giant anal condyloma is a rare sexually transmitted disease involving the perianal and external genital tract area in the form of a large exophytic , cauliflower - like mass .
complete surgical excision is the treatment of choice and often wide wounds are necessary to reach clear margins and prevent recurrence . various rotation or advancement flaps can be utilized as alternatives methods for covering wide wounds , decrease the length of recovery and minimize risk of anal stricture .
we present two cases treated with an s - plasty rotation and a bilateral house advancement flap respectively .
a 60-year - old man , heterosexual , presented in our department in june 2009,with a typical cauliflower - like tumor mass involving the perianal region .
the patient was treated with daily wound cleansing with a good final result . a 64-year - old heterosexual man presented in our department in may 2012 with a typical cauliflower - like tumor mass involving the perianal region , and multiple condylomata involving the penis and prepuce .
the patient was reluctant to undergo to medical treatment as symptoms had been present for 20 years .
the patient was treated with a wide surgical excision and reconstruction with a bilateral house advancement flap ( fig .
the lesion on the penis and prepuce were excised by electrocautery scissors and a circumcision respectively . in this case
dehiscence of the muco - cutaneus anastomosis developed during the second postoperative week maybe due to straining during defecation with consequent increased tension . at one month
both patients were given a bowel preparation with polietilenglicole 4  l. intravenous antibiotic therapy with cephalosporine and metronidazole was administered for 7 days .
a liquid diet and codeine were administered to all patients for three days after surgery to prevent evacuation and early contamination of the wound .
a 60-year - old man , heterosexual , presented in our department in june 2009,with a typical cauliflower - like tumor mass involving the perianal region .
a 64-year - old heterosexual man presented in our department in may 2012 with a typical cauliflower - like tumor mass involving the perianal region , and multiple condylomata involving the penis and prepuce .
the patient was reluctant to undergo to medical treatment as symptoms had been present for 20 years .
the patient was treated with a wide surgical excision and reconstruction with a bilateral house advancement flap ( fig .
the lesion on the penis and prepuce were excised by electrocautery scissors and a circumcision respectively . in this case
dehiscence of the muco - cutaneus anastomosis developed during the second postoperative week maybe due to straining during defecation with consequent increased tension . at one month
both patients were given a bowel preparation with polietilenglicole 4  l. intravenous antibiotic therapy with cephalosporine and metronidazole was administered for 7 days .
a liquid diet and codeine were administered to all patients for three days after surgery to prevent evacuation and early contamination of the wound .
giant anal condyloma also called buschke  lwenstein ( gcbl ) tumor is a large exophytic , cauliflower - like mass that is characterized by local aggressive behavior . despite a benign histology in most cases , malignant degeneration into invasive squamous carcinoma ( scc ) is possible especially in immunocompromised patients .
foci of invasive carcinoma are noted in 50% of the reports and carcinoma in situ in 8% .
histologically gcbl presents with massive epidermal hyperplasia , hyperkeratosis and parakeratosis and is markedly exophytic .
blunt - shaped masses of tumor project deeply into the dermis but tumor cells have little evidence of atypia and are not found inside blood vessels or lymphatics .
lwenstein tumor is a sexually transmitted disease and like genital tract condylomata , bowen 's disease , anal squamous intraepithelial lesions and anal cancer are strongly associated with hpv infection .
for this reason patient 's sexual habit should be investigated and if possible the patient 's sexual partners should also be examined .
immunosuppression favors rapid growth of the condylomas and increases the risk of their malignant transformation maybe favoring the oncogenetic mechanisms caused by hpv infection .
the patient 's immunological status must be checked including screening test serology for stds [ human immunodeficiency virus ( hiv ) , syphilis , hepatitis b virus ( hbv ) ] and hepatitis c virus ( hcv ) .
it allows histologically examination of the entire specimen and to evaluate for foci of scc .
the cure rate with radical surgery reportedly is 61% and recurrences of giant condyloma acuminatum can be successfully treated with radical surgery . in limited lesions primary excision can be safely performed leaving wounds open to granulate without major primary flap reconstructions . in
more extensive lesions flap or skin graft coverage is preferable to decrease the length of recovery and minimize risk of severe anal stricture .
circumferential sleeve rectal advancement , house advancement , s - plasty rotations , v  y advancement flaps are all effective alternatives methods for covering wide wounds .
most authors do not perform colostomy for fecal diversion with acceptable postoperative complication rate . a combination of bowel cleansing
, low fiber diet and loperamide can be administered to reduce early contamination with feces of the wound . in cases of anal canal involvement
when mucosectomy extends beyond the dentate line colostomy helps to prevent potentially serious pelviperineal sepsis due to the high rate of suture dehiscence at this level . when performing anoplasty it is important to construct large flaps with a good blood supply and to obtain complete hemostasis of the raw surface to prevent hematomas as in our case 1 .
avoidance of tension on the muco - cutaneus anastomosis is important but not always technically simple . partial or complete dehiscence is not uncommon as in our experience but with a good follow up anal stenosis is rare .
abdominoperineal resection should be performed for more extensive lesions with deep invasion , malignant transformation or tumor recurrence .
no sufficient data are available to recommend any medical treatment such as interferon , radiotherapy or chemotherapy although sporadic cases of deeply infiltrating or recurrent tumors have been treated with apparent good results .
postoperative complications such as hematoma or suture dehiscence are possible and should be avoided with accurate haemostasis and a good mobilization of the flap .
local wound cleansing and an adequate follow up can avoid anal stenosis even without performing colostomy .
the authors declare that written informed consent was obtained from the patient for publication of this case report and accompanying images .
 introductiongiant anal condyloma also called buschke  
 lwenstein tumor is a rare sexually transmitted disease involving anogenital region with potential malignant degeneration into invasive squamous carcinoma . 
 complete surgical excision is the treatment of choice and often wide wounds are necessary to reach clear margins and prevent recurrence.presentation of casethe authors present two cases treated with an s - plasty rotating and a bilateral house advancement flap respectively with good functional result.discussiongiant anal condyloma also called buschke  
 lwenstein tumor is a large exophytic , cauliflower - like mass that is characterized by local aggressive behavior . 
 immunosuppression favors rapid growth of the condylomas and increases the risk of their malignant transformation . 
 in limited lesions primary excision can be safely performed leaving wounds open to granulate while in more extensive lesions flap or skin graft coverage is preferable to decrease the length of recovery and minimize risk of severe anal stricture . 
 abdominoperineal resection should be performed for more extensive lesions with deep invasion , malignant transformation or tumor recurrence.conclusiongiant anal condyloma also called buschke  lwenstein is a rare pathology with mainly sporadic single center experience reported in literature 
 . surgical complete excision remains the best treatment although elevate should be eventual recurrence . 
 no sufficient data are available to recommend any medical treatment such as interferon , radiotherapy or chemotherapy . 
Introduction
Presentation of cases
Case 1
Case 2
Discussion
Conclusions
Conflict of interest
Funding
Ethical approval
Author contributions