Successfully treated patient with verrucous carcinoma developed from anogenital giant condyloma

Introduction: Verrucous carcinoma is a low-grade variant of squamous cell carcinoma. The anourogenital type is called Buschke-Loewenstein tumor. Mostly occurs in men under the age of 50. The pathogenesis is not yet fully elucidated. Often develops from condyloma, theories include HPV infection also, however no presence of HPV could be identified in most cases. Presents as exophytic, cauliflowerlike, well-differentiated lesions with minimal metastatic potential. The tumor may enlarge to enormous sizes, ulceration and bleeding may occur. Lymphadenomegaly is almost always reaction to bacterial superinfection. Treatment in most cases is surgical, but it responds well to chemo and/or radiation therapy as well. Prognosis is good, although local recurrence is not uncommon.

Case: 53 year old male without any co-morbidity, with a two fist size perineal mass expanding onto the scrotum, leaving the anus intact, was admitted to the emergency room due to weakness, stenocardia, generalized edema, bedriddenness and severe anemia. Patient has been observing the growing mass for 10 years, which became painful and bled recently. Received transfusion. CT scans showed no distant metastases. Primer biopsy justified condyloma acuminata. Authors performed a radical excision and wound was covered with xenograft. Histology proved verrucous carcinoma developed from a giant condyloma. Skin grafts were not required as the wound despite its size healed almost perfectly. Six months later excision and laser vaporization was performed due to local recurrence. Response to radiotherapy was good, thus patient is tumor free for eight months now.

Conclusion: Patients often seek medical attention tardily, which may cause difficulties in definitive treatment. Inadequate biopsy is also a pitfall in the diagnostic evaluation. Being so well differentiated the pathologist may misread the tissue. It has a potential to cause substantial morbidity and even mortality, resulting from local skin and soft tissue destruction. Therefore it's necessary to ensure attentive treatment plan and adequate patient follow-up.