Staged resection in the management of HIV-related anogenital giant condyloma acuminatum. A case report. (December 2019)

• Record Type: Journal Article
• Authors: Loo, Guo Hou; Lim, Li Yi; Zainuddin, Zulkifli Md; Fam, Xeng Inn
• Is Part Of: Annals of medicine and surgery. Volume 48(2020)
• Page Start: 73
• Page End: 76
• Publication Date: 2019-12
• Subjects: Bushke-lowenstein tumour -- Human immunodeficiency virus -- Human papilloma virus -- Anogenital warts -- Defunctioning colostomy in genital warts; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2019.10.024
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: Giant condyloma acuminata (GCA), also known as Bushke-Lowenstein tumour, is a rare disease which affects 0.1% of the population. Although histopathologically benign, it tends to be locally destructive. The common sites of involvement include the penis and the anorectum. Due to the rarity of the disease, there is a lack of controlled studies on the optimal management of this entity. Thus, we report a case of anogenital GCA in a 40-year-old HIV-positive man. Case presentation: A 40-year-old man presented with progressive anogenital warts associated with foul-smelling discharge and fever. He has been diagnosed with HIV and was on HAART on presentation. A warty excrescence had infiltrated the entire external genitalia, gluteals and sacral region. Serial excision was performed along with a defunctioning colostomy. The patient recovered well, and the final histopathological showed features of GCA. Discussion: With HIV, the HPV infection goes unchecked may develop into GCA. Malignant transformation to squamous cell carcinoma may occur in more than half of the cases. A complex interaction between HIV and HPV may lead to a higher risk of recurrence even after resection. The diagnosis is usually clinical. Imaging modalities may be used in identifying the extent and depth of invasion. Conclusion: The optimal management of anogenital giant condyloma acuminata remains to be determined. Staged surgical excision should be conducted to achieve an optimum outcome. Radical reconstructive surgery should be reserved for patients with recurrence, malignant transformation or sphincter involvement. Highlights: Giant condyloma acuminata (GCA) is a rare disease which is locally destructive in nature. Patients usually delay treatment until the growth restricts mobility or when it becomes infected. With HIV co-infection, the HPV infection goes unchecked may develop into GCA. Malignant transformation to squamous cell carcinoma may occur in more than half of the cases. Staged surgical excision with R0 resection should be conducted to achieve an optimum outcome.