INVASIVE SQUAMOUS-CELL CARCINOMA IN GIANT ANORECTAL CONDYLOMA (BUSCHKE-LOWENSTEIN TUMOR)

Giant condyloma acuminata, first described by Buschke and Lowenstein i n 1925 as a penile lesion, is extremely rare in the anorectal region. The cauliflower-like tumor behaves clinically in a malignant fashion, although it shows no histomorphological criteria of malignancy. Up to the time of writing only 33 cases of anorectal origin, 42% with malign ant transformation, have been published. The authors report 2 more cas es of squamous-cell carcinoma in giant anorectal condylomata acuminata . Buschke-Lowenstein tumor is an intermediate entity between ''ordinar y'' condyloma acuminata and squamous-cell carcinoma. Benign condyloma acuminata is caused by human papillomavirus 6 or 11. Carcinogenic cofa ctors promote the transition to giant, locally destructive condyloma a cuminata and subsequent malignant transformation. Cure can only be ach ieved by early and radical excision. Formation of multiple fistulas an d destruction of the sphincter may necessitate abdomino-perineal resec tion. Adjuvant radiation therapy should only be considered to render a tumor operable, as radiation may act as a cocarcinogenic effect and l ead to a less differentiated and more aggressive cancer. The small num ber of cases reported and the variety of treatment regimens applied, h owever, do not allow the formulation of definitive therapeutic guideli nes.