Rapidly Progressive Buschke-Löwenstein Tumor Managed With Wide Local Excision and Healing by Secondary Intention: A Case Report and Literature Review

Buschke-Löwenstein tumor (BLT) is a rare, locally aggressive anogenital tumor associated predominantly with low-risk human papillomavirus (HPV) types 6 and 11. BLT is classically described as a slow-growing lesion predominantly affecting middle-aged men who are immunocompromised; cases of rapid progression are rarely reported. We present the case of a 23-year-old male with a progressively enlarging perianal mass over 1 year that was accompanied by rectal pain and intermittent bleeding. He reported prior unprotected heterosexual intercourse, though serologic testing for HIV, syphilis, and hepatitis B/C was negative. CT imaging revealed a fungating lesion entirely distal to the dentate line without evidence of internal extension. Subsequently, the patient underwent wide local excision with electrocautery fulguration, and the wound was managed with healing by secondary intention. Histopathology revealed clear margins around a low-grade squamous intraepithelial lesion (LSIL) without high-grade dysplasia or carcinoma; in situ hybridization (ISH) confirmed HPV types 6 and 11, without detection of high-risk HPV. A review of the literature on BLT epidemiology, histopathology, differential diagnosis, and management is presented. This case illustrates that BLT can progress rapidly in young, immunocompetent individuals and highlights that healing by secondary intention following wide local excision is a viable option in appropriately selected cases.