Buschke-Löwenstein tumour associated with low-risk human papillomavirus genotypes successfully treated surgically

Giant condyloma acuminatum termed as a Buschke-Löwenstein tumour (BLT) is an invasively slow-growing wart-like skin lesion of the anogenital region [1]. Although the disorder is histologically benign, its management is challenging due to its large size, local tissue destruction, and high recurrence rate [2]. We report a case of genital BLT associated with a low-risk human papillomavirus (HPV) infection which was treated successfully with radical excision and reconstructive surgery.
A 66-year-old man was admitted to the dermatological outpatient clinic due to a large polypoid lesion in the genital area (Figure 1 A). The single brownish small wart had first appeared on the penis 19 years before and had grown gradually expanding also the perineal region. The lesion was painless, but caused disfigurement of the penis and made sexual intercourses impossible. Nevertheless, the patient had not sought any therapy. He denied any sexual risk behaviours. The patient was suffering from hypertension, benign prostatic hyperplasia and degenerative joint disease. The family history of skin disorders was negative.
In the conducted digital rectal examination, the wall of the anus and anal canal were unaffected. The prostate gland was enlarged, smooth, symmetrical, without palpable changes. Urination was effortless. The mucosa of the glans penis was normal. Lymph nodes were not palpable. The diagnostic tests towards other sexually transmitted diseases was negative. The skin biopsies were taken and the patient was referred to the department of urology for further diagnostics and treatment. Histopathological examination of the genital skin lesion confirmed the clinical suspicion of giant condyloma acuminatum. Moreover, HPV detection by polymerase chain reaction method (PCR) from the biopsy specimens was performed and revealed the presence of HPV 6 and 11 genotypes (Figure 2 B).
The therapy consisted of radical excision with the follow-up reconstruction by rotation flap surgery (Figure 1 B). The patient was discharged from hospital in good condition with recommendation of antibiotic treatment and daily wound dressings. All the surgical material was forwarded for histopathological examination which confirmed the previous diagnosis of BLT (Figure 2 A). No recurrence was observed during 5 months of follow-up.
The giant condyloma acuminatum was originally described by Buschke in 1986 [3] and Löwenstein in 1925 [4] as a penile lesion. The disorder belongs...


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