Perianal squamous cell carcinoma with high-grade anal intraepithelial neoplasia in an HIV-positive patient using highly active antiretroviral therapy: case report

Abstract

CONTEXT: Highly active antiretroviral therapy (HAART) has turned human immunodeficiency virus (HIV) infection into a chronic condition, and this has led to increased incidence of anal dysplasia among HIV-positive patients. Routine anal evaluation including the anal canal and perianal area is recommended for this population, especially for patients infected by oncogenic human papillomavirus (HPV) types. CASE REPORT: A 54-year-old homosexual HIV-positive man presented with a six-year history of recurrent perianal and anal warts. He had previously undergone incomplete surgical excision and fulguration in another institution on two occasions. He had been using HAART over the past two years. He presented some condylomatous spreading lesions occupying part of the anal canal and the perianal skin, and also a well-demarcated slightly painful perianal plaque of dimensions 1.0 x 1.0 cm. Both anal canal Pap smears and biopsies guided by high-resolution anoscopy revealed high-grade squamous intraepithelial lesion. Biopsies of the border of the perianal plaque also revealed high-grade squamous intraepithelial lesion. HPV DNA testing of the anus detected the presence of HPV-16 type. The patient underwent local full-thickness excision of the lesion. Histological analysis on the excised tissue revealed high-grade squamous intraepithelial lesion with one focus of microinvasive squamous cell cancer measuring 1 mm. No lymph vessel or perineural invasion was detected. The patient showed pathological evidence of recurrent anal and perianal high-grade squamous intraepithelial lesions at the sixth-month follow-up and required further ablation of those lesions. However no invasive squamous cell carcinoma recurrence has been detected so far.

Rastreamento de lesões precursoras do carcinoma espino-celular anal em indivíduos portadores do HIV

“…Remember that screening should not be limited exclusively to the anal canal, but also the perianal region, where relatively frequently since there is slight changes in pigmentation of the skin, flat warts, even persistent ulcers that may mimic herpes infections or syphilis, but which actually represent high-grade dysplastic lesions, including foci of microinvasive containing a few millimeters 16 . In a recent review of 52 HIV positive patient who went to Memorial Sloan Kettering Cancer Center for anorectal complaints, 19 (37%) had abnormalities noted in the perianal region to anuscopy with image magnification and were biopsied.…”

Current Understanding and Potential Immunotherapy for HIV‐Associated Squamous Cell Carcinoma of the Anus (SCCA)

“…Infection with many of these subtypes can lead to premalignant transformation of squamous epithelial cells [14], resulting in high-grade squamous intraepithelial lesions as well as invasive squamous cell carcinoma [20]. HPV-16 and -18, for example, account for about 70% of cancers of the cervix, vagina and anus, and for about 30%-40% of cancers of the vulva, penis and orophaynx [21].…”

“…The considerable variation present in the HPV genome results in variations in the strength of the association of different HPV types with different types of cancer [13]. Infection with many of these subtypes can lead to premalignant transformation of squamous epithelial cells [14], resulting in high-grade squamous intraepithelial lesions and invasive squamous cell carcinoma [20]. HPV-16 and -18 account for approximately 70% of cancers of the cervix, vagina, and anus, and 30-40% of cancers of the vulva, penis, and orophaynx [21].…”