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Clinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases

  • Dongwei ZhangEmail author
  • Raul S. Gonzalez
  • Michael Feely
  • Kavita Umrau
  • Hwajeong Lee
  • Daniela S. Allende
  • Dipti M. Karamchandani
  • Michael Zaleski
  • Jingmei Lin
  • Maria Westerhoff
  • Xuchen Zhang
  • Lindsay Alpert
  • Xiaoyan Liao
  • Jinping Lai
  • Xiuli Liu
Original Article

Abstract

Buschke-Löwenstein tumor (BLT) is a rare sexually transmitted disease, mostly described in clinical literature as case reports or small series. Here, we investigated the clinicopathologic features of BLT in a total of 38 cases retrieved from multiple academic institutions. The average age was 47.6 ± 12.8 (mean ± SD) years old at diagnosis. The male to female ratio was 4.4:1. Common presenting symptoms were pain/discomfort, bleeding, mass lesion, and discharge. It was frequently linked to smoking and positive human immunodeficiency virus status. The tumor size and thickness were 8.5 ± 6.6 cm and 1.5 ± 1.3 cm, respectively. Histologically, 19 (50%) cases had an invasive squamous cell carcinoma component and were associated with high-risk human papillomavirus infection. There was no lymphovascular or perineural invasion, or nodal metastasis at initial diagnosis. BLTs with invasion had higher frequency of dyskeratosis, neutrophilic microabscesses, and abnormal mitoses, but lower frequency of pushing border compared with BLTs without invasion. All patients underwent wide excision, and some also received chemoradiation therapy. After a median follow-up of 23 months (range 1–207), the recurrence rate was 23.7% and disease-specific mortality was 2.6%. In summary, we presented the largest case series of BLT to date to characterize its unique clinicopathologic features. Our study indicated that certain histologic features such as dyskeratosis, neutrophilic microabscess, and abnormal mitosis in the non-invasive portion may be important clues on lesional biopsy to predict the presence of underlying invasive carcinoma.

Keywords

Buschke-Löwenstein tumor Invasive squamous cell carcinoma Human papillomavirus Prognosis 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Author’s contributions

DZ and XL (Xiuli Liu) contributed to the design and implementation of the study, to the analysis of the results, and to the writing of the manuscript. RG, MF, KU, HL, DA, DK, MZ, JL, MW, XZ, LA, and JL contributed to the retrieval of the cases and interpretation of the results. All authors provided critical feedback and helped shape the research, analysis, and manuscript. XL (Xiaoyan Liao) contributed to the final version of the manuscript.

Compliance with ethical standards

The study was approved by Institutional Review Board of each participating institution.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Dongwei Zhang
    • 1
    • 2
    Email author
  • Raul S. Gonzalez
    • 2
  • Michael Feely
    • 1
  • Kavita Umrau
    • 3
  • Hwajeong Lee
    • 3
  • Daniela S. Allende
    • 4
  • Dipti M. Karamchandani
    • 5
  • Michael Zaleski
    • 5
  • Jingmei Lin
    • 6
  • Maria Westerhoff
    • 7
  • Xuchen Zhang
    • 8
  • Lindsay Alpert
    • 9
  • Xiaoyan Liao
    • 2
  • Jinping Lai
    • 1
  • Xiuli Liu
    • 1
  1. 1.Department of Pathology, Immunology, and Laboratory MedicineUniversity of Florida College of MedicineGainesvilleUSA
  2. 2.Department of Pathology and Laboratory MedicineUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Department of PathologyAlbany Medical CenterAlbanyUSA
  4. 4.Department of PathologyCleveland ClinicClevelandUSA
  5. 5.Department of PathologyPenn State Health Milton S. Hershey Medical CenterHersheyUSA
  6. 6.Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisUSA
  7. 7.Department of PathologyUniversity of MichiganAnn ArborUSA
  8. 8.Department of PathologyYale School of MedicineNew HavenUSA
  9. 9.Department of PathologyUniversity of Chicago MedicineChicagoUSA

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