A Two-Decade Journey of Buschke-Löwenstein Tumor Without Malignant Transformation: Clinical Insights and Management

Buschke-Löwenstein tumor (BLT), also known as giant condyloma acuminatum (GCA), represents a rare, slow-growing pseudoepitheliomatous lesion attributed to human papillomavirus (HPV) infection, characterized by local aggressiveness and potential for malignant transformation. We report a 62-year-old male with a 20-year history of progressive perineal lesions, alongside a medical background of non-muscle-invasive bladder carcinoma and chronic tobacco use. Clinical examination revealed a painless exophytic mass encompassing the perineum, scrotum, and adjacent structures; preoperative imaging and sexually transmitted infection screening yielded unremarkable findings. Histopathological analysis following wide surgical excision confirmed BLT without histological evidence of malignant transformation, with no recurrence observed at 18-month follow-up. Although an uncommon sexually transmitted entity with substantial risks of recurrence and malignant degeneration, BLT diagnosis rests upon integrated clinical and pathological correlation. Complete surgical excision remains the therapeutic cornerstone, potentially supplemented by adjunctive modalities. This case underscores the association with bladder neoplasia, likely mediated by shared risk factors including chronic inflammation and smoking, while emphasizing that early recognition and aggressive resection-even in extensive disease-can yield excellent long-term outcomes.