Giant Cumulated Condyloma (Tumor of Buschke Lõwenstein). Presentation of a Case

The condylomataacuminataor genital warts are produced by the human papiloma virus. Infection typically occurs when host basal cells are exposed to viral infection through a damaged epitelial barrier, such as during sexual inter course or as a product of other minor skin abrasions. In few occasions they can evolve with a marked growth and cause the well-known Buschke-Löwenste in síndrome or Giant Condiloma Acuminado. We present a patient with Giant Condyloma Accumulated in the inguinal and anal regions that was surgically treated with exeresis of the inguinal lesions and electro fulguration of the annals with satisfactory evolution, without tumor recurrence at three months.


Introduction
Condylomataacuminata or genital warts are one of the most common sexually transmitted diseases. They are produced by the human papillomavirus. Infection typically occurs when host basal cells are exposed to viral infection through a damaged epithelial barrier, such as during sexual intercourse or as a product of other minor skin abrasions (1,2).
The presence of other associated factors is necessary to produce the disease such as: sexual promiscuity, poor nutrition, smoking, depression of the immune system and prolonged use of oral contraceptives. (1,2,3) On rare occasions they can evolve as an invasive tumor with local malignancy, although without metastasis, equivalent to a verrucous carcinoma and it is when they are diagnosed as Buschke-Löwenstein syndrome or tumor.

Presentation of the Case
Male patient I.K.M. 47 years old, Bahamés, who attended the surgery clinic of the Central Clinic "Cira García" for presenting skin lesions in the inguinal and anal region of 5 years of evolution that have been growing progressively. It started as a "little ball" until it reached the size of a tumor lesion approximately 20 cms. high, of semi-hard consistency. Therefore, their admission is decided for study and surgical treatment.

The condylomataacuminataor genital warts are produced by the human papiloma virus. Infection typically occurs when host basal cells are exposed to viral infection through a damaged epitelial barrier, such as during sexual inter course or as a product of other minor skin abrasions. In few occasions they can evolve with a marked growth and cause the well-known Buschke-Löwenste in síndrome or Giant Condiloma Acuminado. We present a patient with Giant Condyloma Accumulated in the inguinal and anal regions that was surgically treated with exeresis of the inguinal lesions and electro fulguration of the annals with satisfactory evolution, without tumor recurrence at three months.
Keywords: Giant Condiloma Accuminado. Warty carcinoma. The diagnosis was concluded as a giant Condilomatosis or Buschke-Lowenstein tumor.

Giant Cumulated Condyloma (Tumor of Buschke Lõwenstein). Presentation of a Case
The patient progressed satisfactorily and remains in follow-up bySurgery. There have been no recurrences after three months of surgery.

Discussion
The Buschke-Lowenstein tumor is a rare variant genital condyloma associated with infection by HPV strains 6 and 11. The average age of presentation is under 50 years, with a predominance of men in a 3: 1 ratio. It is a pre-malignant lesion, considered an atomopathologically between condyloma acuminatum and perianal squamous cell carcinoma, which explains its high morbidity and mortality. It is characteristically
Rectosigmoidoscopy: No internal injury, no anal canal involvement was observed.
He underwent a complete excision of the lesion of the inguinal region and electro-fulguration of the perianal lesion. It was not necessary to perform the plastic reconstruction given the pedunculated characteristic of the inguinal lesion that was completely resected.

Giant Cumulated Condyloma (Tumor of Buschke Lõwenstein). Presentation of a Case
bulky (more than 10 cm in diameter) and slowgrowing and exophytic with a tendency to invade and destroy the tissues on which it sits. (5, 6,) Among the risk factors that predispose to suffer from this pathology we can find: immuno suppression (mostly with HIV positive), homosexuality, promiscuity, poor genital hygiene, chronic genital infections, malnutrition and alcoholism. Freed to its free evolution, this tumor can spread intraanally, fistulize, become infected, recur once it is operated (66%) or undergo malignant transformation (56%). (7. 8) The Buschke-Lowenstein tumor does not present cellular atypia, it is a benign tumor, but in 30% of cases it can be malignant; nevertheless, due to the great power it has of recurrence, it is considered by some authors as a malignant tumor. (9,10.) The differential diagnosis of Buschke-Lowenstein tumor will be made with other pathologies of genital location among them: Bowen's disease in its condylomatous form, pseudo-epitheliomatous balanitis caused by fungi, spinocellular epitheliomas, warty carcinomas, syphilis, lymphogranulomatosis venereum (Nicolás disease) Favre). The difference of the giant acuminate condyloma is that it is more proliferating and penetrates deeper tissues than squamous cell tumors, respects the basement membrane and does not metastasize. Of the rest of the pathologies raised is discarded by serology and other complementary. (8,11,12).
Regarding treatment, the most appropriate option is the radical surgical excision of the lesions and their anatomopathological study. Some cases may even require abdomino-perineal amputation. Other treatments that have been used in some cases are chemo and radiotherapy, as well as topical treatments although the available bibliographic evidence is not conclusive regarding the systematic use of them, tending in general terms to be ineffective. (12,13,14).

Conclusions
Definitive diagnosis: Tumor of Buschke Lõwensteinor Condiloma Accuminado Gigante Surgical treatment: excision of inguinal lesions and electro fulguration of anal lesions.
Evolution: Satisfactory. There have been no recurrences in the assessment performed at 3 months.