title: Giant condylomata acuminata of Buschke and Lowenstein: A peristomal variant.
abstract: BACKGROUND
  Giant condylomata acuminata (GCA) is a rare, locally invasive tumour that may undergo malignant transformation. It was first described a HPV-induced penile tumour which clinically resembled both a squamous cell carcinoma and condyloma acuminatum, often arising from a pre-existing warty lesion. We describe a case of peri-stomal GCA transformation into invasive squamous cell carcinoma (SCC), which is, to our knowledge, the first report of this in the literature.
  
  
  METHODS
  A 74 year old gentleman developed an acuminate, papillomatous peristomal eruption around a fifty year old ileostomy, with biopsies of the eruption showing reactive changes. Two years later, he developed ulcerating plaques affecting the previously papillomatous areas and an erythematous nodular lesion involving the superior part of the ileostomy and adjacent skin. Histological examination of the ileostomy lesion showed focal small islands of atypical squamous epithelium, and moderately differentiated invasive squamous cell carcinoma was shown in the excised tissue subsequently. Human papillomavirus (HPV type 16), p16 and p53 tumour suppressors were positive in the peri-stomal skin sample.
  
  
  CONCLUSIONS
  Recurring, changing papillomatous lesions in the peristomal area should be reviewed with a high index of suspicion in relation to GCA tumours as they can progress to invasive squamous cell carcinomas.
authors.affiliation: The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester M6 8HD, UK. Electronic address: zenas.yiu@manchester.ac.uk.
authors.forename: Z Z N
authors.initials: ZZ
authors.lastname: Yiu
authors.affiliation: The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester M6 8HD, UK. Electronic address: faisalali@doctors.org.uk.
authors.forename: F R
authors.initials: FR
authors.lastname: Ali
authors.affiliation: Christie Hospital, Manchester, UK. Electronic address: Malcolm.wilson@christie.nhs.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Wilson
authors.affiliation: Christie Hospital, Manchester, UK. Electronic address: david.mowatt@christie.nhs.uk.
authors.forename: D
authors.initials: D
authors.lastname: Mowatt
authors.affiliation: York Hospital, York, UK. Electronic address: calum.lyon@virgin.net.
authors.forename: C C
authors.initials: CC
authors.lastname: Lyon
keywords: Buschke–Lowenstein tumour; Giant condylomata acuminata; Human papillomavirus; Stoma