Hpv-Associated Penile Pigmented Lesion

HPV infection is involved in the etiology of a number of nonmalignant, premalignant and malignant cutaneous lesions. One of them is the so-called giant condyloma of Buschke-Löwenstein type (Buschke-Löwenstein tumor, BLT), which sometimes can imitate clinically other tumors or tumor-like conditions. Clinicians face a particular challenge in cases of BLT where, clinically, the lesions demonstrate a permanent brown hyperpigmentation in parallel with the dermatoscopic lack of the characteristic melanocytic network, globules or regression zones. There are uncommon clinical presentations with solitary, sharply demarcated pigmented lesions. In these cases the histopathological verification of the lesion is obligatory and the most efficient treatment method in the early period of the disease is the complete surgical excision. We report a case of a 74-year-old man who was admitted to the University Hospital “Lozenetz” in connection with profuse variceal bleeding of the esophagus associated with liver cirrhosis of unknown etiology. He underwent a consultative examination at the department of dermatology because of suspected advanced stage melanoma of the prepuce. Computed tomographic analysis indicated diffuse bone metastases located in the small pelvis and femur, as well as metastatic disease in the left inguinal lymph nodes. However, the subsequent histopathologic examination of the lesion, rather than showing melanoma, confirmed the presence of HPV-associated giant condyloma of Buschke and Löwenstein in initial stage, without histopathological evidence for invasive and destructive tumor growth. After his death, the patient’s relatives did not give consent for an autopsy, and therefore the genesis of the metastases, demonstrated by nuclear magnetic resonance imaging (NMR), remained unclear. In some cases, the clinical picture of the malignant and premalignant cutaneous lesions in the genital area could be problematic. The complete surgical excision with a subsequent histopathological verification is the best way to find out the exact diagnosis