Malignant Transformation of Perianal Giant Condyloma Acuminatum

acuminatum (GCA) on the penile foreskin. Buschke and Lowenstein further elaborated on this clinical entity in 1925. 2 GCA, synonymous with BuschkeLowenstein tumor, is a variant of condyloma acuminatum, which appeared cytologically benign but behaved in a malignant manner with the risk of transformation to invasive squamous cell carcinoma (SCC). GCA is characterized by its aggressiveness to underlying tissues; resistance to simple excision, local electrofulgaration or therapeutic agents; and high recurrence rate, despite the lesion having shown no histological criteria of malignancy. The first case of GCA located in anorectal and perianal regions was reported by Dawson in 1965. Chu and colleagues, analyzing 42 cases of GCA in anorectal and perianal regions, observed that the hallmark of the disease is the high rate of recurrence (66%), malignant transformation (56%), and no distant metastases. In a review literature of Creasman, malignant transformation was described in thirty percent of cases of anorectal GCA. Although rare, perianal GCAhas been well documented. In a review article by Trombetta, fifty-two cases of perianal GCA were found prior to 2000. The incidence of perianal GCAin Taiwan is not clear, but at least one case (without malignant change) was reported in literature prior to 2006. GCA is frequently indistinguishable from benign lesions. Among published studies, there is a consensus that GCA probably represents a verrucous carcinoma (VC). Malignant transformations of GCA are rarely seen, but have occasionally been reported in the J Soc Colon Rectal Surgeon (Taiwan) March 2007