Squamous Cell Carcinoma of the Penis on Buschke-Lowenstein Tumor Recurring After Emasculation: A Case Report

Urology Department, Ibn Rochd Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco

*Corresponding Author: Dr. Mamane Taïbou Tanimoune, Urology Department, Ibn Rochd Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco, Phone: 0640575306, Email: [email protected]

Received Date: April 25, 2025

Published Date: May 21, 2025

Citation: Tanimoune MT, et al. (2025). Squamous Cell Carcinoma of the Penis on Buschke-Lowenstein Tumor Recurring After Emasculation: A Case Report. Mathews J Case Rep. 10(3):206.

Copyrights: Tanimoune MT, et al. © (2025).

ABSTRACT

Background: Buschke-Löwenstein tumor (BLT) is a rare and locally aggressive lesion of viral origin. It may progress to invasive squamous cell carcinoma (SCC) if not diagnosed and treated early. Case Presentation: We report the case of a 74-year-old man with a history of emasculation for SCC arising on a BLT, who presented with local tumor recurrence. Histopathological analysis revealed a well-differentiated verrucous SCC. Radical surgery was initially effective, but recurrence occurred within months, highlighting the aggressive nature of BLT. Conclusion: BLT may undergo malignant transformation to SCC and requires wide surgical excision and close follow-up. Early detection and preventive HPV vaccination are crucial in high-risk populations.

INTRODUCTION

Buschke-Löwenstein tumor (Buschke-Löwenstein tumor (BLT)), also called giant condyloma acuminatum, is a rare tumor lesion of viral origin, linked to chronic infection by human papillomaviruses (HPV), most often types 6 and 11. It preferentially affects immunocompromised individuals or those with risk factors such as poor hygiene, unprotected sexual intercourse, or a history of sexually transmitted infections [1]. Although histologically benign at its onset, this tumor can exhibit slow but invasive growth, leading to significant local destruction and malignant degeneration in 30 to 50% of cases [2,3]. Treatment is based on wide, sometimes mutilating, surgical excision. Recurrences are frequent, and the prognosis depends on the degree of locoregional spread and the differentiated nature of the carcinoma. We report here a particularly aggressive form, with recurrence after emasculation.

In addition to its anatomical implications, this condition has a significant psychological and social impact, particularly in advanced forms requiring mutilating procedures such as emasculation. The overall prognosis is linked to the stage at diagnosis, the effectiveness of surgical excision, and rigorous postoperative monitoring to prevent frequent recurrences.

Histologically, Buschke-Löwenstein tumor (Buschke-Löwenstein tumor (BLT)) is distinguished by its papillomatous architecture, marked acanthosis, and significant hyperkeratosis. It is characterized by the absence of significant cellular atypia at the onset, which can delay diagnostic suspicion. However, its slow but invasive exophytic growth is often accompanied by major tissue destruction, making its surgical treatment complex.

Epidemiologically, Buschke-Löwenstein tumor (BLT) primarily affects men between the ages of 40 and 70 and is more common in resource-limited countries due to limited access to sexual health care and HPV vaccination. The prevalence is also higher in immunocompromised patients, particularly those infected with HIV.

Buschke-Löwenstein tumor (Buschke-Löwenstein tumor (BLT)) (Buschke-Löwenstein tumor (BLT)), or giant condyloma acuminatum, is a rare and atypical entity. It presents distinct clinical, histological, and evolutionary characteristics from classic condylomata acuminata. This tumor, although histologically benign at its onset, is recognized for its marked local invasiveness, with destructive potential to surrounding soft tissues, and its high risk of malignant transformation.

CLINICAL OBSERVATION

This is a 74-year-old married patient with a history of Fournier's gangrene in 2018, urethral stricture diverted by cystostomy, and risky sexual intercourse. He had been presenting with a growth at the base of the penis for more than six months, accompanied by purulent discharge. Clinical examination revealed a 10 cm cauliflower-shaped tumor at the left base of the penis, superinfected, with areas of necrosis and inflammatory inguinal lymphadenopathy. HIV serologies were negative, as were tumor markers (alphaFP, LDH, HCG). The biopsy confirmed a well-differentiated verrucous squamous cell carcinoma. The staging assessment was negative. The patient then underwent a total penectomy with bilateral lymph node dissection. However, a few months later, a local recurrence was observed despite radical excision.

Figure 1. Preoperative tumor appearance showing a large ulcerative-budding cauliflower tumor at the base of the penis.

Figure 2. Immediate postoperative result after emasculation and bilateral lymph node dissection.

Figure 3. Local tumor recurrence observed 1 month after surgery.

DISCUSSION

Buschke-Löwenstein tumor (Buschke-Löwenstein tumor (BLT)) is characterized by its slow but infiltrative and destructive progression. Although histologically benign, its tendency to invade underlying structures without distant metastases makes it a unique entity [4]. Malignant transformation into squamous cell carcinoma is well documented in the literature, with an estimated transformation rate of 30 to 50% [5,6]. There are multiple associated risk factors: chronic HPV infection, immunosuppression, poor genital hygiene, smoking, and sexual promiscuity [7]. Diagnosis is based on clinical findings, histology, and extension imaging. The distinction between verrucous tumor and invasive carcinoma is based on subtle histological criteria, often necessary to guide treatment [8]. The standard treatment remains surgery, with wide margins. However, in very extensive or recurrent forms, management may require emasculation, as in our case [9]. The role of adjuvant treatments (chemotherapy, radiotherapy) remains limited, because Buschke-Löwenstein tumor (Buschke-Löwenstein tumor (BLT)) (Buschke-Löwenstein tumor (BLT))s are not very radiosensitive and chemoresistant [10,11]. Local recurrence, such as that observed in our patient, is frequent. It reflects the infiltrative nature of the tumor and the difficulty of obtaining complete resection. Prolonged monitoring is therefore necessary [12,13]. Finally, prevention is based on anti-HPV vaccination, sexual education, and early diagnosis of genital lesions [14,15].

CONCLUSION

Buschke-Löwenstein tumor (Buschke-Löwenstein tumor (BLT)) is a rare but serious condition due to its potential for degeneration and frequent recurrences. The therapeutic approach is essentially surgical. Prolonged monitoring is essential to detect recurrence, even after radical treatment.

ACKNOWLEDGMENTS

None.

CONFLICTS OF INTEREST

The authors declare that there are no conflicts of interest.

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