Giant Buschke-Lowenstein Tumor: A Consequence of Delayed Diagnosis and Management

   

Firdaouss Boukamza^1,2*, Ouiame El Jouari^1,2, Faiçal Abbad³ and Salim Gallouj^1,2

Citation: Boukamza F, Jouari OEL, Abbad F, and Gallouj S. P Giant Buschke-Lowenstein Tumor: A Consequence of Delayed Diagnosis and Management. J Clin Pract Med Case Rep. 2(1):1-3.

Received: August 01, 2025 | Published: August  11, 2025.

Copyright^© 2025 genesis pub by Boukamza F, et al. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0  International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

DOI: https://doi.org/10.52793/JCPMCR.2025.2(1)-25

Abstract

Po A 56-year-old man presented with a giant exophytic perianal mass that had been gradually enlarging for the past seven years. The lesion was initially small and asymptomatic, but over time, the patient reported discomfort during sitting and defecation, intermittent bleeding, and persistent foul-smelling discharge.

Keywords

Buschke-Löwenstein tumor; Giant condyloma; Perianal mass; HPV; Diagnostic delay.

Description

A 56-year-old man presented with a giant exophytic perianal mass that had been gradually enlarging for the past seven years. The lesion was initially small and asymptomatic, but over time, the patient reported discomfort during sitting and defecation, intermittent bleeding, and persistent foul-smelling discharge.

Clinical examination revealed a massive papillomatous tumor, approximately 15 × 20 cm, with a cauliflower-like surface, lobulated margins, and ulcerated zones. The mass extended from the anal margin to the intergluteal cleft and the scrotal base (Figures 1a, 1b). Histopathological analysis showed marked papillomatosis, acanthosis, parakeratosis, and koilocytosis without dysplasia, consistent with a diagnosis of Buschke-Löwenstein tumor (Figure2).

Buschke-Löwenstein tumor (BLT) is a rare variant of giant condyloma acuminatum, most commonly associated with low-risk human papillomavirus (HPV) types 6 and 11. Despite its benign histological nature, it can behave aggressively, infiltrating adjacent tissues and carrying a substantial risk of malignant transformation into squamous cell carcinoma — reported in 30% to 56% of cases [1,2].

This case illustrates the severe clinical consequences of diagnostic and therapeutic delay. Left untreated, BLT can reach giant dimensions, resulting in significant local morbidity, social embarrassment, and complications such as infection, fistulization, or obstruction [3,4]. Standard treatment involves complete surgical excision with wide margins, although recurrence remains frequent due to local aggressiveness and difficulty achieving clear margins. In selected cases, topical agents or immunotherapy have been proposed, but surgery remains the cornerstone of management [5].

Figure 1: Posterior view showing a giant verrucous perianal tumor with lobulated, papillomatous surface.

Figure 2: Lateral view showing scrotal root extension and ulcerated areas.

Figure 3: Histological section (H&E, ×100) showing pronounced papillomatosis, acanthosis, parakeratosis, and presence of koilocytes, consistent with Buschke-Löwenstein tumor.

References

1. Trombetta LJ, Place RJ. (2001) Giant condyloma acuminatum of the anorectum: epidemiology and management trends. J Am Coll Surg. 193(4):376-84.
2. Chu QD, Vezeridis MP, Libbey NP, Wanebo HJ (1994)  Giant condyloma acuminatum of the anorectal and perianal regions: analysis of 42 cases. Am Surg. 60(6):427-34.
3. Purzycka-Bohdan D, Nowicki RJ, Herms F, Casanovaet JL, Fouéré S, et al. (2022) The pathogenesis of giant condyloma acuminatum: an overview. Int J Mol Sci. 23(9):4547.
4. Bouhout T, Ramdani A, Kharkhach A, Serji B et al. (2024) A report of two rare cases of Buschke-Löwenstein tumor. Cureus. 16(1):e52700.
5. Nieves-Condoy JF, Acuña-Pinzón CL, Chavarría-Chavira JL, Hinojosa-Ugarteet D, Zúñiga-Vázquezal LA. (2021) Giant condyloma acuminata: review of an unusual and difficult-to-manage disease. Infect Dis Obstet Gynecol. 2021:9919446.