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  • Rapid progression of an anal Buschke–Löwenstein tumour into a metastasising squamous cell carcinoma in an HIV-infected patient

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Rapid progression of an anal Buschke–Löwenstein tumour into a metastasising squamous cell carcinoma in an HIV-infected patient
  1. A Handisurya1,
  2. A Rieger1,
  3. Z Bago-Horvath2,
  4. C Schellenbacher1,
  5. A Bankier3,
  6. A Salat4,
  7. G Stingl1,
  8. R Kirnbauer1
  1. 1
    Laboratory of Viral Oncology (LVO), Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University Vienna, Vienna, Austria
  2. 2
    Department of Pathology, Medical University Vienna, Vienna, Austria
  3. 3
    Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  4. 4
    Department of General Surgery; Medical University Vienna, Vienna, Austria
  1. Dr R Kirnbauer, Department of Dermatology, DIAID, Medical University Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria; reinhard.kirnbauer{at}meduniwien.ac.at

Abstract

Background: Buschke–Löwenstein tumour (BLT) of the anogenitalia is a locally invasive, destructively growing verrucous carcinoma that does not metastasise. Histologically BLT resembles benign condylomata acuminata. Nevertheless, the tumour grows relentlessly and may rarely progress into squamous cell cancer (SCC).

Results: A human immunodeficiency virus (HIV)-infected immunosuppressed patient developed (peri)anal warts accompanied by recurrent abscesses and fistulae. Histology revealed condylomata acuminata, and low-risk genital human papillomavirus (HPV) type 11b was detected. Six months later, the tumour had progressed into an ulcerated SCC that destroyed the rectum and perineum, with metastases to the inguinal lymph nodes. Whereas highly active antiretroviral therapy (HAART) effectively suppressed HIV replication, radiochemotherapy plus anti-EGFR antibody did not halt tumour progression, and the patient died from tumour-cachexia.

Discussion: As far as is known, this is the first report demonstrating rapid progression of a BLT into a metastasising SCC in an HIV-infected patient.

https://doi.org/10.1136/sti.2008.034959

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    Footnotes

    • Contributors: AH, AR, GS and RK were involved in the clinical care of this patient. AH and CS collected data; AH and RK prepared the manuscript and carried out the literature review; RK and GS reviewed the manuscript before submission; AH and RK revised the manuscript for resubmission; AS supplied the biopsies; ZB-H supplied the histopathology; AB supplied the radiographs.

    • Funding: Supported by a grant to RK from the Austrian Science Foundation (FWF; P18990-B13).

    • Competing interests: None.

    • Patient consent: Obtained.