Case and Research Letter
Giant periurethral condyloma acuminata in a 2-year-old girl: Successful treatment with carbon dioxide laser
Condiloma acuminado periuretral gigante en niña de 2 años: tratamiento exitoso con láser de dióxido de carbono
X. Calderón-Castrat
, S. Blanco, J.C. Santos-Durán, M. Roncero-Riesco
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Department of Dermatology, University Hospital of Salamanca, Spain
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Calderón-Castrat, S. Blanco, J.C. Santos-Durán, M. Roncero-Riesco" "autores" => array:4 [ 0 => array:4 [ "nombre" => "X." "apellidos" => "Calderón-Castrat" "email" => array:1 [ 0 => "xime_777@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Blanco" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Santos-Durán" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Roncero-Riesco" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, University Hospital of Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Condiloma acuminado periuretral gigante en niña de 2 años: tratamiento exitoso con láser de dióxido de carbono" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1724 "Ancho" => 2500 "Tamanyo" => 617798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Giant periurethral condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery for the giant periurethral condyloma acuminata.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pediatric anogenital condyloma acuminata (CA) is not infrequent, as increasing reports of its prevalence have demonstrated in recent years.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> However, periurethral CA is an unusual location for this virally transmitted disease and is exceptionally reported in medical literature. Human papilloma viruses (HPV) are the etiological causes for all types of warts, and variable modes of transmission both sexual and non-sexual, have been described in the pediatric population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Current treatments for anogenital CA in children prove challenging due to their young age, anatomic location and the high recurrence rates.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> Multiple therapeutic approaches range from topical treatments to more aggressive procedures, including surgery.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present an otherwise healthy, 2-year-old girl referred to our Department of Dermatology, with progressively increasing asymptomatic lesions in the diaper area of 2 months in duration. Physical examination showed multiple flesh-colored and brownish papules of 1–2<span class="elsevierStyleHsp" style=""></span>mm in diameter located in the vestibular and vulvar region in a symmetric V-shaped distribution as well as in the perianal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>(A)) Additionally, careful periurethral examination revealed an exophytic, reddish and papillomatous lesion of 1.2<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>(A)) observing rich vascularity with dermoscopy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A clinical diagnosis of CA stage IV was established due to the extension of the lesions.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> PCR testing was performed for the vulvar, perianal and the periurethral lesions confirming the diagnosis of CA for HPV subtype 6. Subsequently, the patient was screened for other sexually transmitted diseases and reported to social services for possible child abuse investigations. The father presented genital warts, however, PCR testing results were not conclusive for the detection and typification of the HPV. No further information was retrieved from the mother. The exact source of infection could not be determined, but most importantly, no signs of sexual abuse were identified.</p><p id="par0020" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser surgery was proposed as a prompt solution for lack of sphincter control and the giant periurethral CA. The procedure was carried out in an in-patient regimen under general anesthesia and prophylactic systemic antibiotic with cefazolin. Under gynecological examination, urethral catheterization was performed. The operators were required to use a mask to prevent HPV in the vapor plume emitted by the CO<span class="elsevierStyleInf">2</span> laser. Vaporization with CO<span class="elsevierStyleInf">2</span> laser was performed with the following parameters: 5 Watts, continuous mode and repeated pulse in two consecutive passes. After vaporization and using the same CO<span class="elsevierStyleInf">2</span> laser parameters, the periurethral wart was coagulated from the base and sent for histopathological analysis. The treated area was covered with mupirocin ointment and a non-adherent dressing, both of which were changed on a daily basis until complete healing was achieved. The laser surgery lasted approximately 30<span class="elsevierStyleHsp" style=""></span>min with no intra or postoperative complications. The histopathological study revealed acanthosis and parakeratosis with elongation of rete ridges and the presence of koilocytes, features consistent with CA. Complete epithelialization was achieved within 9 days and only one session was required to achieve clearance. The giant periurethral and anogenital CA did not recur. A 13-month follow-up shows complete remission and no signs of scarring (<a class="elsevierStyleCrossRefs" href="#fig0005">Fig. 1(B) and 2(B)</a>).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Anogenital CA in the pediatric population is not rare in daily practice as one may suppose.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> However, giant periurethral condyloma occurs exceptionally in association with extensive dissemination of CA.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Most importantly, anogenital HPV infection in this particular age group poses a therapeutic challenge. Among several treatment recommendations for CA are podophyllin or imiquimod,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> trichloroacetic acid, 5-fluorouracil,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> cryotherapy, CO<span class="elsevierStyleInf">2</span> laser,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> electrocautery and surgery,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5-7</span></a> all of which present variable cure and recurrence rates. The multiple approaches and varying responses suggest that there is no gold standard for the treatment of CA in children<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6-8</span></a> and while topical treatments are indicated as a first line approach, there is no consensus regarding pediatric management.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7-9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our case, topical therapy was not a treatment option owing to the clinical presentation of the periurethral CA. Another important factor taken into account, was the infant that required diapers, for the occlusion and constant diaper changes would have interfered with the topical treatments, leading to possible lack of therapeutic effectiveness and adherence. However, the greatest concern was the periurethral wart, which due to size and location required a surgical procedure.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser surgery is an effective technique, demonstrating rapid healing and lower recurrence rates as the main advantages.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a> In our patient's case, after 9 days and only one session, complete epithelialization was achieved and no recurrence was observed in the 13-month follow-up (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>(B)). To our knowledge, this is the first pediatric case presenting a periurethral CA successfully treated with CO<span class="elsevierStyleInf">2</span> laser reported in medical literature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In summary, we report the outstanding results achieved with the CO<span class="elsevierStyleInf">2</span> laser for the treatment of a periurethral and disseminated CA in a pediatric patient. We therefore recommend this surgical procedure in cases where large CA in association with extensive disseminated infection are observed.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1304 "Ancho" => 2500 "Tamanyo" => 462629 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Multiple vestibular and vulvar condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery of anogenital condyloma acuminata.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1724 "Ancho" => 2500 "Tamanyo" => 617798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Giant periurethral condyloma acuminata. (B) 13-month follow-up post-CO<span class="elsevierStyleInf">2</span> laser surgery for the giant periurethral condyloma acuminata.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric anogenital warts: a 7-year review of children referred to a tertiary-care hospital in Montreal, Canada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Marcoux" 1 => "K. Nadeau" 2 => "C. McCuaig" 3 => "J. Powell" 4 => "L.L. 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English 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Adolesc Gynecol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "150" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22530225" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant condyloma acuminatum in an infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Tinsa" 1 => "A. Gharbi" 2 => "A. Essid" 3 => "M. Driss" 4 => "S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 6 | 19 |
| 2024 Octubre | 72 | 55 | 127 |
| 2024 Septiembre | 78 | 30 | 108 |
| 2024 Agosto | 96 | 74 | 170 |
| 2024 Julio | 79 | 38 | 117 |
| 2024 Junio | 86 | 22 | 108 |
| 2024 Mayo | 59 | 34 | 93 |
| 2024 Abril | 63 | 30 | 93 |
| 2024 Marzo | 66 | 27 | 93 |
| 2024 Febrero | 61 | 35 | 96 |
| 2024 Enero | 44 | 27 | 71 |
| 2023 Diciembre | 46 | 17 | 63 |
| 2023 Noviembre | 53 | 23 | 76 |
| 2023 Octubre | 50 | 20 | 70 |
| 2023 Septiembre | 49 | 32 | 81 |
| 2023 Agosto | 37 | 18 | 55 |
| 2023 Julio | 43 | 33 | 76 |
| 2023 Junio | 45 | 26 | 71 |
| 2023 Mayo | 43 | 24 | 67 |
| 2023 Abril | 31 | 21 | 52 |
| 2023 Marzo | 34 | 22 | 56 |
| 2023 Febrero | 40 | 22 | 62 |
| 2023 Enero | 48 | 25 | 73 |
| 2022 Diciembre | 49 | 40 | 89 |
| 2022 Noviembre | 22 | 32 | 54 |
| 2022 Octubre | 25 | 19 | 44 |
| 2022 Septiembre | 19 | 37 | 56 |
| 2022 Agosto | 21 | 32 | 53 |
| 2022 Julio | 16 | 47 | 63 |
| 2022 Junio | 24 | 25 | 49 |
| 2022 Mayo | 39 | 43 | 82 |
| 2022 Abril | 63 | 58 | 121 |
| 2022 Marzo | 86 | 67 | 153 |
| 2022 Febrero | 72 | 38 | 110 |
| 2022 Enero | 86 | 39 | 125 |
| 2021 Diciembre | 61 | 46 | 107 |
| 2021 Noviembre | 54 | 48 | 102 |
| 2021 Octubre | 49 | 44 | 93 |
| 2021 Septiembre | 58 | 30 | 88 |
| 2021 Agosto | 109 | 36 | 145 |
| 2021 Julio | 121 | 26 | 147 |
| 2021 Junio | 42 | 25 | 67 |
| 2021 Mayo | 72 | 41 | 113 |
| 2021 Abril | 371 | 45 | 416 |
| 2021 Marzo | 159 | 36 | 195 |
| 2021 Febrero | 111 | 35 | 146 |
| 2021 Enero | 97 | 24 | 121 |
| 2020 Diciembre | 87 | 26 | 113 |
| 2020 Noviembre | 123 | 28 | 151 |
| 2020 Octubre | 105 | 19 | 124 |
| 2020 Septiembre | 262 | 19 | 281 |
| 2020 Agosto | 267 | 15 | 282 |
| 2020 Julio | 283 | 20 | 303 |
| 2020 Junio | 282 | 39 | 321 |
| 2020 Mayo | 132 | 9 | 141 |
| 2020 Abril | 21 | 16 | 37 |
| 2020 Marzo | 15 | 10 | 25 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 7 | 0 | 7 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 2 | 4 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Febrero | 9 | 3 | 12 |
| 2018 Enero | 21 | 7 | 28 |
| 2017 Diciembre | 14 | 5 | 19 |
| 2017 Noviembre | 16 | 5 | 21 |
| 2017 Octubre | 22 | 6 | 28 |
| 2017 Septiembre | 14 | 9 | 23 |
| 2017 Agosto | 27 | 7 | 34 |
| 2017 Julio | 12 | 7 | 19 |
| 2017 Junio | 34 | 10 | 44 |
| 2017 Mayo | 38 | 23 | 61 |
| 2017 Abril | 4 | 3 | 7 |
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