Buschke-Lowenstein Tumor: An Unusual Therapeutic Approach

Giant condyloma acuminatum, known as Buschke-Lowenstein tumor, is a rare benign tumor. Several risk factors are described, including immunosuppression, diabetes, tobacco use, and multiple sexual partners, with about 90% of cases being associated with human papillomavirus infection. Given the rarity of this lesion, there are still no established guidelines for the assessment and treatment of this tumor. The most reported and consensus approach described in the literature is surgical intervention. We report a case of a 32-year-old man who was immunosuppressed following a lung transplant due to cystic fibrosis. He also had stage IV chronic kidney disease and chronic pancreatitis. The patient was evaluated in a proctology consultation due to complaints of itching, perianal pain, and constipation with a 4-month history. Clinical examination showed a cauliflower-like, papillomatous tumor measuring 9 cm along the perianal area with other surrounding smaller lesions. The assessment of immunodeficiency virus, hepatitis C virus, hepatitis B virus and syphilis was negative. The patient denied engaging in receptive anal sex and other risky sexual behaviors. A macro biopsy of the lesion was performed and the histopathological examination revealed an anal condyloma acuminatum, with no signs of malignancy. Therapy with imiquimod was initiated, for several weeks, with no significant reduction of lesion size. In a multidisciplinary discussion, it was decided to start neoadjuvant chemoradiotherapy with capecitabine and mitomycin. After 5 months of treatment, a significant reduction in lesion size was observed with significant clinical improvement. Currently, the patient has no proctological symptoms and no need for analgesia.