Buschke-Löwenstein Anal Tumour in Children: Two Case Reports

Introduction

Buschke-Löwenstein tumour (BLT) or giant condyloma acuminatum is a large exophytic lesion of the anogenital region, with a clinically malignant aspect but a benign histology [1], [6], [7], [12]. First described by Buschke in 1896, then by Buschke and Löwenstein in 1925 as a lesion of the penis [1], [6], [7], [11], [12], it can affect all anogenital mucous membranes including the vulva, vagina, rectum, scrotum, perineum, and bladder [1]. Thereafter, few cases have been reported with only two series of adult patients in the English literature: Creasman et al. [7] in 1989 with 20 patients and Chu et al. [6] in 1994 with 42 patients. Because of its low incidence, this pathology is exceptional in childhood. There are only two case reports of giant condyloma acuminatum in children: Attipou et al. [3], in 2001, reported a case of a 14-year-old boy who died due to advanced disease, and in 2005 Ambriz-Gonzàlez et al. [1] described a case of a 12-year-old girl treated surgically with good results.

BLT is considered to be an intermediate lesion between common condyloma acuminatum and epidermoid carcinoma [1], [11]. Despite its benign histology, morbidity is due to the risk of local invasion, frequent local recurrence and malignant transformation, albeit with a low risk of metastasis [1], [6], [7], [12]. The entity is associated with HPV infection types 6 and 11 [1], [3], [6], [7], [12]. Although other risk factors including poor hygiene, promiscuity, immunosuppression and diabetes may be implicated [1], an important question in childhood is the elucidation of the route of transmission, with particular attention paid to the risk of sexual abuse [1], [3], [4], [5], [9], [11].

References

• 1 Ambriz-Gonzàlez G, Escobedo-Zavala L C, Carillo de la Mora F. et al . Buschke-Löwenstein tumor in childhood: a case report.  J Pediatr Surg. 2005;  40 25-27
• 2 Arbyn M, Dillner J. Review of current knowledge on HPV vaccination: an appendix to the European Guidelines for Quality Assurance in Cervical Cancer Screening.  J Clin Virol. 2007;  38 189-197
• 3 Attipou K, Yawovi K, James N. et al . Giant anal condyloma acuminatum in childhood: a case report.  Nig J Surg Res. 2001;  3 170-174
• 4 Boyd A S. Condylomata acuminata in the pediatric population.  Am J Dis Child. 1990;  144 817-824
• 5 Budayr M, Ankney R N, Moore R A. Condyloma acuminata in infants and children: a survey of colon and rectal surgeons.  Dis Colon Rectum. 1996;  39 1112-1115
• 6 Chu Q D, Vezeridis M P, Libbey N P. et al . Giant condyloma acuminatum (Buschke-Löwenstein tumor) of the anorectal and perianal regions. Analysis of 42 cases.  Dis Colon Rectum. 1994;  37 950-957
• 7 Creasman C, Haas P A, Fox Jr T A. et al . Malignant transformation of anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor).  Dis Colon Rectum. 1989;  32 481-487
• 8 Eyer de Jesus L, Cirne Neto O LL, Monteiro do Nascimento L M. et al . Anogenital warts in children: sexual abuse or unintentional contamination?.  Cad Saude Publica. 2001;  17 1383-1391
• 9 Marcoux D, Nadeau K, McCuaig C. et al . Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada.  Pediatr Dermatol. 2006;  23 199-207
• 10 Markowitz L E, Dunne E F, Saraiya M. et al . Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP).  MMWR Recomm Rep. 2007;  56 1-24
• 11 Noffsinger A, Witte D, Fenoglio-Preiser C M. The relationship of human papillomaviruses to anorectal neoplasia.  Cancer. 1992;  70 1276-1287
• 12 Trombetta L J, Place R J. Giant condyloma acuminatum of the anorectum: trends in epidemiology and management. Report of a case and review of the literature.  Dis Colon Rectum. 2001;  44 1878-1886