Regression of Deeply Infiltrating Giant Condyloma (Buschke-Löwenstein Tumor) Following Long-term Intralesional Interferon Alfa Therapy

In 1995, a 40-year-old heterosexual man developed a perianal tumor that rapidly increased in size. Following a clinical and histologic diagnosis of a large condyloma acuminatum (CA), the tumor was partially resected in a primary care hospital. Subsequently, recurrent perianal fistulae and abscesses required several surgical interventions, and the patient underwent a transverse colostomy to allow subsequent complete resection of the condyloma. At the patient’s first visit in our clinic in 1996, physical examination demonstrated a smooth, exophytic, cauliflowerlike perianal verrucous tumor extending toward the perineum, scrotum, and buttocks (Figure 1, left). A magnetic resonance imaging scan revealed that the tumor infiltrated deeply into the right side of the pelvis, including the ischiorectal fossa, internal obturator muscle, anal sphincter, perineum, and penile root (Figure2, top). Histologic reevaluation of a previously obtained biopsy specimen showed a large papillomatous tumor infiltrating deeply into the underlying tissues, without penetration of the basement membrane (Figure 3, top). The epithelium was acanthotic with blunt rete ridges, well stratified without apparent cellular atypia, and contained few mitoses and koilocytes (Figure 3, bottom). There was no evidence of areas of malignant degeneration or squamous cell carcinoma (SCC). DNA was extracted from the biopsy specimen and analyzed for human papillomavirus (HPV) DNA by hybrid capture assay