Condyloma acuminatum caused by Human Papillomavirus is the most commonly occurring sexually transmitted infection in the anogenital region. Buschke-Löwenstein tumor (BLT) known also as giant condyloma acuminatum is a rare disease. The disease, for which the most important treatment method is the surgical excision, differs from normal condyloma acuminatum cases with its high degree of malignancy. The purpose of this paper is to present the case that reached huge dimensions in the perianal region and that was treated with wide resection in the literature.

53-year-old-male patient was applied with the complaint of palpable mass that originated 10 years ago and gradually enlarged, causing discharge with unpleasant odor, recently causing gas-fecal incontinence. His history did not reveal any characteristics. In the examination of the patient, 20 × 20cm mass was observed which was covered with exudate with unpleasant odor, shaped like broccoli, and grew towards scrotum and penis root covering all perianal region beginning from anal channel (Figure 1). Colonoscopic examination showed that the mass reached linea dentata and enclosed mucosa. Magnetic resonance imaging of the patient showed that the mass did not invade anal sphincter and was localized to anal mucosa. Laboratory findings did not reveal any feature other than high leucocyte count (WBC: 14000). Local excision of the mass with negative surgical margins in lithotomy position and general anesthesia was applied to the patient. Findings of peroperative infection were determined and excision region was left open for secondary healing (Figure 2). Then operation was terminated after the laparoscopic loop colostomy was performed. After histopathological examination of the mass, it was reported as condyloma acuminatum and invasive tumor was not observed in the mass. Chemoradiotherapy was not planned because malignant transformation was not detected in the patient. Colostomy of the patient was closed 6 months later after the excision region is secondarily healed (Figure 3) and its sphincter tone was evaluated as normal in manometric studies. There was not any complaint or recurrence in the patient during postoperative 6-month follow-up period.

Early surgical resection in the treatment of condyloma acuminatum prevents the development of BLT. It is necessary to determine histopathologically whether a malignant transformation occurred, or whether the anal sphincter muscles and rectum are invaded with radiological and endoscopic imaging in BLT cases before the surgery for determining the surgical method.