Giant condylomata acuminata of Buschke and Lowenstein: A peristomal variant

Abstract

Introduction: Giant condylomata acuminata (GCA) is a rare, locally invasive tumour that may undergo malignant transformation. It was first described a HPV-induced penile tumour which clinically resembled both a squamous cell carcinoma and condyloma acuminatum, often arising from a pre-existing warty lesion. We describe a case of peri-stomal GCA transformation into invasive squamous cell carcinoma (SCC), which is, to our knowledge, the first report of this in the literature.

Presentation of case: A 74 year old gentleman developed an acuminate, papillomatous peristomal eruption around a fifty year old ileostomy, with biopsies of the eruption showing reactive changes. Two years later, he developed ulcerating plaques affecting the previously papillomatous areas and an erythematous nodular lesion involving the superior part of the ileostomy and adjacent skin. Histological examination of the ileostomy lesion showed focal small islands of atypical squamous epithelium, and moderately differentiated invasive squamous cell carcinoma was shown in the excised tissue subsequently. Human papillomavirus (HPV type 16), p16 and p53 tumour suppressors were positive in the peri-stomal skin sample.

Discussion and conclusions: Recurring, changing papillomatous lesions in the peristomal area should be reviewed with a high index of suspicion in relation to GCA tumours as they can progress to invasive squamous cell carcinomas.

Keywords: Buschke–Lowenstein tumour; Giant condylomata acuminata; Human papillomavirus; Stoma.

Fig. 1

(A) At presentation; superficial erosion at the 2 o’clock position and an exudative verrucous plaque at the 7–9 o’clock position. (B) Nine months later the plaque has recurred and is more obviously verrucous with acuminate papules. (C) Warty, papillomatous lesions affecting the ileostomy and peristomal skin.

Fig. 2

Histology of the biopsy to the ileostomy, showing squamous atypia (H&E, magnification 20×).

Fig. 3

Histology of the resected peristomal skin showing squamous cell carcinoma in situ on the upper left and squamous cell carcinoma invading into the subcutis on the right (H&E, magnification 40×).

Fig. 4

Immunohistochemistry staining for p16, showing diffuse positive staining in the non-neoplastic hyperplastic squamous epidermis (p16, magnification 40×).