Buschke–Löwenstein tumor (BLT), also known as giant condyloma acuminatum or verrucous carcinoma, is a rare sexually transmitted disease associated with human papillomavirus (HPV) infection, predominantly HPV types 6 and 11, which account for approximately 90% of cases. It occurs mainly in males, with an estimated overall incidence of 0.1%. Despite its benign histological appearance, BLT is characterized by marked local aggressiveness, a capacity for extensive and destructive growth, a high recurrence rate following surgical excision and a significant risk of malignant transformation reported in up to 56% of cases. We report the case of a 50-year-old patient with no significant medical history who presented with a large exophytic perineal lesion evolving over five years, accompanied by recurrent bleeding and pain. Clinical examination revealed multiple exophytic, vegetative, blackish tumors involving the penile shaft, glans and scrotum, measuring between 1 and 10 cm, with a characteristic cauliflower-like papillomatous appearance. Histopathological examination demonstrated papillomatous epidermal hyperplasia with koilocytic vacuolization, confirming the diagnosis. Radical surgical excision was performed, followed by four sessions of chemical destruction using 50% trichloroacetic acid and imiquimod, with close clinical follow-up. No recurrence was observed after one year, emphasizing the importance of early diagnosis, complete surgical management and rigorous monitoring to optimize outcomes. Multiple therapeutic modalities have been described in the literature, including laser therapy, cryotherapy, radiotherapy, electrocoagulation, immunotherapy, topical agents such as imiquimod and sinecatechins, intralesional 5-fluorouracil, isolated perfusion and systemic or local chemotherapy. In extensive cases, neoadjuvant chemotherapy or radiotherapy may be considered to reduce tumor volume and facilitate safer surgical debulking. HPV vaccination, which includes HPV types 6 and 11, significantly reduces the incidence of genital warts and may consequently decrease the risk of developing BLT, underscoring the critical role of HPV infection in the pathogenesis of this rare tumor.
El Ghazouli Israe*, Gallouj Salim, Rimani Mouna and El Jouari Ouiame (Mon,) studied this question.