Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

Can quadrivalent human papillomavirus prophylactic vaccine be an effective alternative for the therapeutic management of genital warts? an exploratory study

ABSTRACT Objective: To evaluate the treatment effect of genital warts, we investigated the quadrivalent HPV vaccine injection compared with surgical excision. Materials and Methods: This prospective study included 26 patients (M:F = 24:2) who received HPV vaccine or surgical excision. After explanation of surgical excision or HPV vaccine, 16 patients underwent surgical excision and the others received HPV vaccine injections. Based on gross findings of genital warts, treatment outcomes were classified as complete response (no wart), partial response, and failed treatment. Results: Among enrolled patients, 42% (11 / 26) patients had recurrent genital warts. In vaccination group, complete response rates of genital wart were 60% following 3 times HPV vaccine. Partial response patients wanted to excise the genital lesions before the 3 times injection, because they worried about sexual transmission of disease to their sexual partners. One patient underwent surgical excision after 3 times injection. Excision sites included suprapubic lesions, but other sites including mid-urethra and glans showed complete response after injection. At a mean follow-up period of 8.42 ± 3.27 months, 10 patients (100%) who received HPV vaccine did not show recurrence. Conclusion: The response rates after HPV vaccine injection were 90% (complete and partial). Our results suggested that HPV vaccines could be effective in management of genital warts.

Manejo Quirúrgico de Múltiples Condilomas de la Mucosa Oral en Paciente Bajo Terapia Antirretroviral de Gran Actividad / Surgical Management of Multiple Condylomas in the Oral Mucosa in Patient Undergoing Highly Active Antiretroviral Therapy

RESUMEN: El objetivo de este estudio fue reportar un caso clínico donde se realizó el manejo quirúrgico de múltiples condilomas de la mucosa oral en un paciente infectado por Virus de Inmunodeficiencia Humana (VIH) bajo Terapia Antirretroviral de Gran Actividad (TARGA). Hombre de 58 años en tratamiento por infección con VIH en TARGA hace 17 años, que acude al Servicio de Cirugía Maxilofacial del Hospital Barros Luco-Trudeau con múltiples lesiones verruciformes ubicadas en margen y cara dorsal de lengua, cara interna de ambas mejillas y labio inferior. Se realizó escisión quirúrgica de las lesiones de labio, cara dorsal de lengua y cara interna de mejilla del lado derecho, obteniéndose el diagnóstico histopatológico de condiloma. Tras 2 meses de realizar la cirugía se obtuvo recurrencia. La recurrencia de las lesiones puede originarse por la recrudescencia del virus latente adyacente al lecho quirúrgico y, por ello, deben considerarse otras alternativas de tratamiento. Por el impacto en la función, estética, potencial de contagio y malignización, es necesario su tratamiento.

ABSTRACT: The objective of this study was to report a clinical case in which surgical management of multiple condylomas in the oral mucosa was performed in a patient infected by Human Immunodeficiency Virus (HIV) who is under highly active antiretroviral therapy (HAART). A 58-yearold man, under HAART for 17 years for HIV infection, was admitted at the Maxillofacial Surgery Service at the Hospital Barros Luco-Trudeau as he was experiencing multiple verrucous lesions located on the lateral margin and dorsum of the tongue, as well as on the inner face of both cheeks and the lower lip. A surgical excision of the lesions on the lip, dorsum of the tongue and inner face of the right cheek was performed, where the histopathological diagnosis of condyloma was obtained. There was a recurrence two months after surgery. Recurrence of the lesions may be due to the recrudescence of the latent virus adjacent to the surgical bed and, therefore, other treatment alternatives should be considered. Treatment is necessary due to the impact on the function, aesthetics, and the potential to become contagious and malignant.

Condiloma acuminado gigante (tumor de Buschke-Lowenstein) / Giant condyloma acuminatum (Buschke-Lowenstein tumor)

Se presenta un paciente masculino de 72 años de edad de la raza blanca, que es remitido al Servicio de Coloproctología por presentar desde hace más de un año, aumento de volumen alrededor del ano que le dificulta la defecación y sentarse. Se han realizado múltiples tratamientos tópicos con resultados no satisfactorios por el servicio de dermatología. Se le realiza estudio histopatológico de la lesión y se obtuvo un condiloma acuminado gigante (tumor de Buschke-Lowenstein). Se ha dado seguimiento sin presentarse hasta el momento recurrencia. El tumor de Buschke-Lowenstein es una entidad rara, considerada una lesión premaligna provocada por el papiloma virus humano. Hasta el momento no se ha podido encontrar el tratamiento ideal y continúa presentando una alta tasa de recurrencia(AU)

This case report presented a 72 years-old Caucasian patient, who was referred to the Coloproctology Service because of increased volume around his anus that made it difficult for him to defecate and to sit down. He had followed several topical treatments prescribed by the dermatology service with unsatisfactory results. The lesion was histopathologically studied and the final diagnosis was giant condyloma acuminatum (Buschke-Lowenstein tumor). The patient was followed up and no recurrence has been so far observed. Buschke-Lowenstein tumor is a rare entity, being considered as a premalignant lesion caused by human papillomavirus. The ideal treatment ha not been yet found and it remains a disease of high rate of recurrence(AU)

Giant Condyloma Acuminatum of the Anorectum : Surgical or Topical Treatment.

Giant condyloma (Buschke-Loewenstein tumour) is a rare disease that commonly affects the urogenital area. We encountered an eighteen year old, nonhomosexual, HIV negative, male, who presented with a cauliflower like warty mass around perianal region. The mass was 8×6 cm in size, circumferential, soft and papillary in nature. Wide excision of mass was carried out with anoplasty reconstruction. Post-operatively, wound healing was uneventful. After wound healing, the topical applications of five percent imiquimod were done regularly under the care of dermatologist for three months. At six months of follow-up, patient is free from tumour, and is having neither signs of anal stenosis nor incontinence.

Results of Surgical Treatment on Benign Anal Diseases in Korean HIV-Positive Patients

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/microL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients.

Condiloma acuminado gigante (tumor de Buschke-Lowenstein): presentación de un caso / Giant acuminated condiloma (Bushke-Lowenstein tumor): case report

El condiloma gigante del pene o tumor de Buschke-Lowenstein, es un tumor epitelial benigno de origen viral y sexualmente transmisible, que en raros casos puede malignizar. Su histología se caracteriza por papilomatosis y acantosis endo y exofítica. Existen diferentes tratamientos del tumor, pero el más efectivo es la resección quirúrgica radical para evitar recidivas y malignización. Describir y documentar un caso de un condiloma acuminado gigante o tumor de Buschke-Lowenstein. Revisaremos la bibliografía existente sobre este tipo de tumor. Paciente masculino de 51 años de edad con lesiones vegetantes de 6 años de evolución, que se extienden desde la región perianal a perineal y ambas regiones inguinales, escroto y base de pene, a quien se le realizó resección quirúrgica amplia de la lesión. El estudio anatomopatológico reporta condiloma acuminado gigante, con inflamación crónica severa sobre agregada, el paciente mantiene resultados funcionales y estéticos muy satisfactorios después de la cirugía. El tumor de Buschke-Lowenstein es un condiloma acuminado gigante que se presenta con más frecuencia en hombres, benigno, cuyas lesiones clínicas son mayores de 10 cm, por lo que el tratamiento de elección debe ser siempre quirúrgico.

The giant condyloma of the penis or denominated Buschke-Lowenstein tumor is a benign epithelial tumor of viral origin and its sexually transmissible, in rare cases can become transformation to malignant. Histology is characterized by papillomatosis and acanthosis endophytic and exophytic. There are different treatments of the tumor, but the most effective of them is the radical surgical resection to prevent recurrences and the malignant transformation of the lesion. To describe and document a case view of us in our institution of giant condyloma acuminatum or Buschke-Lowenstein tumor. We will review the existent literature on this type of tumor. Male patient 51 years old with vegetative lesions of 6 years of evolution, extending from the perineal and per anal region to groins, the scrotum and the penis base, who underwent extensive surgical resection treatment. The pathology reports giant condyloma acuminatum with severe chronic inflammation, actually the patient maintains satisfactory functional and aesthetic results after the surgery. The Buschke-Lowenstein tumor is a giant condyloma acuminated it´s occurs more often in men, benign clinical lesions which are greater than 10 cm, so the treatment of choice should always be the surgical.

Colostomía previa a escisión quirúrgica de un tumor de Buschke-Lõwenteim en la infancia / Temporary colostomy before surgery in Buschke-Lõwenteim tumour in children

Buschke-Lõwentein tumor is a verrucous lesion, with slow growth and locally infiltrating. Despite her benign histology, is an intermediate lesion between condiloma acuminatum and verrucous carcinoma. It has been linked to human papilloma virus (subtypes 6 and 11). Other factors implicated include poor hygiene, chronic irritation, promiscuity and cellular inmunocompromised states. It is exceptional in children. We report a case of a 6-year-old girl with HIV infection B3 and giant condyloma that affect genitoanal region and rectal mucosa. The temporary colostomy aimed good results of the surgical excision.

El tumor de Buschke-Lõwentein es una lesión verrucosa, con crecimiento lento, y localmente infiltrante. A pesar de su histología benigna, se trata de una lesión intermedia entre el condiloma acuminado y el carcinoma verrucoso. Su aparición está ligada con el virus del papiloma humano (subtipos 6 y 11). Otros factores que intervienen son la baja higiene, promiscuidad, irritación crónica y la inmunosupresión celular. Es excepcional su aparición en niños. La exéresis quirúrgica radical es el tratamiento de elección. La realización de una colostomía de descarga previa, permite el aislamiento, facilitando la cicatrización de la zona y evitando el contacto con material fecal que contribuye a la recidiva. Presentamos un caso de una niña de 6 años con VIH estadio B3 y condilomatosis gigante que afectaba a la región genitoanal y a la mucosa rectal adyacente. La colostomía temporal contribuyó al éxito tras la resección quirúrgica.

Buschke -Loewenstein tumor: identification of HPV type 6 and 11 / Condiloma acuminado gigante de Buschke-Lowenstein: identificação dos HPV 6 e 11

The authors report a case of exuberant giant condyloma acuminatum of Buschke-Loewenstein in a male patient, slow-growing, progressive and with locally destructive behavior in the inguinal, body of the penis, scrotum, perineal and perianal regions. After surgery he showed no signs of recurrence in 20 months of follow-up. The identification of HPV types 6 and 11 was performed using in situ hybridization.

Os autores relatam um caso exuberante de condiloma acuminado gigante de Buschke-Lowenstein, em paciente do sexo masculino, de crescimento lento e progressivo e de comportamento destrutivo das regiões inguinal, corpo do pênis, escroto, perineal e perianal. Após tratamento cirúrgico, não apresentou sinais de recidiva em 20 meses de seguimento. A identificação dos HPVs, tipos 6 e 11, foi realizada através da técnica de hibridização in situ.

Tratamento do condiloma vulvar: relato de caso / Treatment of vulvar condyloma: case report

As lesões associadas ao papilomavírus humano (HPV), excluídas as neoplasias intraepiteliais cervicais, são mais prevalentes nas mulheres portadoras do vírus da imunodeficiência humana tipo 1 (HIV-1). Apesar de opiniões radicais a favor do tratamento cirúrgico para a maioria das lesões, a conduta terapêutica mais adequada deve ser individualizada. Relato de Caso: mulher de 25 anos, portadora do HIV-1, com extensa lesão condilomatosa vulvar, com 10 cm em seu maior diâmetro e um ano de evolução. Optou-se por realizar a exérese da lesão com cirurgia por ondas de radiofrequência. À avaliação, 90 dias após a cirurgia, não havia sinais de recidiva e não foram vistas lesões em vagina ou colo uterino. O exame anatomopatológico confirmou a hipótese diagnóstica de condiloma acuminado. Discussão: o tratamento cirúrgico de condilomas em mulheres imunodeprimidas constitui-se em opção de escolha para diminuir a transmissibilidade da infecção pelo HPV e o risco de carcinoma vulvar, aparentemente aumentado para essas pacientes. Além disso, pretende eliminar os sintomas, amenizar a carga psicológica decorrente do estigma social e melhorar o aspecto estético da paciente.

Lesions associated with human papilomavirus (HPV), excluding intraepithelial cervical neoplasias, are more prevalent among women infected with type 1 human immunodeficiency virus (HIV-1). Despite the radical opinions favoring surgical treatment for most of these lesions, the most adequate therapeutic conduct should be planned on an individual basis. Case report: A 25-year-old HIV-infected woman with an extensive vulvar condylomatous lesion of one year duration measuring 10 cm in its widest diameter was investigated. Exeresis of the lesion was performed by radio frequency waves surgery. Evaluation 90 days after surgery showed no signs of recurrence, and no lesions were observed in the vagina or uterine cervix. Anatomopathological examination confirmed the diagnostic hypothesis of condyloma acuminatum. Discussion: surgical treatment of condylomata in immunodepressed women is an option of choice in order to reduce the transmissibility of HPV infection and the risk of vulvar carcinoma, which is apparently increased in these patients. In addition, the aim of surgery is to eliminate symptoms, relieve the psychological burden due to the social stigma and improve the aesthetic appearance of the patient.

Utilidad de la criocirugía en el tratamiento de Condiloma Acuminado en Ciego de Ávila (2007-2008) / Usefulness of cryosurgery in the management of condyloma acuminata in Ciego de Avila province (2007-2008)

Se realizó un estudio experimental de un solo grupo en el Hospital Provincial Docente Dr Antonio Luaces Iraola en el período comprendido de noviembre del 2007 a noviembre del 2008. Con el fin de conocer el comportamiento de la criocirugía en el tratamiento de los condilomas acuminados. Se creó una consulta especializada para la selección y tratamiento de los casos, obteniéndose una muestra de 160 pacientes que presentaban lesiones condilomatosas. Se observó un predominio de las edades comprendidas entre 20 y 24 años en ambos sexos. Mediante los complementarios indicados se detectaron varios casos de sífilis, algunas neoplasias intraepiteliales cervicales y dos casos de SIDA y veinte y tres casos presentaron células escamosas con atipia en la citología orgánica de las lesiones condilomatosas. Más del 70 por ciento de los pacientes respondieron satisfactoriamente al tratamiento con tres ciclos de aplicaciones como mínimo. La criocirugía resultó ser un método muy útil y poco costoso en el tratamiento de las verrugas ano genitales comparados con otras modalidades terapéuticas.

It was carried out an experimental study of a single group in the Provincial Educational Hospital Dr Antonio Luaces Iraola in the understood period of November of the 2007 to November of the 2008. With the purpose of knowing the behavior of the cryosurgery in the management of the condyloma acuminata it was created a specialized consultation for the selection and treatment of the cases, it was taken a sample of 160 patients who presented condyloma’s lesions. A prevalence of the ages was observed understood between 20 and 24 years in both sexes. By means of the complementary ones suitable several cases of syphilis, some neoplasias cervical intraepitelials and two cases of AIDS were detected and twenty three cases presented scaly cells with atipia in the organic cytology of the lesions condilomatosas. More than 70 percent of the patients they responded satisfactorily to the treatment with three cycles of applications like minimum. The cryosurgery turned out to be a very useful and not very expensive method in the treatment of the warts anus genital compared with other therapeutic modalities.

Remoção de condiloma acuminado em porção lateral de língua:relato de caso / Condyloma acuminatum remotion of the lateral tongue: case report

Objetivo: relatar o caso de um paciente portador de lesão sugestiva de condiloma acuminado na porção lateral de língua, em decorrência da prática frequente de sexo oral com diversas parceiras. Método: estudo descritivo de fonte secundária de paciente atendido na clínica odontológica do HGeBe. Resultado: Presença de tumor na porção lateral da língua, séssil, apresentando cerca de 2mm de diâmetro. o laudo histopatológico confirmou o diagnóstico inicial de condiloma acuminado. Conclusão: o tratamento cirúrgico é capaz de erradicar a lesão, mas o vírus pode persistir no epitélio seja na região genital, anal ou cavidade oral. Em razão do alto poder de infectabilidade do HPV, possível malignização e também devido o aspecto social envolvido com a doença, são necessários relatos mais concisos sobre a infecção por este vírus na mucosa oral, seu estado latente e subclínico.

Aim: a case report of a patient with a suggestive lesion of condyloma acuminatum in the tongue?s lateral portion, caused by oral and anal sex practice, frequently with diversified partners. Method: The patient was attended at HGeBe Odontologic Clinic, where he was submitted to the basic anamneses, and related that he constantly practiced oral and anal sex, without a fixed partner. In clinical examinations, it was observed a tumor in the tongue?s lateral portion, sessile, presenting about 2mm of diameter. After pre-surgical laboratories exams, the patient was submitted to surgical procedure for removing the lesion and then, the sample was taken to a histopathologic examination. Results: histopathological findings confirmed the initial diagnosis of condyloma acuminatum. Conclusions: the surgical treatment is capable to eradicate the lesion, but the virus can persist in the epithelium, anal region and, also, in the oral cavity. Regarding HPV high power infectibility, possible malignization and the social aspects involved, more concise case reports about the infection of this virus in oral mucosa are necessary, observing it?s latent and subclinical state.

Condiloma acuminado - resposta terapêutica com imiquimode e cirurgia / Genital wart - therapeutic response with immiquimod and surgery

O condiloma acuminado é uma das manifestações do papilomavírus humano (HPV) na área genital. Relata-se o caso de uma paciente do sexo feminino, 27 anos com extensa lesão condilomatosa na região vulvar. O tratamento foi realizado com exérese cirúrgica das lesões maiores, seguido da aplicação de imiquimode nas lesões menores e recidivas, com resolução clínica completa em 8 semanas. Foram abordadas as diferentes formas de tratamento com enfoque na terapêutica com imiquimode.

Condylomata acuminata is one of the genital manifestations of the Human papillomavírus (HPV) infection in the genital area. This is a case report of a 27 years-old female patient with extensive genital warts in the vulvar. The treatment was performed with surgical ressection of the biggest warts and local application of immiquimod in the others lesions and relapses. The complete clinical resolution was observed in 8 weeks. We will review the different forms of treatment emphasing immiquimod treatment.

Condiloma acuminado e gestação: transmissão vertical e tratamento / Condyloma acuminata and pregnancy: perinatal transmission and treatment

Atualmente, a infecção genital pelo Papilomavírus Humano (HPV) é a doença sexualmente transmissível mais comum entre adultos jovens sexualmente ativos. Estima-se que aproximadamente 10 a 60% das mulheres com vida sexual ativa estejam infectadas pelo HPV. As verrugas anogenitais decorrentes da infecção pelo HPV denominadas condilomas acuminados são a forma clínica mais comum da doença. Na gestação, o condiloma acuminado é a manifestação mais comum da infecção pelo HPV, com incidência variando de 11,6 a 51,7%. Sabe-se que durante o período gravídico ocorrem mudanças fisiológicas na genitália feminina que, somadas a alterações imunológicas inerentes à gestação, criam ambiente propício à proliferação do HPV. Além disso, os modos de transmissão vertical e as conseqüências para o produto conceptual têm sido amplamente estudados. Durante a gestação, são de fundamental importância os tratamentos eficazes, visando a baixas taxas de recorrência materna e mínimos efeitos deletérios para o feto.

Nowadays, the Human Papilomavirus (HPV) infection of the lower genital tract is the most common sexually transmitted disease among young people who are sexually active. It is said that approximately 10% a 60% of women that have a sexual contact are contaminated with HPV. The genital warts from the HPV infection denominated condyloma acuminata are the most common clinical form of the disease in pregnancy, the condyloma acuminata is the most common manifestation of the infection of HPV with and incidence that ranges from 11,6% to 51,7%. It is of knowledge that during the gestation period physiologic changes of the female genitalia occur, and this fact added to immunology alterations expected at pregnancy, made the local environment optimal for the viral proliferation. Moreover, the modes of vertical transmission and the fetal consequences are being extensively studied. During pregnancy, it is of fundamental importance an efficient treatment, which provides lower rates of recurrences and without deleterious effects for the concept.

Condilomatosis gigante / Giant Condyloma

Las verrugas perianales son producidas por el papiloma virus. Los tipos asociados son 6, 11 y 18. Comunicamos nuestra experiencia en el tratamiento de una paciente de 42 años con un condiloma perianal gigante.

Condylomas of genital warts are caused by the papiloma virus. Is produced by type 6, 11 and 18. We communicate our experience in the treatment of giant condylomatosis in a woman of 42 years old.

Condiloma acuminado gigante o tumor de Buschke-Loewenstein del anorrecto / Giant condyloma acuminatum or Buschke Loewenstein tumor of the anorectum

Antecedentes: El condiloma acuminado gigante o tumor de Buschke-Loewenstein es una rara entidad que afecta a la región anogenital. Se trata de una lesión vegetante, exofitica, habitualmente voluminosa, provocada por los virus HPV tipo 6, 11 y 16. A pesar de su apariencia histopatológica benigna, clínicamente presenta características de malignidad invadiendo los tejidos adyacentes. Su tratamiento puede plantear controversias, con elevados índices de recidiva. Objetivo: Presentar un paciente con condiloma acuminado gigante de la región perianal tratado quirúrgicamente, con revisión de la literatura actual. Paciente y método: Hombre de 52 años heterosexual, sin antecedentes médico-quirúrgicos, que consultó por tumoración exofitica de 4 años de evolución en región perianal derecha, de 10x8 cm., indolora. Se realizó resección-biopsia amplia, constatándose infiltración de los planos profundos. La anatomía patológica informó condiloma acuminado gigante. Resultados: Presentó recidiva tumoral a los 2 meses. Se realizó una nueva resección amplia y completa hasta el piso del periné. Evolucionó favorablemente y está libre de enfermedad a los 15 meses. Conclusión: El condiloma acuminado gigante es una variante de la condilomatosis anal, de carácter invasor local. El manejo quirúrgico es controvertido y consiste en la resección amplia de los tejidos afectados. La recidiva local es frecuente. Puede asociarse tratamiento neoadyuvante mediante quimioradioterapia preoperatoria con el intento de reducir la masa.

Background: The giant condyloma acuminatum or Buschke-Loewenstein tumor of the anorectum is an unusual entity that affects to genital area. It is an exophytic, usually voluminous mass, caused by HPV type 6, 11, and 16 virus. Despite its apparently benign hystopathologic appearance, presents malignant characteristics, with invasion of surrounding tissues. The treatment has controversies, and a high rate of recurrence. Objective: To present a patient with a perianal giant condyloma acuminatum, surgically treated, and a review of the current biblíography. Patient and methods: Heterosexual, 52 year old male, with no remarkable medical or surgical history, complaining of a four year history of a painless, 10x8 cm exophytic mass in the right perianal region. Wide resection biopsy was made, and infiltration to the deep planes was noted. Pathology revealed Giant Condyloma Acuminatum. Results: The tumor recurred after two months. A new wide and complete resection, up to the pelvic floor, was carried out. There is no evidence of disease on a 15 month follow-up. Conclusion: Giant Condyloma Acuminatum is a variant of the anal condilomatosis, of invading local character. The surgical management is controversial and consists of wide resection of the tumor and surrounding tissues. Recurrence is common. Preoperative chemoradiotherapy can be indicated to reduce mass.

Tratamiento quirúrgico de condilomas perianales en pacientes VIH positivos / Surgical treatment of anogenital warts in hiv positive patients

Los condilomas acuminados corresponden a la patología ano rectal más frecuente en los pacientes portadores del virus de la inmuno deficiencia humana (VIH+). Su tratamiento genera controversias por la posible progresión a carcinoma epidermoide y su alta recurrencia. Se presenta nuestra experiencia en el tratamiento de los condilomas acuminados en pacientes VIH+. La serie corresponde a veinte pacientes todos homosexuales de sexo masculino, con edad promedio de 32 años, once de ellos recibían terapia anti retroviral al momento de la cirugía. Los síntomas más frecuentes fueron el sangrado, el prurito y la sensación de masa anal. Quince pacientes presentaron condilomas en todo el margen anal con extensión al canal anal. En cuatro casos se realizó fulguración de las lesiones y los restantes fueron resecados. La anatomía patológica de estos casos mostró infección por virus papiloma en todos ellos, con displasia moderada en solo un caso. No se registraron casos de displasia intensa ni carcinoma invasor. El seguimiento alejado se logró en 16 pacientes, dos de ellos presentaron recidiva de las lesiones debiendo ser sometidos a un nuevo procedimiento quirúrgico sin nuevas recidivas y lográndose el control sintomático en todos ellos. Los cuatro pacientes restantes se encuentran fallecidos por su patología de base. En esta serie aunque la histología no muestra displasia intensa ni carcinoma, el control sintomático justifica el tratamiento quirúrgico de estas lesiones.

Carcinoma epidermoide en condilomatosis vulvoperineal gigante / Epidermoid carcinoma in giant vulvoperineal condilomatosis

La condilomatosis vulvoperineal es una entidad muy frecuente en mujeres en edad reproductiva; recomendándose realizar la tipificación del virus papiloma humano, dada la relación de algunos subtipos con el carcinoma epidermoide a nivel ginecológico. Se presenta el caso de una paciente femenina de 39 años que consultó por presentar una lesión exofítica, verrugosa que ocupa labios mayores y menores de la vulva, clítoris, introito vaginal y región perianal; de la cual se toma biopsia incisional reportando papilomatosis por virus papiloma humano, sin evidencia de atipias. Se lleva a quirófano realizando dermovulvectomía, cuya biopsia definitiva reportó carcinoma epidermoide invasor bien diferenciado, focal, con bordes resección libres; se completa con disección inguinal bilateral superficial y profunda sin evidencia de lesión metastásica ganglionar. Se realizó tipificación viral por reacción de cadena de polimerasa resultando VPH 16. A 20 meses de seguimiento, no hay evidencia clínica ni citológica de lesión recurrente. Es importante realizar la tipificación viral de estas lesiones por su relación con el carcinoma epidermoide de la vulva. Se realizó una revisión de la literatura.

The vulvoperineal condylomatosis it’s a very frequent disease in reproductive age young women; it’s recommended to realize the viral typification, because the relation between some human papillomavirus subtypes with gynaecology epidermoid cancer. We present the case of a 39 years old female patient who consulted to present a exofitic injury, warty that occupies the majora and minora labia of the vulva, clitoris, vaginal vestibule and perianal region; from which incisional biopsy was taken, reporting papilomatosis by human papillomavirus, without evidence of atypias. Patient went to operating room to receive a dermovulvectomy, whose definitive biopsy reported invasive epidermoid carcinoma well differentiated, focal, with free resection margins; it is completed with superficial and deep bilateral inguinal dissection without evidence of metastasic nodal involment. Viral tipificación by reaction of polymerase chain reaction was made being VPH 16. To 20 months of fall up, there are not clinical or cytological evidence of recurrent lesions. It is important to make the viral tipificación of these lesions by its relation with the epidermoid carcinoma of the vulva. A revision of literature was made.