Introduction Buschke Löwenstein tumour (BLT) is a rare Human Pappiloma Virus (HPV)- triggered indolent lesion involving perineal and/or perianal skin. The lesions are locally invasive and difficult to manage because of the voluminous tissue bulk and recurrence potential. Underlying immune defect in the background of HIV infection may enhance tumour-aggressiveness in these lesions. Three HIV-infected patients with BLT have been reported.
Case reports Patient 1: A 46-year-old woman presented with a cauliflower-like pink, fleshy mass of 18 months duration, protruding through the anal orifice, causing discomfort and disturbance in defecation. She was HIV-infected, acquired through conjugal relation. In addition to the above lesion, she had multiple genital molluscum contagiosum and bowenoid papulosis. Her CD4 T cell count was 350 and she was not on antiretroviral therapy (ART). Histopathology of the lesion was suggestive of BLT. The patient was treated with cryotherapy followed by surgical debulking of the lesion. ART was advised. Patient 2: A 35-year-old commercial sex worker presented with a large, variegated growth involving labia minora, extending to perineum, perianal region and lower part of gluteal folds, since last 5 years. There was sudden increase in extent and ulceration of the lesion since last 6 months. In the pubic region she had a conglomerated lesion of multiple condyloma acuminata and multiple bowenoid papulosis. She was HIV-infected with CD4 T cell count of 660. The lesion was biopsied from multiple sites and histopathological examination was consistent with BLT with grade II squamous cell carcinoma in some specimens. The patient was treated with surgical debulking followed by radiotherapy. Patient 3: A 40-year-old man with history of high risk sexual practices and intravenous drug abuse presented with multiple, fleshy masses over penis, scrotum and peno-scrotal junction, giving rise to deformed appearance of the genitalia. The lesions were present since several years with slow growth. He was HIV positive with a CD4 T cell count of 300. He was on ART since last 6 months. Histopathology of the lesion was suggestive of BLT. The patient was treated with cryotherapy followed by surgery.
Conclusion HIV-infected patients with Buschke Löwenstein tumour are at a higher risk of developing invasive squamous cell carcinoma because of higher incidence of abnormal anal and genital cytology, presence of HPV-DNA in these cells and a low CD4 T cell count.
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