, Lee JY. Recalcitrant extragenital giant condyloma acuminatum: a need for combination therapy. Dermatol Ther. 2019;32(3):e12867. https://doi.org/10.1111/dth.12867.

    Article  PubMed  Google Scholar 

  50. Geusau A, Heinz-Peer G, Volc-Platzer B, Stingl G, Kirnbauer R. Regression of deeply infiltrating giant condyloma (Buschke-Löwenstein tumor) following long-term intralesional interferon alfa therapy. Arch Dermatol. 2000;136(6):707–10. https://doi.org/10.1001/archderm.136.6.707.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Bowman IA, Parra A, Arriaga Y. Metastatic giant condyloma acuminata (Buschke-Löwenstein tumor). J Oncol Pract. 2016;12(10):951–3. https://doi.org/10.1200/JOP.2016.013441.

    Article  PubMed  Google Scholar 

  52. Lukács A, Máté Z, Farkas N, Mikó A, Tenk J, Hegyi P, Németh B, Czumbel LM, Wuttapon S, Kiss I, Gyöngyi Z, Varga G, Rumbus Z, Szabó A. The quadrivalent HPV vaccine is protective against genital warts: a meta-analysis. BMC Public Health. 2020;20(1):691. https://doi.org/10.1186/s12889-020-08753-y.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Deshmukh A, Gulanikar A, Pathrikar S, Pawar SS. Buschke-Lowenstein tumor treated with intralesional measles, mumps, and rubella vaccine. Indian J Sex Transm Dis. 2022;43(1):94–6. https://doi.org/10.4103/ijstd.ijstd_97_20.

    Article  Google Scholar 

  54. Hu Y, Lu Y, Qi X, Chen X, Liu K, Zhou X, Yang Y, Mao Z, Wu Z, Hu Y. Clinical efficacy of paiteling in the treatment of condyloma acuminatum infected with different subtypes of HPV. Dermatol Ther. 2019;32(5):e13065. https://doi.org/10.1111/dth.13065.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria

    S. Kordeva &  G. Tchernev

  2. Department of Common, Abdominal and Vascular Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria

    I. Pidakev

  3. Department of Dermatology and Venereology, Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria

    G. Tchernev

Authors
  1. S. Kordeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Pidakev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Tchernev
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Kordeva.

Ethics declarations

Conflict of interest

S. Kordeva, I. Pidakev, and G. Tchernev declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kordeva, S., Pidakev, I. & Tchernev, G. Fine scalpel surgery: preserving the dartos muscle in a patient with scrotal and perigenital giant Buschke–Löwenstein tumors. Wien Med Wochenschr (2024). https://doi.org/10.1007/s10354-024-01039-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10354-024-01039-7

Keywords

Schlüsselwörter

Search

Navigation