What is Giant Condylomata Acuminata of Buschke and Lowenstein?
Giant condyloma of Bushke-Löwenstein (GCBL) is a rare but serious type of skin cancer that was first identified by two doctors, Buschke and Löwenstein, in 1925. This type of cancer, also known as verrucous carcinoma, most often develops on the penis’s tip, the foreskin, or the area around the anus. Still, it can also appear in other areas related to sexual organs, such as the vulva (the external part of a woman’s genitals), vagina, or bladder. In rare cases, GCBL can even be found in areas like the armpits.
GCBL usually starts as a small, rough growth on the penis or around the head of the penis. Over several years, it slowly turns into a larger, cauliflower-like lump, often growing to be 10 to 15 cm big, and develops skin tunnels and a stone-like appearance.
Although GCBL grows slowly and looks benign (non-cancerous) under the microscope, it indeed behaves like a malignant (cancerous) tumor. This is due to its destructive nature in the area it appears and its tendency to come back even when removed. It can form sores and spread into nearby tissues, but it usually doesn’t spread to other parts of the body; this process is known as metastasis. However, there have been reports where GCBL has transformed into a more severe form of cancer.
What Causes Giant Condylomata Acuminata of Buschke and Lowenstein?
Several reasons can increase the risk of GCBL, a medical condition that affects the genitals. Some of these risk factors are common, while others are specific to certain groups or situations. Here are some of the factors:
Long-lasting phimosis, which is a condition where the foreskin can’t be pulled back over the head of the penis. This is often seen in males who haven’t been circumcised.
Poor hygiene of the penis, often observed in males not circumcised.
Being immunosuppressed, which means the immune system is weakened, making it harder to fight off infections and diseases. This could be due to having HIV or take certain medicines that suppress the immune system.
Prolonged irritation from other medical conditions like ulcerative colitis, which is a chronic disease that affects the colon, or perianal fistulas, which are small tunnels that develop between the end of the bowel and skin near the anus.
Having conditions like diabetes or habits like smoking and substance abuse.
Pregnancy can also increase the risk, as can being in a poor socioeconomic situation.
Risk Factors and Frequency for Giant Condylomata Acuminata of Buschke and Lowenstein
GCBL, a type of tumor, tends to occur more often in males than females, particularly in uncircumcised males under 50 years old. It’s quite rare in children. So far, there’s no evidence that this tumor affects one race more than another. It’s also worth noting that the rates of GCBL are higher in men who have sex with other men, including gay and bisexual men.
- GCBL makes up about 5% to 24% of all the penile tumors reported in the US.
- There have only been a few cases of GCBL reported outside of the penis.
- Although penile cancers are more common outside the US, we don’t have enough reliable data about the international rates of GCBL.
Signs and Symptoms of Giant Condylomata Acuminata of Buschke and Lowenstein
GCBL, or Giant Condyloma of Buschke-Lowenstein, often starts out as a small, rough spot, typically on the foreskin of the penis, and over time (sometimes up to twenty years), it transforms into a large, abnormal growth that looks like a cauliflower. This unusual growth, which can reach a size around twenty centimeters, can form sores or protrusions and often has a bad smell. On the penis, it can spread into the urinary tube or the erectile tissue and create abnormal passages, or fistulas. While this tumor can lead to swollen lymph nodes, it is usually due to the tumor spreading and not because of the spread of cancer cells, which is quite rare.
For perianal GCBL, which is growth near or around the anus, the first noticeable signs often include a painful lump, bleeding, the formation of abnormal passages, or pockets of infection (abscesses). Starting at the transition area between the inner anus and the outer skin surface, it usually grows outward, often involving the anal canal.
In people with weakened immune systems and pregnant individuals, GCBL grows much more quickly compared to people with normal immune function and those who are not pregnant.
Testing for Giant Condylomata Acuminata of Buschke and Lowenstein
A biopsy is a common way to diagnose GCBL, a type of medical condition. During a biopsy, a small amount of tissue is taken from the body so that it can be examined under a microscope. When performing a biopsy on a suspected GCBL area, it’s crucial that the doctor removes enough tissue to reach the lower layers where the disease is likely to be situated. The doctor will also look out for any signs of SCC (Squamous Cell Carcinoma) since its presence could potentially increase the chances of the disease reoccurring or spreading to other parts of the body.
Magnetic Resonance Imaging (MRI), a type of scanner that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body, helps doctors explore the spread of the tumor. The test with a special dye known as gadolinium contrast is used to highlight areas of your body that the doctor needs to focus on. This helps in planning any future surgery that may be necessary to remove the tumor.
Another procedure called a sentinel lymph node biopsy could be considered. This procedure detects cancer cells in the lymph nodes, but it is only used when there is strong clinical evidence suggesting that it is necessary. The reason for this is because GCBL usually does not spread or “metastasize” to the lymph nodes, which are small glands that produce and store cells that fight infection and disease.
Treatment Options for Giant Condylomata Acuminata of Buschke and Lowenstein
The best method to treat Giant Condyloma of Buschke and Löwenstein (GCBL), a very rare type of skin tumor, depends on several factors. These include the size and location of the tumor, how many tumors there are, the patient’s overall health, what the patient prefers and what treatments are available at their healthcare facility.
The most commonly recommended treatment is a wide surgical excision, or the complete removal of the tumor. One particularly effective surgical method is Mohs surgery, which saves as much healthy tissue as possible while also allowing the doctor to make sure that all the tumor cells have been removed. If there are any skin defects after surgery, they can be fixed later with a split-thickness graft, a procedure where a thin layer of skin is transplanted from another part of the body.
If there are any recurrences of GCBL, they are usually treated with another surgery. Carbon dioxide or argon lasers may also be used for this purpose.
Aside from surgery, there are several other treatment options available. These include both local and systemic chemotherapy with various drugs like fluorouracil (5-FU), podophyllin, cidofovir, interferon, imiquimod, bleomycin, cisplatin, and leucovorin. Local chemotherapy applies the drugs directly to the tumor, while systemic chemotherapy involves taking the drugs through the mouth or injecting them into a vein so that they can reach cancer cells throughout the body. These drugs can be used before (neoadjuvant) or after (adjuvant) surgery to help prevent the tumor from coming back.
However, these chemotherapy drugs are generally not used alone as they haven’t shown very promising results when used this way.
Radiation therapy, which uses high energy rays or particles to kill cancer cells, is another treatment option. Despite being useful in limited GCBL cases when used before surgery, it is mostly avoided due to the concern that it might cause the tumor cells to become even more cancerous (anaplastic transformations).
Yet another treatment approach that has shown promising results is autologous vaccination therapy. This therapy involves taking a piece of the tumor from the patient’s body, treating it so that it cannot grow again, and then reintroducing it back into the body. The goal is to stimulate the patient’s immune system to recognize and destroy the tumor cells.
What else can Giant Condylomata Acuminata of Buschke and Lowenstein be?
When doctors are trying to diagnose a condition called Giant Condyloma of Buschke and Lowenstein (GCBL), they consider several other possibilities before making a determination. These are:
- Condyloma acuminatum (a type of genital wart)
- Various forms of skin cancer such as papillary carcinoma, warty carcinoma, and carcinoma cuniculatum
- Rectal cancer (primary rectal adenocarcinoma)
- Bowenoid papulosis (a skin condition related to the human papillomavirus, or HPV)
- Lymphangiomas (benign masses that occur due to an obstruction in the lymphatic system)
Surgical Treatment of Giant Condylomata Acuminata of Buschke and Lowenstein
Giant condyloma of Bushke-Löwenstein (GCBL) is a condition that typically needs extensive medical treatment, including removal of large, afflicted regions of the body. This can sometimes leave substantial areas needing repair, which can be quite challenging. Medical reports have discussed the use of a procedure known as ‘reconstructive surgery with a flap’ to help cover these areas after GCBL has been removed. Essentially, this type of surgery uses a piece of tissue that is still attached to the body (a “flap”) to cover the area where the treatment took place.
What to expect with Giant Condylomata Acuminata of Buschke and Lowenstein
GCBL, if not treated properly, is always fatal because of its destructive nature. It spreads into and damages organs and bones in the pelvic area. Even when sufficiently treated, about 21% of patients don’t survive, and there’s a recurrence rate of roughly 68%.
Also, malignant transformations, which is a change where normal cells become cancer cells, are found in up to 56% of GCBL lesions.
Possible Complications When Diagnosed with Giant Condylomata Acuminata of Buschke and Lowenstein
Complications related to GCBL, also known as Granulomatous Cheilitis or Miescher’s Cheilitis, can vary widely. They may consist of complications arising from the treatment itself or from the condition. The list of these complications includes:
- Creation of an abnormal connection between two body parts, otherwise known as fistula formation
- Secondary infections, meaning infections that occur as a result of the original condition
- Discharge that has a bad smell
- Frequent return of the condition, even after treatment
- Transformations into a malignant, or cancerous state
Preventing Giant Condylomata Acuminata of Buschke and Lowenstein
Given that circumcised boys are less likely to develop GCBL, a type of penis problem, it’s really important that we help parents learn about the benefits of having their newborn boys circumcised. This isn’t just to help avoid GCBL, but also other potential issues with the penis.
We should also talk to patients about using condoms, because these can reduce the chances of getting HPV, which is a virus that is often linked to GCBL.
Moreover, there’s a vaccine for HPV which should be taken by individuals between the ages of nine and twenty-six. This vaccine helps to protect against HPV Types 9 and 11, these are the types most associated with causing GCBL.
