Giant Condyloma of Buschke-Lowenstein: An Atypical Case

Joseph K. Kim, MD; Gabriel S. Levi, MD; David L. Carr-Locke, MD

Disclosures

January 05, 2012

Introduction and Case Report

Introduction

Giant condyloma of Buschke-Lowenstein (GCBL) was first discovered in the 1920s and has been a topic of controversy for both pathologic and clinical evaluation and treatment. Multiple nomenclatures have been given to this disease, namely giant condyloma, verrucous carcinoma, giant condyloma with carcinoma in situ, and giant condyloma with squamous cell carcinoma.[1] Regardless of the title, this phenomenon is locally aggressive but histologically innocuous. GCBL is most commonly seen on the glans penis, but cases of presentation elsewhere in the anogenital region do exist.[2] This case report describes a patient diagnosed with GCBL histologically with radiographic suggestion of a highly metastatic variant.

Clinical Presentation

A 25-year-old Taiwanese man with a history of HIV presented with painless bright red blood per rectum (BRBPR) with clots for 36 hours. He was an international exchange student who lived primarily in Taiwan but had also spent several years in Brussels. He was in New York City for a 3-month exchange program at the time of his presentation. The patient was not on antiretroviral therapy for HIV. He admitted to bisexual activity but denied anal trauma, stating that last intercourse was more than 3 weeks ago. Before presentation, the patient was in his usual state of health. He denied fevers, chills, or abdominal pain. He also denied sick contacts. The patient had no family history of colonic disorders or bleeding abnormalities. He stated that the episodes were as frequent as every hour. The volume was described as "filling the toilet bowl." The patient also noted slight shortness of breath.

Physical Examination

The patient appeared healthy and was in no distress. His temperature was 98.7°F, blood pressure was 131/73 mm Hg, respiratory rate was 16 breaths per minute, heart rate was 103 beats per minute, and oxygen saturation was 98% on room air. Abdominal examination was completely benign. The patient's sheets were stained with bright red blood and several quarter-sized clots. Rectal examination revealed a large circumferential, firm, nodular, and mobile mass in the rectum. Subsequently, the patient had a large episode of BRBPR.

Laboratory and Radiologic Findings

Basic metabolic panel was normal with a blood urea nitrogen of 13 mg/dL and creatinine of 0.78 mg/dL. White blood cell count was 8500 cells/μL with 54% segmented neutrophils and 34% lymphocytes. Hemoglobin was 12.4 g/dL with a mean corpuscular volume of 90 fL. Platelets were 391,000 cells/μL and coagulations studies were within normal. Gastrointestinal bleeding scan was also normal.

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