Inverted-Growth Buschke-Löwenstein Tumor: A Case Report with Therapeutic Proposal
DOI:
https://doi.org/10.22516/25007440.1258Keywords:
Condyloma acuminatum, human papillomavirus,, verrucous carcinoma, anoscopy, anal cancer, anal neoplasmsAbstract
The Buschke-Löwenstein tumor (BLT) is a type of giant epithelial tumor typically characterized by a broad base, infiltrative potential, and local tissue destruction. As a result, recurrences are common, which confers a certain degree of malignant potential. From a histopathological standpoint, it is composed of hyperplastic epithelium, minimal atypia, and well-differentiated tissue with hyperkeratosis, parakeratosis, and the presence of koilocytes. This finding is a hallmark of human papillomavirus (HPV) infection at the cellular level, along with granular changes and mitotic activity in the basal layer. This article describes a rare variant with inverted growth and infiltration of the anal and perianal tissues, associated with a clinical presentation of anal fissures and fistulas. A therapeutic proposal is also discussed. The case involves a 35-year-old male from Bello, Antioquia, who presented to our institution with a 4-year history of perianal openings with purulent discharge, pain, and bleeding. A contrast-enhanced pelvic MRI revealed infiltration of the anal, perianal, and adipose tissues by condylomatous lesions with displacement of adjacent structures. A medical management protocol developed at the Instituto de Coloproctología (ICO) in Medellín, Colombia, was implemented and complemented with surgical treatment.
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