Rare Vulvar Presentation of a Giant Condyloma Acuminatum (Buschke-Löwenstein Tumor): A Diagnostic and Therapeutic Challenge

Abstract

Introduction: The Buschke-Löwenstein tumor, also known as giant condyloma acuminatum, is a rare sexually transmitted lesion associated with human papillomavirus (HPV), most commonly types 6 and 11. It is characterized by a slow but aggressive local growth that can cause significant tissue destruction while maintaining a benign histological appearance. Due to its rarity and resemblance to malignant lesions, the diagnosis and management of this entity represent a clinical and therapeutic challenge. Early recognition and appropriate treatment are essential to prevent recurrence and malignant transformation.

Clinical Case: We present the case of a 63-year-old woman with a history of diabetes and hypertension, who presented with multiple exophytic lesions in the vulvar and perineal regions. Clinical examination revealed a cauliflower-like mass approximately 10 cm in diameter involving the labia majora, clitoris, and perineum. Histopathological biopsy confirmed the diagnosis of Buschke-Löwenstein tumor (giant condyloma acuminatum). The patient underwent surgical management with electrofulguration under regional anesthesia, achieving complete ablation of the lesion and satisfactory hemostasis. Postoperative recovery was uneventful, and follow-up at six month showed adequate healing without recurrence.

Discussion: Female presentation of BLT, such as in this case, is exceedingly rare, with vulvar involvement reported only in isolated cases. The clinical course and histopathological findings were consistent with literature descriptions of locally invasive but non-metastatic behavior. Early biopsy and histopathological confirmation are crucial for distinguishing BLT from squamous cell carcinoma and other verrucous lesions. Among treatment options, electrofulguration represents an effective and safe approach for extensive vulvar disease, providing local control with minimal morbidity.

Conclusion:  This case highlights the importance of considering BLT in the differential diagnosis of large exophytic vulvar lesions. Early diagnosis and prompt surgical intervention are key to preventing recurrence and malignant transformation. Awareness of this rare presentation among gynecologists can improve clinical recognition and optimize multidisciplinary management of HPV-related anogenital disease.