Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2019; 11(2): 172-180
Published online Feb 15, 2019. doi: 10.4251/wjgo.v11.i2.172
Anal carcinoma in giant anal condyloma, multidisciplinary approach necessary for optimal outcome: Two case reports and review of literature
Santosh Shenoy, Murali Nittala, Yazen Assaf
Santosh Shenoy, Murali Nittala, Yazen Assaf, Department of General and Colorectal Surgery, KCVA and University of Missouri at Kansas City, Kansas City, MO 64128, United States
Author contributions: Shenoy S designed and drafted the report with other authors as listed analyzed the data and manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the guidelines from the check list have been adopted in the preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Santosh Shenoy, MD, Surgeon, Department of General and Colorectal Surgery, KCVA and University of Missouri at Kansas City, 4801 E Linwood Blvd., Kansas city, MO 64128, United States. shenoy2009@hotmail.com
Telephone: +1-816-8614700 Fax: +1-816-9224609
Received: November 14, 2018
Peer-review started: November 15, 2018
First decision: December 24, 2018
Revised: December 31, 2018
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: February 15, 2019
Abstract
BACKGROUND

Anal cancers are caused by human papilloma virus (HPV). Buschke-Lowenstein tumor also known as giant anal condyloma (GCA) is a variant of giant neglected anal tumors arising from warts caused by HPV infection. HPV are a family of double-stranded DNA viruses and primarily cause sexually transmitted disease of the genitalia and oropharyngeal mucosa. These tumors are slow growing; locally destructive large verrucous masses.

CASE SUMMARY

We present a series of two cases with large anal tumors harboring invasive cancers and highlight their presentation and management. Tumors with high risk HPV subtypes (HPV 16, 18, 31, 33) may progress into invasive squamous cell carcinoma (SCC). Untreated GCA can attain enormous size and extend into the pelvic organs and bony structures. Some tumors show malignant degeneration into SCC and are often difficult to diagnose given the large size of the tumors. Complete surgical excision with negative margins is the treatment of choice and necessary to prevent recurrence. This is often not feasible and leaves large surgical wounds with tissue defects with delay in healing and increases post-operative morbidity. Pelvic reconstructive techniques including muscle flaps and grafts are often necessary to close the defects. Human immunodeficiency virus and immunocompromised patients generally do poorly with standard treatments.

CONCLUSION

A multidisciplinary team of colorectal and plastic surgeons, medical and radiation oncologists along with combination treatment modalities are necessary when malignant transformation occurs in GCA, for optimal outcomes.

Keywords: Squamous cell carcinoma of anus, Human papilloma virus infection, Giant anal condyloma, Buschke-Lowenstein tumor, Multidisciplinary treatment, Case report

Core tip: Large anal condylomas are generally caused by low risk human papilloma virus 6, 11, however in certain instances can be caused by high risk subtypes 16, 18, 31, 33. Malignant transformation to squamous cell carcinoma may occur in large neglected tumors and human immunodeficiency virus (HIV) patients. Deep core biopsy, P16 staining and positron emission tomography computed tomography scans are necessary to diagnose carcinoma and metastases. Due to enormous size of the tumors a multidisciplinary team approach is necessary with combination of neoadjuvant chemo radiation followed by wide excision of these tumors. Large perineal and pelvic defects may need pelvic reconstructive surgery. Patients with HIV and anal cancers carry a poor prognosis.