Penile Intraepithelial Neoplasia (PeIN) in a young man with the clinical appearance of Buschke Lowenstein Tumor

Fiona wongkar; Ni Nyoman Ayu  Sutrini

doi:10.15562/bmj.v12i1.4083

Penile Intraepithelial Neoplasia (PeIN) in a young man with the clinical appearance of Buschke Lowenstein Tumor

Fiona wongkar ,

Ni Nyoman Ayu Sutrini ,

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DOI: https://doi.org/10.15562/bmj.v12i1.4083 |
Published: 2023-02-15

Abstract

Background: The incidence of penile cancer in the general population is rare. Epidemiologically, penile cancer occurs less than 1% compared to other types of cancer. Penile Intraepithelial Neoplasia (PeIN) is a precancerous lesion of invasive squamous cell carcinoma characterized by dysplastic changes of squamous epithelium with the intact basement membrane. This case report aims to increase understanding of Penile Intraepithelial Neoplasia (PeIN), especially with the clinical appearance of the Buschke Lowenstein Tumor, diagnosis, examination, and appropriate management.

Case Presentation: A 21-year-old Balinese man presented with a lump on his genitalia without itching, pain, and a lesion that bleeds easily, which has appeared since January 2022. He complained that the lump was getting bigger and bigger. Physical examination showed multiple hyperpigmented papules and plaques with well-defined oval and corn shapes that vary in size with a dense consistency and a verrucous surface. Laboratory tests showed negative on Hep-B and HIV tests. The patient also had a biopsy of the lump where the results showed Penile Intraepithelial Neoplasia. The patient was treated with 6 cycles of TCA 80% once a week, but it did not improve, so circumcision and surgical excision were carried out on June 2022. Fourteen days after surgery, multiple lumps appeared, recurred, and increased in number and size. On 1-month observation after the second surgery, the patient denied complaints of the genitals. Venerological status was within normal limits.

Conclusion: HPV-related Penile Intraepithelial Neoplasia (Warty subtype) with the clinical appearance of Buschke Lowenstein Tumor was reported in a 21-year-old Balinese man treated with Glans Resurfacing surgical excision with satisfactory results characterized by no functional abnormalities both during urination or erection.

References

Wolff K, Johnson RA, Roh E, Saavedra AP. Squamous Cell Carcinoma In Situ. In: Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 8th ed. New York: McGraw-Hill Education. 2017:227–229.
Huang K, Lu S, Wang Y, Tu X. Case report: Treatment of Penile Intraepithelial Neoplasia in an Asian male with reconstructive plastic surgery. Frontiers in Surgery. 2021;8:667417.
Thuret R, Sun M, Budaus L, Abdollah F, Liberman D, Shariat SF, et al. A population-based analysis of the effect of marital status on overall and cancer-specific mortality in patients with squamous cell carcinoma of the penis. Cancer Causes Control. 2013;24(1):71-79.
Kristiansen S, Bjartling C, Svensson Å, Forslund O, Torbrand C. Penile intraepithelial neoplasia, penile cancer precursors and human papillomavirus prevalence in symptomatic preputium: a cross-sectional study of 351 circumcised men in Sweden. BJU Int. 2021;127(4):428-434.
Canete-Portillo S, Sanchez DF, Cubilla AL. Pathology of Invasive and Intraepithelial Penile Neoplasia. Eur Urol Focus. 2019;5(5):713-717. doi:10.1016/j.euf.2019.06.013
Nieves-Condoy JF, Acuña-Pinzón CL, Chavarría-Chavira JL, Hinojosa-Ugarte D, Zúñiga-Vázquez LA. Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage. Infect Dis Obstet Gynecol. 2021;2021:9919446.
Gillard P, Vanhooteghem O, Richert B, De La Brasine M. Tumor de Buschke-Loewenstein. Ann Dermatol Venereol. 2005;7:98–99.
Lonsdorf AS, Hadaschik EN. Squamous Cell Carcinoma and Keratoacanthoma. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, Wolff K, eds. Fitzpatrick’s Dermatology in General Medicine, 8th ed, Vol 1. New York: Mc Graw Hill. 2012: p1902
Amin MB, Edge S, Greene F. AJCC cancer staging manual. 8th. Springer International Publishing: American Joint Commission on Cancer. 2017:257-260.
Sandhu R, Min Z, Bhanot N. A gigantic anogenital lesion: buschke-lowenstein tumor. Case Rep Dermatol Med. 2014;2014:650714.
Siddiqui MAA, Perry CM. Human papillomavirus quadrivalent (types 6, 11, 16, 18) recombinant vaccine (Gardasil). Drugs. 2006;66(9):1263-1271.
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The American College of Obstetri and Gynecologist. Human Papilloma Virus Vaccination. ACOG Committee Opinion. 2017.
Palefsky J, Giuliano A, Goldstone S, Moreira E, Aranda C, Jessen H, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011;365(17):1576–1585.
Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, Budiana ING, Manuaba IBAP. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.
Issa A, Sebro K, Kwok A, Janisch F, Grossmann NC, Lee E, et al. Treatment Options and Outcomes for Men with Penile Intraepithelial Neoplasia: A Systematic Review. Eur Urol Focus. 2022;8(3):829-832.
Barocas DA, Chang SS. Penile cancer: clinical presentation, diagnosis, and staging. Urol Clin North Am. 2010;37(3):343-352.
Rohanda BA, Hutapea R, Nadeak K. Identification of the type of Human Papilloma Virus (HPV) in condyloma acuminata in the genital and/or anal areas in men who have sex with men (MSM). Bali Medical Journal. 2021;10(2):885–890.
Yamaguchi T, Sugiyama Y, Tanaka T, Kimura T, Yumura Y, Nakano M, et al. Summary of the Clinical Practice Guidelines for Penile Cancer 2021 by the Japanese Urological Association. Int J Urol. 2022;29(8):780-792.

[1] Wolff K, Johnson RA, Roh E, Saavedra AP. Squamous Cell Carcinoma In Situ. In: Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 8th ed. New York: McGraw-Hill Education. 2017:227–229.

[2] Huang K, Lu S, Wang Y, Tu X. Case report: Treatment of Penile Intraepithelial Neoplasia in an Asian male with reconstructive plastic surgery. Frontiers in Surgery. 2021;8:667417.

[3] Thuret R, Sun M, Budaus L, Abdollah F, Liberman D, Shariat SF, et al. A population-based analysis of the effect of marital status on overall and cancer-specific mortality in patients with squamous cell carcinoma of the penis. Cancer Causes Control. 2013;24(1):71-79.

[4] Kristiansen S, Bjartling C, Svensson Å, Forslund O, Torbrand C. Penile intraepithelial neoplasia, penile cancer precursors and human papillomavirus prevalence in symptomatic preputium: a cross-sectional study of 351 circumcised men in Sweden. BJU Int. 2021;127(4):428-434.

[5] Canete-Portillo S, Sanchez DF, Cubilla AL. Pathology of Invasive and Intraepithelial Penile Neoplasia. Eur Urol Focus. 2019;5(5):713-717. doi:10.1016/j.euf.2019.06.013

[6] Nieves-Condoy JF, Acuña-Pinzón CL, Chavarría-Chavira JL, Hinojosa-Ugarte D, Zúñiga-Vázquez LA. Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage. Infect Dis Obstet Gynecol. 2021;2021:9919446.

[7] Gillard P, Vanhooteghem O, Richert B, De La Brasine M. Tumor de Buschke-Loewenstein. Ann Dermatol Venereol. 2005;7:98–99.

[8] Lonsdorf AS, Hadaschik EN. Squamous Cell Carcinoma and Keratoacanthoma. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, Wolff K, eds. Fitzpatrick’s Dermatology in General Medicine, 8th ed, Vol 1. New York: Mc Graw Hill. 2012: p1902

[9] Amin MB, Edge S, Greene F. AJCC cancer staging manual. 8th. Springer International Publishing: American Joint Commission on Cancer. 2017:257-260.

[10] Sandhu R, Min Z, Bhanot N. A gigantic anogenital lesion: buschke-lowenstein tumor. Case Rep Dermatol Med. 2014;2014:650714.

[11] Siddiqui MAA, Perry CM. Human papillomavirus quadrivalent (types 6, 11, 16, 18) recombinant vaccine (Gardasil). Drugs. 2006;66(9):1263-1271.

[12] World Health Organization, United Nations Population Fund. Preparing for the introduction of HPV Vaccines: Policy and Programme Guidance for Countries. WHO. 2006.

[13] The American College of Obstetri and Gynecologist. Human Papilloma Virus Vaccination. ACOG Committee Opinion. 2017.

[14] Palefsky J, Giuliano A, Goldstone S, Moreira E, Aranda C, Jessen H, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011;365(17):1576–1585.

[15] Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, Budiana ING, Manuaba IBAP. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.

[16] Issa A, Sebro K, Kwok A, Janisch F, Grossmann NC, Lee E, et al. Treatment Options and Outcomes for Men with Penile Intraepithelial Neoplasia: A Systematic Review. Eur Urol Focus. 2022;8(3):829-832.

[17] Barocas DA, Chang SS. Penile cancer: clinical presentation, diagnosis, and staging. Urol Clin North Am. 2010;37(3):343-352.

[18] Rohanda BA, Hutapea R, Nadeak K. Identification of the type of Human Papilloma Virus (HPV) in condyloma acuminata in the genital and/or anal areas in men who have sex with men (MSM). Bali Medical Journal. 2021;10(2):885–890.

[19] Yamaguchi T, Sugiyama Y, Tanaka T, Kimura T, Yumura Y, Nakano M, et al. Summary of the Clinical Practice Guidelines for Penile Cancer 2021 by the Japanese Urological Association. Int J Urol. 2022;29(8):780-792.

Penile Intraepithelial Neoplasia (PeIN) in a young man with the clinical appearance of Buschke Lowenstein Tumor

Abstract

References

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