1 Department of Gynecology and Obstetrics at the University Hospital of Angré, Ivory Coast
2 Department of Gynecology and Obstetrics at the University Hospital of Cocody, Ivory Coast
Submission: July 01, 2020; Published:July 08, 2020
*Corresponding author:Effoh Ndrin Denis, Department of Gynecology and Obstetrics at the University Hospital of Angré, Abidjan, France
How to cite this article:Effoh Ndrin D, Adjoby R, Kouame A D, Koffi S V, Gbary-Lagaud E, et al. Giant Condyloma Acumina or Tumor of Buschke And
Lowenstein During Pregnancy: About A Case at The University Hospital of Angré, Abidjan.Glob J Reprod Med. 2020; 8(1): 5556726.
We are reporting a rare case of giant condyloma diagnosed in a young woman with a full-term pregnancy. It is a benign tumor of viral origin that may constitute a dystocia of soft tissue during pregnancy. It is transmitted mainly by sexual transmission and the virus responsible is Human Papilloma Virus (HPV) of the types 6 and 11. It is a tumor whose benignity is related to the presence of non-oncogenic HPV. It is characterized by its recurrent and invasive evolutionary power enabling to classify it as a borderline tumor, which could explain its severity. It is a tumor that most often occurs in an immunocompromised area, but in our observation, retroviral serology was negative. The treatment is essentially surgical and must be early and radical. Its prevention is imperative, based on the treatment of acuminated condylomas and the fight against sexually transmitted diseases.
Giant acuminous condyloma (GAC) or Buschke Lowenstein tumor (TBL) is a rare clinical entity of viral origin, transmitted mainly by sexual transmission . The risk of local invasion, the strong recurrent power and the degenerative potential explain its severity [2,3]. We propose to study the particularities of this disease during pregnancy from 1 case of this tumor, observed in the gynecology and obstetrics department of the University Hospital of Angré (Abidjan).
We are reporting a case of giant acuminate condyloma (GAC) in K.Y. a 29-year-old girl with a full-term pregnancy in whom the HIV serological test is negative. This was about a fourth primiparous procedure (G4P1) with a spontaneous miscarriage of 17 weeks due to a malaria attack and an abortion at 11 weeks of amenorrhea. She was referred for a blooming giant condyloma during a 38-week pregnancy of amenorrhea. The personal medical
history had nothing particular, no diabetes or sickle cell disease was noted. She was not hypertensive and was never referred for a malignant disease that required chemotherapy and radiotherapy. Besides, she has never screened for cervical cancer. The obstetrical examination concluded that the pregnancy was 38 weeks of age and not in labor. Vulva examination showed giant flourishing peri-vulvar and intra-vulvar condylomas that hindered even urination (Figure 1). Biological assessments have been carried out: The already negative HIV. serology was confirmed by a new retroviral serology by ELISA technique. N.F.S. showed microcytic hypochrome anemia with a hemoglobin level of 9.5g/dl, syphilis serology and HBS Ag testing were negative. The biological search for possible STIs was negative.
Our observation is a sexually transmitted viral pathology whose voluminous nature was described in 1925 by Buschke and Lowenstein . Human papilloma virus of type 6,11 are mainly
the viruses responsible for condylomas. The transformation of
condylomas into TBL appears to be controlled by the immune
system; TBL may be associated with congenital or acquired
immunodeficiency (AIDS, immunosuppressive treatment,
ethylism, diabetes, chemotherapy) . In our observation, there is
no pathology or immunosuppressive defects. However, in addition
to pregnancy, there are also the modest socio-economic conditions
of pregnancy associated with anemia of deficient origin. In western
countries and in France in particular, the prevalence of condylomas
or genital warts is about 1% of the sexually active population .
But the appearance of the quadrivalent prophylactic vaccine,
capable of preventing the occurrence of most condylomas, should
change the frequency and importance of this problem [6,7]. In Côte
dIvoire, there has been no study on the prevalence of this disease.
However, the CAG is found in several other clinical specialties:
gastroenterology, urology and dermatology. Giant condylomas
occur at all ages with an average age of 45 years. But for women, it
is especially during periods of genital activity with a peak between
25 and 30 years of age  as is the case in our observation where
the pregnant woman is 29 years of age. Pregnancy being one of
the favoring factors could explain the prevalence of condylomas
in this age group. Multiple partners, prostitution, homosexuality,
poor hygiene and chronic infections contribute to HPV infection
. In the Reichenbach study, TBL were common in males (77%),
with penile localization in 81 to 94% and in 10 to 17% of cases
in the anorectal area . Urethral localization is 5% of cases in
some series . In women, localization is essentially vulval in
90% of cases, unlike anorectal localization, which remains less
frequent . In our pregnant woman, the ano-rectal examination
is without particularity, the vulval localization was the essential
site of the lesion. Clinically, GACs most often begin with small
rounded or pinkish filiform lesions or lesions of normal skin color.
The duration of the transformation varies from a few months to
several years. During the condition phase, a large tumor (which
can exceed 10 cm of major axis) is observed, papillomatous,
irregular, with a surface bristling with digitations, flourishing,
cauliflower-shaped, often whitish or yellowish in color, often with
superficial ulcerations and added infectious lesions [9,11]. The
clinical description as made by Maimon and Sykes [12,13] may
appear to be the same as in our case. In Ms. KY, several small perivulval
nodules were described and they increased in size with
gestational age and subsequently became complicated by urinary
disorders. The other tests: dermatological, digestive (ano-rectal)
and urinary were without particularity. The urinary disorders
could be explained by the position of one of the giant condylomas
located under the base of the urethra (Figure 1). The presence of
bleeding, infiltration of the base or the presence of adenopathy
should make malignant degeneration suspect  these signs
have not been found in our pregnant woman.
Although pregnancy is a contributing factor to the occurrence
of condyloma, the flourishing and disseminated nature of these
lesions should lead to the search for other sources of immuno
depression. HIV serology by ELISA technique was negative. The
other biological assessments related to STIs (syphilis, gonorrhea,
hepatitis B and C, chlamydia trachomatis) are normal. The cervicovaginal
smear did not show any precancerous lesions. Biopsy of the
lesion provides histological confirmation and allows for the search
for possible foci of degeneration [9,15]. In microscopy  TBL is
a perfectly limited squamous tumor, characterized by considerable
epithelial hyperplasia, sometimes pseudo-epitheliomatous,
with the basement membrane still intact, hyperacontosis, hyper
papillomatous and koilocytes that are pathognomonic markers
of HPV infection, however their presence is not constant . The
identification of HPV, which was not investigated in our study, can
be performed by electron microscopy, immuno-histochemical
methods and finally the molecular biology technique either by
hybridization or by PCR . However, PCR remains the most
sensitive and widely used method, often showing the presence of
HPV 6 and 11 DNA .
We opted for two surgical procedures: first the classical
caesarean section at term (Figure 2) and then the CAG surgery,
which consisted of a broad surgical removal of the lesion without
removing an organ (Figure 3) The circumstances of the discoveries,
the appearance of the benign tumor and especially the absence
of lymph nodes made it possible to postpone the lymph node
cleaning. Medical treatment was instituted as a first-line treatment
after cicatrization with Podophylline. Immunomodulators should
be instituted as a second line of action; however, we lost sight of
the patient as soon as medical treatment with Podophylline was
initiated. In literature, surgery appears as the treatment of choice
because it is the most effective, especially during the early stage of
the disease [15,19] and allows histological analysis of the whole
piece with search for foci of degeneration . The excision can
be completed by adjuvant treatment with chemotherapeutic
and immune modulating agents  (Interferon or Imiquimod).
Podophylline, which was the only chemical, antimitotic means
used in our study (apart from pregnancy and breastfeeding). But
its success does not seem to be totally in agreement with some
authors [9,12,16] because of its neurotoxic and hematotoxic effects
and even causing necrosis of the treated tissues . However,
it remains more effective on young TBL . Radiotherapy
of Buschke-Lowenstein tumors is not recommended because
it would promote malignant transformation . Malignant
transformation of TBL is estimated at between 8.5% and 23.8%
. The most frequent histological type is represented by
squamous cell carcinoma .
The CAG or Buschke-Lowenstein tumor (TBL) is a rare
tumor of viral origin. It is a tumor with recurrent potential and
uncertain evolution that can evolve into squamous cell carcinoma.
Treatment is essentially surgical and must be early and broad. Its
prevention is imperative based on the treatment of acuminated
condylomas and the fight against sexually transmitted infections.
Rigorous clinical and histological post-operative monitoring is
required, without losing sight of the notion of recurrence or even
Ben Brahim E, Chadli Debbiche A, Fraoua Abdelmoula F, Lahmar Boufaroua A, Bouchoucha S (2000) Condylome géant de Buschke-Löwenstein de la région périanale avec envahissement inguinal: à propos dun cas 1. Barrasso R. Savoir traiter les condylomes externes. Gyn Obs 426: 18-19.