背景:Buschke-Löwenstein肿瘤(BLT)是一种罕见的性传播疾病,归因于人乳头瘤病毒(HPV)-通常为6或11型(90%)-男性占主导地位,总体感染率为0.1%。BLT或巨大尖锐湿疣被认为是具有局部侵袭性的肿瘤,表现出鲜明的特点:破坏性增长的潜力,良性组织学,恶性转化率为56%,手术切除后复发率高。有几种治疗方法已经尝试过,包括激光,冷冻疗法,放射治疗,电凝法,免疫疗法,imiquimode,辛儿茶素,病灶内注射5-氟尿嘧啶(5-FU),隔离灌注,和局部或全身化疗。在广泛的肿瘤的情况下,术前化疗或放疗用于肿瘤缩小,使剔除程序更安全。HPV疫苗显着降低生殖器疣的发病率,也降低了BLT的风险;HPV-6和HPV-11包括在这些疫苗中.
方法:我们介绍了一个53岁的异性恋男子,2021年6月在我们部门住院,典型的花椰菜样肿瘤肿块累及肛周区域,在近7年的时间里逐渐增加。肛周肿块被完全切除,确保手术切缘阴性。用筋膜皮肤V-Y推进皮瓣重建发生的大型肛周皮肤缺损。不需要保护性造口。文献综述从1980年1月到2022年12月扩展,利用Pubmed和GoogleScholar作为搜索平台。
结果:由于该疾病靠近肛门边缘且报告病例数量有限,达成一个明确和令人满意的治疗策略变得具有挑战性。最佳方法需要彻底手术切除病变,确保明确的手术切缘,并进行广泛切除,以最大程度地减少复发的可能性。为了修复大面积的伤口缺损,可以使用各种旋转或前进襟翼,减少恢复时间,减少肛门狭窄或其他并发症的可能性。我们的目标是通过介绍涉及严重的肛周尖锐湿疣的病例来强调手术切除在解决BLT中的重要性,通过完全手术切除和使用V-Y推进皮瓣技术成功管理。在目前的情况下,术后5个月,病人回来时臀部脓肿,它被切开和排水。又过了5个月,病人因排便困难而返回,诊断为肛门狭窄.进行了肛门扩张和括约肌切开术,术后效果良好。
结论:Buschke-Löwenstein肿瘤的外科治疗需要一个具有专业知识的多学科团队。所涉及的重建技术可能是具有挑战性的,并且可能引入额外的并发症。我们考虑积极的手术,其中包括重建程序,作为Buschke-Löwenstein肿瘤的标准治疗方法。这种方法旨在获得最佳的手术效果并防止任何复发。
BACKGROUND: The Buschke-Löwenstein tumor (BLT) is an uncommon sexually transmitted ailment attributed to the human papillomavirus (HPV)-usually the 6 or 11 type (90%)-with male predominance and an overall infection rate of 0.1%. BLT or giant condyloma acuminatum is recognized as a tumor with localized aggressiveness, displaying distinctive features: the potential for destructive growth, benign histology, a rate of 56% malignant transformation, and a high rate of recurrence after surgical excision. There are several treatment choices which have been tried, including laser, cryotherapy, radiotherapy, electrocoagulation, immunotherapy, imiquimode, sincatechins, intralesional injection of 5-fluoruracil (5-FU), isolated perfusion, and local or systemic chemotherapy. In the
case of an extensive tumor, preoperative chemotherapy or radiotherapy is used for tumor shrinkage, making the debulking procedure safer. HPV vaccines significantly decrease the incidence of genital warts, also decreasing the risk of BLT; HPV-6 and HPV-11 are included in these vaccines.
METHODS: We present a 53-year-old heterosexual man, hospitalized in our department in June 2021 with a typical cauliflower-like tumor mass involving the perianal region, which progressively increased in size for almost 7 years. The perianal mass was completely removed, ensuring negative surgical margins. The large perianal skin defect which occurred was reconstructed with fascio-cutaneous V-Y advancement flap. There was no need for protective stoma. The literature review extended from January 1980 and December 2022, utilizing Pubmed and Google Scholar as search platforms.
RESULTS: Due to the disease\'s proximity to the anal verge and the limited number of reported cases, arriving at a definitive and satisfactory treatment strategy becomes challenging. The optimal approach entails thorough surgical removal of the lesion, ensuring well-defined surgical margins and performing a wide excision to minimize the likelihood of recurrence. In order to repair the large wound defects, various rotation or advancement flaps can be used, resulting in reduced recovery time and a diminished likelihood of anal stricture or other complications. Our objective is to emphasize the significance of surgical excision in addressing BLT through the presentation of a
case involving a substantial perianal condyloma acuminatum, managed successfully with complete surgical removal and the utilization of a V-Y advancement flap technique. In the present
case, after 5 months post operation, the patient came back with a buttock abscess, which was incised and drained. After another 5 months, the patient returned for difficult defecation, with an anal stenosis being diagnosed. An anal dilatation and sphincterotomy were carried out, with good postoperative results.
CONCLUSIONS: The surgical management of Buschke-Löwenstein tumors needs a multidisciplinary team with specialized expertise. The reconstruction techniques involved can be challenging and may introduce additional complications. We consider aggressive surgery, which incorporates reconstructive procedures, as the standard treatment for Buschke-Löwenstein tumors. This approach aims to achieve optimal surgical outcomes and prevent any recurrence.