Medscape is available in 5 Language Editions – Choose your Edition here.


Giant Condylomata Acuminata of Buschke and Lowenstein Workup

  • Author: Catharine Lisa Kauffman, MD, FACP; Chief Editor: Dirk M Elston, MD  more...
Updated: Jul 21, 2016

Imaging Studies

 Giant condyloma of Buschke and Löwenstein (GCBL) has shown mild, heterogenous enhancement with gadolinium-diethylenetriamine pentaacetic acid (DTPA) contrast on MRI. This study may be useful in delineating the expansion of the lesion when planning for removal.[14]



Biopsy is the diagnostic procedure necessary for evaluation. It must be sufficiently deep and generous to evaluate for possible foci of SCC because lesions with these changes have been shown to have a higher recurrence rate and to metastasize. Vacuolar change is not a reliable differentiator between GCBL and condyloma, and visualizing the base of the lesion and the characteristic broad, blunt, deeply penetrating rete pegs is necessary to make the diagnosis.

Although the rate of regional lymph node involvement is low, sentinel lymph node biopsy should be considered if clinical findings suggest the need for it.


Histologic Findings

GCBL characteristically has massive epidermal hyperplasia, hyperkeratosis, and parakeratosis and is markedly exophytic. Granular vacuolization may be present, and individual keratinocytes have large cytoplasm and a nucleus with prominent nucleoli.

Blunt-shaped masses of tumor project deeply into the dermis and contiguous structures. The tumor cells have little evidence of atypia and are not found inside blood vessels or lymphatics. Individual keratinocytes may show keratinization, but no horn pearls are seen. Lymphohistiocytic inflammation is usually present.

Giant condyloma acuminatum is differentiated histologically from ordinary condyloma acuminata by its thicker stratum corneum and the presence of an endophytic downgrowth, along with a tendency to invade deeper. Because the distinction of GCBL from verrucous carcinoma can be difficult, GCBL has been regarded by some as a variant of verrucous carcinoma.[15]

Contributor Information and Disclosures

Catharine Lisa Kauffman, MD, FACP Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, Royal Society of Medicine, Women's Dermatologic Society, American Medical Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


Doru Traian Alexandrescu, MD Assistant Professor of Medicine, Georgetown University

Doru Traian Alexandrescu, MD is a member of the following medical societies: American Association for Cancer Research, American Cancer Society, American College of Physicians, American Medical Association, American Society of Hematology, Medical Society of the State of New York, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Christopher Norwood, MD, and Mary K. Mather, MD, to the development and writing of this article.

  1. Wiedemann A, Diekmann WP, Holtmann G, Kracht H. Report of a case with giant condyloma (Buschke-Lowenstein tumor) localized in the bladder. J Urol. 1995 Apr. 153(4):1222-4. [Medline].

  2. Dianzani C, Bucci M, Pierangeli A, Calvieri S, Degener AM. Association of human papillomavirus type 11 with carcinoma of the penis. Urology. 1998 Jun. 51(6):1046-8. [Medline].

  3. Braga JC, Nadal SR, Stiepcich M, Framil VM, Muller H. Buschke -Loewenstein tumor: identification of HPV type 6 and 11. An Bras Dermatol. 2012 Jan-Feb. 87(1):131-4. [Medline].

  4. del Pino M, Bleeker MC, Quint WG, Snijders PJ, Meijer CJ, Steenbergen RD. Comprehensive analysis of human papillomavirus prevalence and the potential role of low-risk types in verrucous carcinoma. Mod Pathol. 2012 Oct. 25(10):1354-63. [Medline].

  5. Chu QD, Vezeridis MP, Libbey NP, Wanebo HJ. Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions. Analysis of 42 cases. Dis Colon Rectum. 1994 Sep. 37 (9):950-7. [Medline].

  6. Papiu HS, Dumnici A, Olariu T, Onita M, Hornung E, Goldis D, et al. Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature. Chirurgia (Bucur). 2011 Jul-Aug. 106(4):535-9. [Medline].

  7. Malek-Mellouli M, Ben Amara F, Fatnassi A, Reziga H. Giant condyloma in pregnancy. Tunis Med. 2013 Jun. 91(6):422-3. [Medline].

  8. Crespo R, Puig F, Lanzon A, Borell A. Buschke-Lowenstein tumor and pregnancy: a case report. Eur J Gynaecol Oncol. 2007. 28(4):328-9. [Medline].

  9. Trombetta LJ, Place RJ. Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. Dis Colon Rectum. 2001 Dec. 44(12):1878-86. [Medline].

  10. Nambudiri VE, Mutyambizi K, Walls AC, Fisher DC, Bleday R, Saavedra AP. Successful treatment of perianal giant condyloma acuminatum in an immunocompromised host with systemic interleukin 2 and topical cidofovir. JAMA Dermatol. 2013 Sep. 149(9):1068-70. [Medline].

  11. Long CA, Lewis JM, Orucevic A. Primary rectal adenocarcinoma presenting as a giant perianal mass mimicking giant condyloma of Buschke-Lowenstein. Am Surg. 2013 Jun. 79(6):E228-30. [Medline].

  12. Dinleyici M, Saracoglu N, Eren M, Kiliç Ö, Ciftci E, Dinleyici EC, et al. Giant Condyloma Acuminate Due to Human Papillomavirus Type 16 in an Infant Successfully Treated with Topical Imiquimod Therapy. Dermatol Reports. 2015 Dec 3. 7 (3):6134. [Medline].

  13. Zhu JW, Lu ZF, Zheng M. Acquired progressive lymphangioma in the inguinal area mimicking giant condyloma acuminatum. Cutis. 2014 Jun. 93 (6):316-9. [Medline].

  14. Takezawa Y, Shimizu N, Kurokawa K, Suzuki K, Yamanaka H. Appearance on magnetic resonance imaging of Buschke-Lowenstein tumour. Br J Urol. 1996 Aug. 78(2):308-9. [Medline].

  15. Pinto AR, Guedes-Martins L, Marques C, Cabral JM. Buschke-Lowenstein Tumor. Acta Med Port. 2012 Sep-Oct. 25(5):345-7. [Medline].

  16. Renzi A, Giordano P, Renzi G, Landolfi V, Del Genio A, Weiss EG. Buschke-Lowenstein tumor successful treatment by surgical excision alone: a case report. Surg Innov. 2006 Mar. 13(1):69-72. [Medline].

  17. Fathi R, Tsoukas MM. Genital warts and other HPV infections: established and novel therapies. Clin Dermatol. 2014 Mar-Apr. 32(2):299-306. [Medline].

  18. Ambriz-González G, Escobedo-Zavala LC, Carrillo de la Mora F, Ortiz-Arriaga A, Cordero-Zamora A, Corona-Nakamura A, et al. Buschke-Löwenstein tumor in childhood: a case report. J Pediatr Surg. 2005 Sep. 40(9):e25-7. [Medline].

  19. Hengge UR, Tietze G. Successful treatment of recalcitrant condyloma with topical cidofovir. Sex Transm Infect. 2000 Apr. 76(2):143. [Medline]. [Full Text].

  20. Toro JR, Sanchez S, Turiansky G, Blauvelt A. Topical cidofovir for the treatment of dermatologic conditions: verruca, condyloma, intraepithelial neoplasia, herpes simplex and its potential use in smallpox. Dermatol Clin. 2003 Apr. 21(2):301-9. [Medline].

  21. Geusau A, Heinz-Peer G, Volc-Platzer B, Stingl G, Kirnbauer R. Regression of deeply infiltrating giant condyloma (Buschke-Löwenstein tumor) following long-term intralesional interferon alfa therapy. Arch Dermatol. 2000 Jun. 136(6):707-10. [Medline].

  22. Heinzerling LM, Kempf W, Kamarashev J, Hafner J, Nestle FO. Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology. 2003. 207(1):119-22. [Medline].

  23. Ilkay AK, Chodak GW, Vogelzang NJ, Gerber GS. Buschke-Lowenstein tumor: therapeutic options including systemic chemotherapy. Urology. 1993 Nov. 42(5):599-602. [Medline].

  24. Butler TW, Gefter J, Kleto D, Shuck EH 3rd, Ruffner BW. Squamous-cell carcinoma of the anus in condyloma acuminatum. Successful treatment with preoperative chemotherapy and radiation. Dis Colon Rectum. 1987 Apr. 30(4):293-5. [Medline].

  25. Sobrado CW, Mester M, Nadalin W, Nahas SC, Bocchini SF, Habr-Gama A. Radiation-induced total regression of a highly recurrent giant perianal condyloma: report of case. Dis Colon Rectum. 2000 Feb. 43(2):257-60. [Medline].

  26. Wiltz OH, Torregrosa M, Wiltz O. Autogenous vaccine: the best therapy for perianal condyloma acuminata?. Dis Colon Rectum. 1995 Aug. 38(8):838-41. [Medline].

  27. Tian YP, Yao L, Malla P, Song Y, Li SS. Successful treatment of giant condyloma acuminatum with combination retinoid and interferon-? therapy. Int J STD AIDS. 2012 Jun. 23(6):445-7. [Medline].

  28. Hatzichristou DG, Apostolidis A, Tzortzis V, Hatzimouratidis K, Ioannides E, Yannakoyorgos K. Glansectomy: an alternative surgical treatment for Buschke-Löwenstein tumors of the penis. Urology. 2001 May. 57(5):966-9. [Medline].

  29. Talwar A, Puri N, Singh M. Giant condyloma acuminatum of Buschke and Lowenstein: successful surgical treatment. Int J STD AIDS. 2010 Jun. 21(6):446-8. [Medline].

  30. Hemper E, Wittau M, Lemke J, Kornmann M, Henne-Bruns D. Management of a giant perineal condylomata acuminata. GMS Interdiscip Plast Reconstr Surg DGPW. 2016. 5:Doc07. [Medline].

  31. Niazy F, Rostami K, Motabar AR. Giant Condyloma Acuminatum of Vulva Frustrating Treatment Challenge. World J Plast Surg. 2015 Jul. 4 (2):159-62. [Medline].

  32. Akhavizadegan H. Electrocautery resection, shaving with a scalpel, and podophyllin: a combination therapy for giant condyloma acuminatum. World J Mens Health. 2015 Apr. 33 (1):39-41. [Medline].

  33. Parise P, Sarzo G, Finco C, Marino F, Savastano S, Merigliano S. Giant condyloma acuminatum of the anorectum (Buschke-Lowenstein tumour): a case report of conservative surgery. Chir Ital. 2004 Jan-Feb. 56 (1):157-61. [Medline].

  34. Renzi A, Brusciano L, Giordano P, Rossetti G, Izzo D, Del Genio A. Buschke-Löwenstein tumor. Successful treatment by surgical electrocautery excision alone: a case report. Chir Ital. 2004 Mar-Apr. 56(2):297-300. [Medline].

  35. Tripoli M, Cordova A, Maggì F, Moschella F. Giant condylomata (Buschke-Löwenstein tumours): our case load in surgical treatment and review of the current therapies. Eur Rev Med Pharmacol Sci. 2012 Jun. 16(6):747-51. [Medline].

  36. Perniola G, d'Itri F, Di Donato V, Achilli C, Lo Prete E, Panici PB. Recurrent Buschke-Löwenstein tumor treated using CO(2) laser vaporization. J Minim Invasive Gynecol. 2010 Sep-Oct. 17(5):662-4. [Medline].

  37. Mavrogianni P, Fallidas E, Nicolaidou E, Villias K, Stefanaki I, Katsambas A, et al. Therapeutic combination of radiofrequency surgical dissection and oral acitretin in the management of perianal Buschke-Lowenstein tumour: a case report. Int J STD AIDS. 2012 May. 23(5):362-4. [Medline].

Giant condylomata acuminata of Buschke and Lowenstein of the perianal region, consisting of a slow-growing, ulcerated, cauliflowerlike mass.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.