Buschke-Löwenstein Tumor (BLT) - Consequences of Delayed Diagnosis and Management

Reviewed by Dr. Reza Lankarani, General SurgeonFounder | Surgical Pioneering Newsletter and Podcast Series Editorial Board Member | Genesis Journal of Surgery and MedicineGenesis Journal of Clinical Practice and Medical Case Reporthttps://doi.org/10.52793/JCPMCR.2025.2(1)-25Published: August 11, 2025This article from the Genesis Journal of Clinical Practice and and Medical Case Report focuses on a case study of a 56-year-old man diagnosed with a giant Buschke-Löwenstein tumor (BLT), a rare but aggressive form of giant condyloma acuminatum. The authors, from the Department of Dermatology and Venereology at Mohammed VI University Hospital in Tangier, Morocco, emphasize that this patient's severe condition resulted from a delayed diagnosis and management. They highlight that BLT is often associated with Human Papillomavirus (HPV) types 6 and 11, and despite its benign histological appearance, it carries a significant risk of malignant transformation. The authors also discuss the standard treatment, which primarily involves complete surgical excision, and stress the importance of timely intervention to prevent severe local morbidity and complications.SummaryThis briefing document summarizes key information regarding Buschke-Löwenstein Tumor (BLT), a rare variant of giant condyloma acuminatum, with a focus on the severe consequences of delayed diagnosis and management. Drawing from a recent case report, this document highlights the aggressive nature of BLT despite its benign histological appearance, its association with HPV, and the significant morbidity and complications that can arise from untreated cases.Main Themes and Most Important Ideas/Facts1. Definition and Characteristics of Buschke-Löwenstein Tumor (BLT)Rare Variant of Giant Condyloma Acuminatum: BLT is specifically identified as "a rare variant of giant condyloma acuminatum."Association with HPV: It is "most commonly associated with low-risk human papillomavirus (HPV) types 6 and 11."Histological Nature vs. Behavior: Despite its "benign histological nature," BLT "can behave aggressively, infiltrating adjacent tissues."Risk of Malignant Transformation: A significant concern is its "substantial risk of malignant transformation into squamous cell carcinoma — reported in 30% to 56% of cases."2. Clinical Presentation and Progression of Untreated BLTInitial Presentation: The case report describes an initial presentation as a "small and asymptomatic" lesion.Gradual Enlargement: The tumor "gradually enlarg[es] for the past seven years."Symptoms with Progression: As it grows, symptoms emerge, including "discomfort during sitting and defecation, intermittent bleeding, and persistent foul-smelling discharge."Giant Dimensions: Untreated BLT can reach "giant dimensions," as illustrated by the reported case where the mass was "approximately 15 × 20 cm, with a cauliflower-like surface, lobulated margins, and ulcerated zones." The tumor extended "from the anal margin to the intergluteal cleft and the scrotal base."Histopathological Findings: Diagnosis is confirmed by histopathological analysis showing "marked papillomatosis, acanthosis, parakeratosis, and koilocytosis without dysplasia, consistent with a diagnosis of Buschke-Löwenstein tumor."3. Severe Consequences of Diagnostic and Therapeutic DelaySignificant Local Morbidity: The case report explicitly states that delayed diagnosis and treatment lead to "severe clinical consequences," resulting in "significant local morbidity."Social Embarrassment: Patients may experience "social embarrassment."Complications: Untreated BLT can lead to various complications, including "infection, fistulization, or obstruction." The reported patient experienced "intermittent bleeding, and persistent foul-smelling discharge."4. Management and Treatment ChallengesStandard Treatment: Surgical Excision: The "standard treatment involves complete surgical excision with wide margins."High Recurrence Rate: Despite surgery, "recurrence remains frequent due to local aggressiveness and difficulty achieving clear margins."Limited Role of Other Therapies: While "topical agents or immunotherapy have been proposed in selected cases," surgery "remains the cornerstone of management."ConclusionThe source emphasizes the critical importance of early diagnosis and intervention for Buschke-Löwenstein Tumor. Left untreated, this rare HPV-associated condition, despite its benign initial histology, can grow to enormous sizes, leading to debilitating symptoms, severe complications, and a substantial risk of malignant transformation. Complete surgical excision is the primary treatment, but even then, recurrence is common, highlighting the aggressive nature of BLT and the challenges in its long-term management.To access additional details, please refer