Skip to main content

Advertisement

SpringerLink
Log in

Clinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases

  • Original Article
  • Published:
Virchows Archiv Aims and scope Submit manuscript

Abstract

Buschke-Löwenstein tumor (BLT) is a rare sexually transmitted disease, mostly described in clinical literature as case reports or small series. Here, we investigated the clinicopathologic features of BLT in a total of 38 cases retrieved from multiple academic institutions. The average age was 47.6 ± 12.8 (mean ± SD) years old at diagnosis. The male to female ratio was 4.4:1. Common presenting symptoms were pain/discomfort, bleeding, mass lesion, and discharge. It was frequently linked to smoking and positive human immunodeficiency virus status. The tumor size and thickness were 8.5 ± 6.6 cm and 1.5 ± 1.3 cm, respectively. Histologically, 19 (50%) cases had an invasive squamous cell carcinoma component and were associated with high-risk human papillomavirus infection. There was no lymphovascular or perineural invasion, or nodal metastasis at initial diagnosis. BLTs with invasion had higher frequency of dyskeratosis, neutrophilic microabscesses, and abnormal mitoses, but lower frequency of pushing border compared with BLTs without invasion. All patients underwent wide excision, and some also received chemoradiation therapy. After a median follow-up of 23 months (range 1–207), the recurrence rate was 23.7% and disease-specific mortality was 2.6%. In summary, we presented the largest case series of BLT to date to characterize its unique clinicopathologic features. Our study indicated that certain histologic features such as dyskeratosis, neutrophilic microabscess, and abnormal mitosis in the non-invasive portion may be important clues on lesional biopsy to predict the presence of underlying invasive carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Erkek E, Basar H, Bozdogan O et al (2009) Giant condyloma acuminata of Buschke–Lowenstein: successful treatment with a combination of surgicalexcision, oral acitretin and topical imiquimod. Clin Exp Dermatol 34:366–368

    Article  CAS  Google Scholar 

  2. Steffen C (2006) The men behind the eponym – Abraham Buschke and LudwigLowenstein: giant condyloma (Buschke–Loewenstein). Am J Dermatopathol 28:526–536

    Article  Google Scholar 

  3. Trombetta LJ, Place RJ (2001) Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. Dis Colon Rectum 44:1878–1886

    Article  CAS  Google Scholar 

  4. Chu QD, Vezeridis MP, Libbey NP, Wanebo HJ (1994) Giant condyloma acuminatum (Buschke–Lowenstein tumor) of the anorectal and perianal regions. Analysis of 42 cases. Dis Colon Rectum 37:950–957

    Article  CAS  Google Scholar 

  5. Creasman C, Haas PA, Fox TA et al (1989) Malignant transformation of anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor). Dis Colon Rectum 32:481–487

    Article  CAS  Google Scholar 

  6. Boshart M, zur Hausen H (1986) Human papillomaviruses in Buschke–Lowensteintumors: physical state of the DNA and identification of a tandem duplication in the noncoding region of a human papillomavirus 6 subtype. J Virol 58: 963–966.

  7. Rubben A, Beaudenon S, Favre M et al (1992) Rearrangements of the upstream regulatory region of human papillomavirustype 6 can be found in both Buschke–Lowenstein tumours and in condylomataacuminata. J Gen Virol 73:3147–3153

    Article  Google Scholar 

  8. Gissmann L, de Villiers EM, zur Hausen H (1982) Analysis of human genital warts (condylomata acuminata) and other genital tumors for human papillomavirus type 6 DNA. Int J Cancer 29: 143–146.

  9. Haycox CL, Kuypers J, Krieger JN (1999) Role of human papillomavirus typing in diagnosis and clinical decision making for a giant verrucous genital lesion. Urology 53:627–630

    Article  CAS  Google Scholar 

  10. Yang C, Liu S, Wang Z, Yang S (2013) Buschke-Löwenstein tumor in an old woman: cryotherapy and holmium laser treatment. Arch Gynecol Obstet 288:221–223

    Article  Google Scholar 

  11. Geusau A, Heinz-Peer G, Volc-Platzer B, Stingl G, Kirnbauer R (2000) Regression of deeply infiltrating giant condyloma (Buschke–Lowenstein tumor) following long-term intralesional interferon alfa therapy. Arch Dermatol 136:707–710

    Article  CAS  Google Scholar 

  12. Ilkay AK, Chodak GW, Vogelsang NJ et al (1993) Buschke-Loewenstein tumor: therapeutic options including systemic chemotherapy. Urology 42:599–601

    Article  CAS  Google Scholar 

  13. Heinzerling LM, Kempf W, Kamarashev J, Hafner J, Nestle FO (2003) Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology 207:119–122

    Article  CAS  Google Scholar 

  14. Gholam P, Enk A, Hartschuh W (2009) Successful surgical management of giant condyloma acuminatum (Buschke-Löwenstein tumor) in the genitoanal region: a case report and evaluation of current therapies. Dermatology 218:56–59

  15. Zidar N, Langner C, Odar K, Hošnjak L, Kamarádová K, Daum O, Pollheimer MJ, Košorok P, Poljak M (2017) Anal verrucous carcinoma is not related to infection with human papillomaviruses and should be distinguished from giant condyloma (Buschke-Löwenstein tumour). Histopathology 70:938–945

    Article  Google Scholar 

  16. Tytherleigh MG, Birtle AJ, Cohen CE, Glynne-Jones R, Livingstone J, Gilbert J (2006) Combined surgery and chemoradiation as a treatment for the Buschke-Lowenstein tumour. Surgeon 4:378–383

    Article  CAS  Google Scholar 

  17. Nascimento AF, Granter SR, Cviko A, Yuan L, Hecht JL, Crum CP (2004) Vulvar acanthosis with altered differentiation: a precursor to verrucous carcinoma? Am J Surg Pathol 28:638–643

  18. Del Pino M, Bleeker MCG, Quint WG et al (2012) Comprehensive analysis of human papillomavirus prevalence and the potential role of low-risk types in verrucous carcinoma. Mod Pathol 25:1354–1363

    Article  Google Scholar 

  19. Patel KR, Chernock RD, Zhang TR et al (2013) Verrucous carcinomas of the head and neck, including those with associated squamous cell carcinoma, lack transcriptionally active high-risk human papillomavirus. Hum Pathol 44:2385–2392

    Article  CAS  Google Scholar 

  20. Odar K, Kocjan BJ, Hošnjak L, Gale N, Poljak M, Zidar N (2014) Verrucous carcinoma of the head and neck – not a human papillomavirus-related tumour? J Cell Mol Med 18:635–645

    Article  CAS  Google Scholar 

  21. Tauber M, Monsel G, Bonnecarrère L et al (2014) Unresectable perineal cuniculatum carcinoma: partial remission using systemic isotretinoin and interferon-α2a therapy. Acta Derm Venereol 94:721–722

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA

    Dongwei Zhang, Michael Feely, Jinping Lai & Xiuli Liu

  2. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Dongwei Zhang, Raul S. Gonzalez & Xiaoyan Liao

  3. Department of Pathology, Albany Medical Center, Albany, NY, USA

    Kavita Umrau & Hwajeong Lee

  4. Department of Pathology, Cleveland Clinic, Cleveland, OH, USA

    Daniela S. Allende

  5. Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Dipti M. Karamchandani & Michael Zaleski

  6. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Jingmei Lin

  7. Department of Pathology, University of Michigan, Ann Arbor, MI, USA

    Maria Westerhoff

  8. Department of Pathology, Yale School of Medicine, New Haven, CT, USA

    Xuchen Zhang

  9. Department of Pathology, University of Chicago Medicine, Chicago, IL, USA

    Lindsay Alpert

Authors
  1. Dongwei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raul S. Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Feely
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kavita Umrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hwajeong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniela S. Allende
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dipti M. Karamchandani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Zaleski
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jingmei Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maria Westerhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Xuchen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lindsay Alpert
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Xiaoyan Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jinping Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Xiuli Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DZ and XL (Xiuli Liu) contributed to the design and implementation of the study, to the analysis of the results, and to the writing of the manuscript. RG, MF, KU, HL, DA, DK, MZ, JL, MW, XZ, LA, and JL contributed to the retrieval of the cases and interpretation of the results. All authors provided critical feedback and helped shape the research, analysis, and manuscript. XL (Xiaoyan Liao) contributed to the final version of the manuscript.

Corresponding author

Correspondence to Dongwei Zhang.

Ethics declarations

The study was approved by Institutional Review Board of each participating institution.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, D., Gonzalez, R.S., Feely, M. et al. Clinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases . Virchows Arch 476, 543–550 (2020). https://doi.org/10.1007/s00428-019-02680-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00428-019-02680-z

Keywords

Search

Navigation