Giant Buschke-Levenstein condyloma (carcinoma-like genital warts) is a type of genital warts characterized by progressive growth, large size and persistent recurrence after treatment. It is characterized by pronounced exophytic and endophytic growth with destruction of surrounding tissues, the possibility of degeneration into squamous cell skin cancer. The diagnosis of giant Buschke-Levenstein condyloma is based on its clinical picture and requires histological confirmation, which is carried out after the removal of the tumor. Treatment consists in complete excision of warts against the background of general restorative and antiviral therapy, local administration of interferons and bleomycin.
Giant Bushke-Levenstein condyloma occurs both at a young and in old age. It is most often observed in men and is located on the penis. Less often, the development of warts is noted on the genitals of women. Extragenital localization may occur.
Giant Buschke-Levenstein condyloma, along with Bowen’s disease, bovenoid papulosis, Keir’s disease, pigmented xeroderma and cutaneous horn, refers to precancerous skin neoplasms. Its transformation into skin cancer can be facilitated by poor personal hygiene, decreased immunity, prolonged irritating effects of external factors.
The appearance of the giant Buschke-Levenstein condyloma is caused by the human papillomavirus (HPV). Predisposing factors to its occurrence are considered traumatization, immunosuppression, phimosis, excessive sweating, sexual infections (ureaplasmosis, chlamydia, cytomegaly). In venereology, isolated cases of the development of giant Buschke-Levenstein condyloma against the background of lichen planus and scleroatrophic lichen have been observed.
The disease begins with the appearance of small formations on the skin, similar to papillomas, warts or genital warts. These elements rapidly increase in size and merge with each other, forming a single lesion site – a giant Bushke-Levenstein condyloma. It has a wide base covered with villous growths and vegetations separated by pronounced grooves. Isolated genital warts are observed along the periphery of the formation. Over time, vegetation grows, becomes covered with scales of keratinized epithelium and macerated. In the grooves passing between them, a discharge accumulates, which has an unpleasant smell. Infection often occurs, as a result of which the discharge becomes purulent.
Most often, the giant Bushke-Levenstein condyloma is localized on the penis in the area of its head or coronal furrow. It may appear in the anorectal area, around the anus, in the groin, on the skin of the labia and clitoris in women, on the face (on the cheeks, around the mouth, in the eyelids or nose), on the oral mucosa or genitourinary organs.
Giant Bushke-Levenstein condyloma is characterized by slow, steadily progressive growth and a tendency to relapse. Together with the pronounced exophytic growth of the giant Bushke-Levenstein condyloma, leading to its growth in the “cauliflower” type, there is a pronounced germination into the surrounding tissues. The progressive growth of the formation can lead to the destruction of the foreskin, the introduction of the tumor into the cavernous bodies, the germination of adjacent tissues with the formation of fistulas and ulceration. Possible malignancy of giant condyloma with its transition to squamous cell skin cancer.
The diagnosis of giant condyloma is established by a venereologist. To do this, he conducts an examination of the formation and its differential diagnosis with diseases similar in manifestations: genital warts, broad warts characteristic of secondary syphilis, oral papillomatosis, anogenital warts, squamous cell skin cancer. Additionally, PCR studies on HPV are carried out.
The final diagnosis of giant Buschke-Levenstein condyloma can be made only by the histology data of the material removed during surgical treatment. To exclude the malignant transformation of warts, the study is carried out with several tissue samples taken from different areas of the tumor. The histological picture of giant Buschke-Levenshtein condyloma has similarities with the picture of ordinary genital warts and differs only in a greater degree of severity of pathological changes. There is a marked increase in the thickness of the stratum corneum of the epidermis and the germination of condyloma into the deep layers of the dermis. A sign of malignant transformation is the detection of areas of tumor tissue corresponding to the histological picture of cancer in situ.
Given the invasive and rapid growth of giant condyloma, the possibility of its transformation into cancer, its extensive surgical excision is recommended. The operation should be performed as soon as possible after the tumor is detected. Additional cryodestruction of the tumor base is recommended to prevent postoperative recurrence of giant Buschke-Levenstein condyloma.
Surgical treatment is combined with systemic antiviral and general restorative therapy. A number of authors point to the expediency of local administration of interferons, their inducers and bleomycin in the postoperative period.
Radiotherapy of giant condyloma is contraindicated, as it can give an impetus to the cancer transformation of the tumor.
Prognosis for giant Bushke-Levenstein condyloma
Despite the complete and absolutely correct treatment, the giant Bushke-Levenstein condyloma can give relapses. Its malignant transformation is observed in the period from 2 to 12 years after the onset of the disease.