Histologic Variants of Squamous Cell Carcinoma of the Skin

Margaret H. Rinker, MD; Neil A. Fenske, MD; Leigh Ann Scalf, MD, and L. Frank Glass, MD, Division of Dermatology and Cutaneous Surgery, Department of Internal Medicine at the University of South Florida, Tampa, Fla.

Cancer Control. 2001;8(4) 

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Giant Condyloma of Buschke and Löwenstein

Giant condyloma of Buschke and Löwenstein was first described in 1896.[26] It was further studied in 1925 by Buschke and Löwenstein,[22] at which time it was given its name.In 1948, Ackerman[20] described the term "verrucous carcinoma," which occurred in the oral cavity. It is now recognized that giant condyloma of Buschke and Löwenstein is a verrucous carcinoma localized to the anogenital region. It is also referred to as the Buschke-Löwenstein tumor,verrucous carcinoma of anogenital mucosa, or carcinoma-like condyloma.[27]

The classic Buschke-Löwenstein tumor occurs as an exophytic, fun gating,cauliflower-like mass on the penis. There may be ulceration or fistulous tracts with purulent, foul-smelling drainage. The most common site of involvement is the glans penis and prepuce, but this tumor may occur on any ano-urogenital surface.It is most frequently seen in middle-aged, uncircumcised men,with two thirds of cases occurring in men younger than 50 years of age.[25] It has also been reported to occur in women on the vulva, vagina, or cervix.[28] Swollen, tender lymph nodes commonly occur due to secondary bacterial infection. There is a strong association between the Buschke-Löwenstein tumor and HPV types 6 and 11. Other risk factors include poor hygiene and lack of cirmcumcision.[29]

A deep biopsy is required to confirm the diagnosis. Marked papillomatosis and acanthosis with hyperkeratosis and parakeratosis are present. A prominent granular layer with vacuolated cells similar to koilocytes may be seen. Blunt-shaped projections extend into the dermis, some forming sinuses with keratin-filled cysts. A dense, inflammatory infiltrate is often present.Contrary to invasive SCC, there is little atypia, and there are no infiltrating nests of squamous cells.Although this tumor rarely metastasizes,it can cause significant local destruction. It tends to have a downward growth pattern and may compress the corpus cavernosum and involve the urethra.[27]

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