Psychotic depression due to giant condyloma Buschke-Löwenstein tumors

A 63-year-old patient, with no psychiatric history, was admitted in the psychiatric department with depressed mood, loss of interest in activities, apathy, insomnia, attention deficit, irritability, social withdrawal, prejudice and abandon delusions. Cerebral computed tomography (CT) scan was normal but the general physical examination revealed a voluminous tumor in the inguino-pubic-ano-genital area measuring 350/80/40 mm, which appeared 15 years ago and grew gradually leading to local rickety hygiene and also to depression, especially in the last time period when the tumor grew faster. The DSM-IV-TR diagnostic was affective disorder due to general medical condition. Surgical exams concluded it was a giant exophytic tumor and was recommended a pre-operative abdominal CT scan, which did not revealed metastatic spread. The treatment consisted in wide radical excision into the tumor-free resection margins. Anatomopathological exam concluded condyloma acuminatum - Buschke-Löwenstein tumor (BLT), a very rare borderline tumor. In post-operative period, progress of depression was spectacular, with the full mental recovery by decreasing the antidepressant and antipsychotic medication, fact that strengthen the initial diagnostic of depression due to a general medical condition.

Patients diagnosed with BLT may develop mental disorders especially with devaluation and low self-esteem, social withdrawal and secondary functional impairment. Due to the malignancy risk in such tumors and also the psychiatric unfavorable recovery prognostic in case of continuous general medical condition, the only effective treatment is tumor resection with surgical, oncological, psychiatric postoperative revaluation.