GIANT KONDILOMA AKUMINATA ANAL PADA SEORANG PRIA HOMOSEKSUAL YANG MENDERITA HIV
Abstract
Pendahuluan : Giant kondiloma akuminata sering dikaitkan dengan HPV tipe 6 dan 11, namun memiliki perbedaan dengan kondiloma anal pada umumnya, seperti papilomatosis yang berbatas tegas, akantosis, rete ridges yang memanjang, dan meningkatnya aktivitas mitosis. Kasus: Pria, umur 33 tahun, dengan keluhan muncul benjolan yang menyerupai kembang kol di sekitar lubang dubur yang terasa gatal sejak 1 tahun yang lalu. Pemeriksaan status venereologis didapatkan nodul vegetasi, berukuran 8x5x1 cm3, multipel, berbentuk seperti kembang kol, permukaan verokosa, batas tegas, berkelompok, konsistensi padat, warna hiperpigmentasi, tidak dapat digerakkan dan nyeri jika ditekan pada area perianal. Lesi tersebut tidak mudah berdarah. Pasien sudah mendapatkan penotolan TCA (50%) sebanyak tujuh kali namun belum tampak perbaikan, sehingga selanjutnya dilakukan eksisi lesi oleh dokter bedah. Setelah dilakukan pembedahan tampak ada perbaikan lesi. Diskusi: giant kondiloma akuminata merupakan massa eksofitik yang berukuran besar, dapat disertai dengan keluhan gatal, nyeri, perdarahan dan fistel pada lesi. pemeriksaan histopatologi kondiloma akuminata dan giant kondiloma akuminata sangat sulit dibedakan. Mikroskopis giant kondiloma akuminata menunjukkan epitel skuamous berlapis yang mengalami hiperkeratosis, parakeratosis, akantosis dan papilomatosis dengan sedikit sel-sel atypia. Pada epitel juga ditemukan koilositosis. Pada jaringan fibrokolagen didapatkan infiltrat inflamasi kronik. bedah eksisi merupakan terapi lini pertama untuk giant kondiloma akuminata, dengan tingkat kesuksesan mencapai (63-91%) diikuti tingkat relaps yang rendah. Kesimpulan : giant kondiloma akuminata (Buschke-Löwenstein) merupakan penyakit yang sering mengenai kelompok imunosupresif. Giant kondiloma akuminata dapat merupakan prekursor karsinoma sel skuamosa sehingga harus didiagnosis secara tepat dan segera diterapi. Terapi eksisi merupakan terapi lini pertama untuk giant kondiloma akuminata.
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