Ó Springer 2006
International Urology and Nephrology (2006) 38:659–661 DOI 10.1007/s11255-005-3612-8
Giant condylomata accuminata of scrotum representing as carcinoma (a case report) Ahmet Metin1, Ali Haydar Parlak2, Atilla Semercio¨z1 & C¸etin Boran3 1
Urology Clinics of Abant Izzet Baysal School of Medicine, Bolu, Turkey; 2Dermatology Clinics of Abant Izzet Baysal School of Medicine, Bolu, Turkey; 3Pathology Department of Abant Izzet Baysal School of Medicine, Bolu, Turkey
Abstract. In this case report a 51-year-old man admitted with a large warty lesion of scrotum representing as carcinoma was presented. A wide surgical resection of the lesion was done with the hystopathologic diagnosis of condyloma accuminata. He was followed for 12 months with satisfactory functional and cosmetic result with no recurrence with the time being. Key words: Condylomata accuminata, Scrotum
Introduction Giant condylomata accuminata or BuschkeLowenstein tumor (BLT) is a rare sexually
transmitted benign tumor of viral origin that is characterized by large tumor volume arising on the male and female external genitalia. BLT arises from the confluence of multiple condlomata
Figure 1. Macroscopic appearance of giant condylomata accuminata.
660 accuminata and it is induced by a Human Papillomavirus infection [1, 2].
Case report A 51-year-old man admitted with a large disk like enduration occupying the most of the left scrotum with multiple warty lesions and multiple scrotal
fistulous remnants on it. The elastic firm scrotal mass was painless and measured 117 cm2 which had been gradually increasing in size during the past 10 years (Figure 1). The HIV serology was negative, but papillomavirus DNA analysis by polymerase chain reaction has not been done. A complete resection of the tumor with a normal 1 cm surrounding margin was performed. On histopathological examination both upward
Figure 2. The histological findings of giant condylomata accuminata.
661 and downward growth patterns were seen. The hyperplastic epithelium penetrated the underlying tissues and cellular atypia was present in basal and parabasal layers. Koilocytotic cells were found in the more superficial epithelium. Thus the histological findings confirmed the diagnosis of giant condylomata accuminata. (Figure 2). He was treated with wide surgical excision and the postoperative 12th month period was uneventful, allowing satisfactory functional and cosmetic result and there has been no recurrence for the time being.
Discussion Giant condylomata accuminata is a warty lesion characterized by its large size and propensity to infiltrate into deeper tissues contrasting with its microscopically benign pattern. It is proposed that it represent an intermediate lesion between condlomata accuminatum and verricuos carcinoma. As the similar clinical behaviors are suggestive of malignancy, these lesions can only be differentiated by histologic examination [2–4]. A primary therapeutic option of giant condyloma is radical surgery or CO2 laser surgery excision with or without adjunctive chemotherapy such as
alpha interferon [1]. In this case the reason for extensive exophytic growth was due to delay in therapy because of the patients self neglect, not due to immune deficiency. In this case although its appearance represents carcinoma, histopathologic examination confirmed giant condylomata accuminata which is an intermediate condition exhibiting a continuous tendency for growth.
References 1. Frega A, Stentella P, Tinari A et al. Giant condylomata accuminatum or Buschke-Lowenstein tumor; review of the literature and report of three cases treated by CO2 laser surgery. A long term follow-up. Anticancer Res 2002; 22: 1201–1204. 2. Kabiri H, Albouzidi A, Rachid K et al. Degenerated Buschke-Loewenstein tumor of scrotum. Prog Urol 1996; 6(3): 439–442. 3. Rabii R, Joual A, Bellabidia B et al. Giant scrotal condylomata accuminata: a case report. Ann Urol 2001; 35(1): 67–70. 4. Ergun SS, Kural YB, Buyukbabani N et al. Giant conyloma acuminatum. Dermatol Surg 2003; 29(3): 300–303. Address for correspondence: Ahmet Metin, Bag˘lar Cad. U¨zu¨mcu¨ Sk 2/5, Seyranbag˘ları/Ankara/TURKEY Phone: +90-312-4303808 E-mail:
[email protected]
