Giant condyloma acuminatum (Buschke–Löwenstein tumor; BLT) is a rare HPV-associated disease characterized by progressive proliferation, high recurrence rates (60–70%), and potential for malignant transformation to squamous cell carcinoma. Although histologically benign, aggressive local behavior and involvement of functionally critical anatomical structures present substantial therapeutic challenges. This report describes the successful function-preserving surgical management of extensive treatment-refractory BLT. A 69-year-old woman with a history of malignant lymphoma and diabetes mellitus developed vulvar condyloma that was resistant to sequential imiquimod therapy, cryotherapy, and laser ablation. The lesion progressively enlarged to 15 × 9.5 × 2.5 cm, encompassing the entire vulva and perianal area. Clinical examination and imaging confirmed the absence of urethral and rectal mucosal invasion. Preoperative imiquimod was administered to the urethral meatus, vaginal introitus, and perianal area for 4 weeks to control microscopic disease at functionally critical sites. Surgical resection prioritized function preservation: ≥1 cm margin at the periphery, while mucosal boundaries were approached closely at critical sites. Residual rough mucosal areas underwent bipolar cauterization. Primary closure was achieved without the need for flap reconstruction. Mild postoperative wound dehiscence without infection resolved with conservative management, permitting secondary healing. Five months postoperatively, complete epithelialization was achieved with no recurrence, preserved urinary and bowel function, or the absence of vaginal symptoms. This case demonstrates that combining preoperative imiquimod, function-prioritizing surgical margins, local ablation, and tolerance of secondary healing can achieve oncologic control while maintaining quality of life in extensive BLT. Long-term surveillance remains essential.
Hirakawa et al. (Mon,) studied this question.