Buschke-Löwenstein Tumor of the Vulva: Clinical Neglect, Molecular Continuum, and Pathogenetic Insights

Buschke-Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is an uncommon manifestation of low-risk human papillomavirus (HPV) infection, characterized by massive exophytic growth and substantial local morbidity. Although histologically low-grade, BLT can become profoundly function-limiting and carries a variable risk of malignant transformation, particularly in long-standing or untreated lesions. We report a case of a neglected giant vulvar BLT in an adult woman who presented after several years of progressive growth, resulting in impaired ambulation, hygiene difficulties, and sexual dysfunction. Surgical excision with margin control was performed, leading to functional improvement, and histopathological examination confirmed BLT, without evidence of invasive squamous cell carcinoma (SCC). This case highlights the clinical consequences of delayed diagnosis and limited access to care, positioning BLT as a paradigmatic clinically neglected disease. Emerging pathogenetic evidence supports the concept that BLT represents an extreme along a continuous spectrum of low-risk HPV-associated disease, in which sustained epithelial hyperplasia, stochastic persistence of infected basal cell clones, and local immune modulation permit progressive, space-occupying growth over time. Early recognition and definitive surgical management remain essential to prevent severe morbidity and reduce the risk of recurrence or malignant progression.