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

Clinical Course

The patient was given fluid hydration in the emergency department. After numerous episodes of witnessed BRBPR, surgery was consulted. Meanwhile, a bleeding scan was done, which was normal. The patient's vital signs were stable throughout this hospitalization. Surgery initially evaluated the patient before consulting gastroenterology. At this time, repeat hemoglobin was 10.2 g/dL. Due to continuous rectal bleeding and palpable rectal mass, a flexible sigmoidoscopy was performed, which revealed a 3-cm polypoid mass extending along the anterior wall of the rectum (Figure 1). The mucosa was very friable. Multiple biopsies were taken endoscopically (Figure 2) and it was noted that the mass was attached to the rectal wall by a thick stalk (Figure 3). The mass was prolapsed through the anus but was not excised in the endoscopy suite (Figure 4). The mass was pushed back into the rectum and the patient was admitted to the surgical service. The patient required multiple blood transfusions while his hemoglobin decreased steadily to a nadir of 7.9 g/dL. MRI of the abdomen and pelvis with gadolinium displayed a large mid-to-distal rectal cancer with evidence of penetration through the right lateral mesorectal fascia, as well as 4 pathologically enlarged mesorectal lymph nodes. Biopsy showed a grossly pedunculated mass. Histology demonstrated large squamous nests with mild cytologic atypia and pushing borders, raising the possibility of verrucous carcinoma (Figure 5). The patient was taken to the operating room for excision of the mass. He remained in the hospital for several days postoperatively and then decided to return to Taiwan for the remainder of his care.

Figure 1. Retroflexed view of the lesion in the rectum.

Figure 2. Forward view of lesion with biopsy forceps in sight.

Figure 3. Manually prolapsed condyloma with bleeding after multiple biopsies.

Figure 4. Condyloma retracted to visualize the stalk.

Figure 5. Giant condyloma under low power. Broad-based invaginating nests of squamous mucosa without cellular atypia.

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