Abstract
Giant condyloma acuminatum, originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity; however, malignant transformation to frankly invasive squamous-cell carcinoma has been described. Malignant transformation has been reported in 15 patients with “ordinary” condylomata acuminata as well. Twenty giant condylomata acuminata have been previously reported, six of which (30 percent) went on to develop squamous-cell carcinoma. The authors report eight cases of giant condylomata acuminata with invasive squamous-cell carcinoma developing in four patients. Light and electron microscopic methods were used to verify the diagnosis of squamous-cell carcinoma and/or giant condyloma acuminatum in our cases. Human papillomavirus (HPV), known to cause condylomata acuminata, is also known to induce these tumors. The authors support the hypothesis that giant condyloma acuminatum represents an intermediate lesion in a pathologic continuum from condyloma acuminatum to squamous-cell carcinoma. These lesions have a propensity for recurrence, likelihood of malignant transformation, and significant mortality. Therefore, early and radical local excision, and in cases of recurrence, invasion, or malignant transformation, abdominoperineal resection, along with vigilant follow-up, provides the only current hope for cure.
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Knoblich R, Failing JF Jr. Giant condyloma acuminatum (Buschke-Loewenstein tumor) of the rectum. Am J Clin Pathol 1967; 48:389–95.
Buschke A. Neisser's sterokopischer Atlas. New York: Fischer, 1896.
Buschke A, Löwenstein L. Über Carcinomähnliche Condylomata Acuminata des Penis. Klin Wochenschr 1925; 4:1726–8.
Dawson DF, Duckworth JK, Bernhardt H, Young JM. Giant condyloma and verrucous carcinoma of the genital area. Arch Pathol 1965; 79:225–31.
Sturm JT, Christenson CE, Uecker JH, Perry JF Jr. Squamouscell carcinoma of the anus arising in a giant condyloma acuminatum: report of a case. Dis Colon Rectum 1975; 18:147–51.
Drut R, Ontiveros R, Cabral DH. Perianal verrucose carcinoma spreading to the rectum: report of a case. Dis Colon Rectum 1975; 18:516–21.
Prasad ML, Abcarian H. Malignant potential of perianal condyloma acuminatum. Dis Colon Rectum 1980; 23:191–7.
Trope C, Grundsell H, Henrikson H, Johnsson JE, Lindahl B, simonsson E. Giant condyloma acuminatum with focal malignant degeneration. Acta Obstet Gynecol Scand 1982; 61:93–5.
Balthazar EJ, Streiter M, Megibow AJ. Anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor): CT and radiographic manifestation. Radiology 1984; 150:651–3.
Judge JR. Giant condyloma acuminatum involving vulva and rectum. Arch Pathol 1969; 88:46–8.
Shah IC, Hertz RE. Giant condyloma acuminatum of the anorectum: report of two cases. Dis Colon Rectum 1972; 15:207–10.
Lock MR, Katz DR, Samoorian S, Parks AG. Giant condyloma of the rectum: report of a case. Dis Colon Rectum 1977; 20:154–7.
South LM, O'Sullivan JP, Gazet JC. Giant condyloma of Buschke and Loewenstein. Clin Oncol 1977; 3:107–15.
Gingrass PJ, Bubrick MP, Hitchcock CR, Strom RL. Anorectal verrucose squamous carcinoma: report of two cases. Dis Colon Rectum 1978; 21:120–2.
Elliot MS, Werner ID, Immelman EJ, Harrison AC. Giant condyloma (Buschke-Loewenstein tumor) of the anorectum. Dis Colon Rectum 1979; 22:497–500.
Eng AM, Morgan NE, Blekys I. Giant condyloma acuminatum. Cutis 1979; 24:203–9.
Alexander RM, Kaminsky DB. Giant condyloma acuminatum (Buschke-Loewenstein tumor) of the anus: case report and review of the literature. Dis Colon Rectum 1979; 22:561–5.
Balazs M. Buschke-Löwenstein tumor: a histologic and ultrastructural study of six cases. Virchows Arch Anat Pathol 1986; 410:83–92.
Hull MT, Eble JN, Priest JB, Mulcahy JJ. Ultrastructure of Buschke-Loewenstein tumor. J Urol 1981; 126:485–9.
Siegel A. Malignant transformation of condyloma acuminatum. Am J Surg 1962; 103:613–7.
Friedberg MJ, Serlin O. Condylomata acuminatum: its association with malignancy. Dis Colon Rectum 1963; 6:352–5.
Burns FJ, van Goidsenhoven GE. Condyloma acuminata of the rectum with associated malignancy. Proc R Soc Med 1970; 63:119–20.
Oriel JD, Whimster IW. Carcinoma in situ associated with viruscontaining anal warts. Br J Dermatol 1971; 84:71–3.
Fitzgerald DM, Hamit HF. The variable significance of condylomata acuminata. Ann Surg 1974; 179:328–31.
Lee SH, McGregor DH, Kuziez MN. Malignant transformation of perianal condyloma acuminatum: a case report with review of the literature. Dis Colon Rectum 1981; 24:462–7.
Ejeckam GC, Idikio HA, Nayak V, Gardiner JP. Malignant transformation in an anal condyloma acuminatum. Can J Surg 1983; 26:170–2.
Croxson T, Chabon AB, Rorat E, Barash IM. Intraepithelial carcinoma of the anus in homosexual men. Dis Colon Rectum 1984; 27:325–30.
zur Hausen H. Human papillomaviruses and their possible role in squamous-cell carcinomas. Curr Top Microbiol Immunol 1977; 78:1–30
Shah KV, Papovaviruses. In: Fields BN, ed. Virology, New York: Raven Press, 1985, chapt 19:371–91.
Gissman L, DeVilliers EM, zur Hausen H. Analysis of human genital warts (condylomata acuminata) and other genital tumors for human papillomavirus type 6 DNA. Int J Cancer 1982; 29:143–6.
Gissman L, Schneider A. Human papillomavirus DNA in preneoplastic and neoplastic genital lesions. In: zur Hausen H, Peto R, eds. Origins in female genital cancer: virological and epidemiological aspects. Cold Spring Harbor, NY: Cold Spring Laboratory, 1986.
Boshart M, zur Hausen H. Human papillomaviruses in Buschke-Loewenstein tumors: physical state of the DNA and identification of a tandem duplication in the noncoding region of a human papillomavirus 6 subtype. J Virol 1986; 58:963–6.
zur Hausen H. Human genital cancer: synergism between two virus infections or synergism between a virus infection and initiating events? Lancet 1982; 2:1370–2.
Cooper HS, Patchefsky AS, Marks G. Cloacogenic carcinoma of the anorectum in homosexual men: an observation of four cases. Dis Colon Rectum 1979; 22:557–8.
Daling JR, Weiss NS, Klopfenstein LL, Cochran LE, Chow WH, Daifuku R. Correlates of homosexual behavior and the incidence of anal cancer. JAMA 1982; 247:1988–90.
Nash G, Allen W, Nash S. Atypical lesions of the anal mucosa in homosexual men. JAMA 1982; 256:873–6.
Clarke EA, Morgan RW, Newman AM. Smoking as a risk factor in cancer of the cervix: additional evidence from a case-control study. Am J Epidemiol 1982; 115:59–66.
Wexner SD, Milson JW, Dailey TH. The demographics of anal cancer are changing: identification of a high-risk population. Dis Colon Rectum 1987; 30:942–6.
Wexner SD, Smithy WB, Milsom JW, Dailey TH. The surgical management of anorectal diseases in AIDS and pre-AIDS patients. Dis Colon Rectum 1986; 29:719–23.
Penn I. Cancers of the anogenital region in renal transplant recipients. Cancer 1986; 58:611–6
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Read at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988
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Creasman, C., Haas, P.A., Fox, T.A. et al. Malignant transformation of anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor). Dis Colon Rectum 32, 481–487 (1989). https://doi.org/10.1007/BF02554502
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DOI: https://doi.org/10.1007/BF02554502