What is wrong on the CT scan?

A 37 y.o. male with a hx of HIV (CD4 267) and recurrent condylomata of the genital region presented with abdominal pain.    On physical exam he had ulcerations around the anus and was draining purulent material.  A CT scan was performed and the result is posted.  Radiology is unable to read the scan at this time because of multiple traumas so you take a look at the scan.  What do you see?
 

Scroll down for the Case Conclusion.

 

 

 

 

 

 

Final Diagnosis: Buschke-Lowenstein tumor

Case Conclusion & Learning Points: Buschke-Lowenstein tumor is a verrucous carcinoma of the skin and mucosa in the genital area. For unknown reasons, a small subset of long –lasting condyloma acuminata eventually evolve into invasive squamous cell carcinoma.  In our patient, the squamous cell carcinoma invaded through the anus over the wall of the bladder and into the abdomen where it invaded the gall bladder.  It also invaded the thigh which can be seen on the CT.    On the CT several areas of possible abscess were seen and surgery was consulted.  In view of the fact that the patient had had multiple surgeries in the past which showed only necrotic tumor; the surgery service felt further surgery would not be in the patients best interest.  The pt was admitted to the hospital for pain control.  He elected to go home on hospice care.

 ISandhu, R., Min, Z., & Bhanot, N. (2014). A gigantic anogenital lesion: Buschke-Lowenstein tumor.  Case reports in dermatological medicine ,  2014 .mage source:

ISandhu, R., Min, Z., & Bhanot, N. (2014). A gigantic anogenital lesion: Buschke-Lowenstein tumor. Case reports in dermatological medicine, 2014.mage source:

 Buschke-Lowenstein tumor of the penis

Buschke-Lowenstein tumor of the penis

Human papilloma virus type 6 , 11 or 16 DNA is regularly found in verrucous carcinomas suggesting a pathogenic role in tumor development.  High  risk HPV types 16 and 18   are found in anogenital cancers. Viral or host immunity may cause the malignant transformation.

Malignant transformation is reported in 50% of cases of giant condyloma acuminatum.

Case Conclusion by Dr. Roseanne Naunheim

 

References

Creasman C, Haas PA, Fox TA Jr, Balazs M.  Malignant transformation of anorectal giant condyloma acuminatum Dis Colon rectum. 1989;32:481-487.

Levy A, Lebbe C. Buschke-Lowentein tumor: diagnosisand treatment. Ann Urol (Paris) 2006;40:175-178.

Gissman L, De Villiers EM, Aur Hausen H. Analysis of the human genital warts (condyloma acuminate) and other genital tumor for human papillomavirus type 6 DNA. Int J Cancer 1982:29:143-46.

Elliot MS, Werner ID, Immelman EJ, Harrison AC. Giant condyloma of the anorectum Dis Colon Rectum 1979;22:497-502.