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BMJ Case Reports 2012; doi:10.1136/bcr-2012-006241
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Can a perianal condyloma reach the pelvis?

  1. Celia Coelho Henriques2
  1. 1Department of Dermatology and Venereology, Curry Cabral’s Hospital, Lisbon, Portugal
  2. 2Department of Internal Medicine 2, Curry Cabral’s Hospital, Lisbon, Portugal
  1. Correspondence to Dr Celia Coelho Henriques, celia.c.henriques{at}gmail.com

Description

A 42-year-old MSM black male was admitted due to vigorous perianal bleeding. Physical examination revealed a 14×8 cm exophytic erythematous perianal tumour with a moist verrucous surface (figure 1, right). The lesion had its origin on the right anal verge, extending over 3 cm on the anal canal, as seen by anuscopy. There was no loco-regional lymphadenopathy upon palpation. Laboratory data revealed microcytic anaemia (Hg 3.9 g/dl) and pelvic MRI showed abnormalities on the external anal sphincter, right isquiorectal fossa fat and thickening of perianal skin. On histopathology, there was a papillomatous epithelial proliferation with viral cytopathic effect and no signs of atypia, in keeping with condyloma acuminatum (figure 2). Patient’s history was remarkable for a 4-year HIV-1 positive serology (current viral load <50 copies/ml and CD4+ count 123 cells/mm3), diabetes mellitus and chronic renal disease. He was on highly active antiretroviral therapy, insulinotherapy and dialysis. He had had a sexually transmitted diseases appointment 2 years before (figure 1, left) and refused surgical treatment. In face of the presumptive diagnosis of Buschke–Löwenstein tumour, a wide local surgical excision was planned. The patient unexpectedly died during the anaesthetic induction. Buschke–Löwenstein tumour or giant condyloma acuminatum is considered a verrucous carcinoma, being locally invasive, but rarely capable of metastatic disease. It is an uncommon tumour of the anorectum, associated with the human papillomavirus types 6/11. Though foci of squamous cell carcinoma are commonly found, its histology may look remarkably benign; thus, the lack of a wider sample does not allow to rule out a malignant transformation in this case. Radical surgery can be curative, but recurrences are frequent.1 ,2

Figure 1

Patient’s perianal lesion on a sexually transmitted diseases appointment in 2009 and on admission, 2011.

Figure 2

Buschke–Lowenstein tumour sample on microscopy (H&E). Notice the parakeratosis, granular vacuolisation and hyperkeratosis with a thick stratum corneum in the specimen analysed; these features generally characterise the benign BL tumours and support the differential diagnosis from ordinary warts.

Learning points

  • Patients with condylomata acuminata must be treated in an early stage of disease.

  • Buschke–Löwenstein tumour should be aggressively managed due to its high morbidity and possible complications.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

References

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