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


METHODS
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.
Nahas
Sergio Carlos
SC
Surgical Division of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. sergionahas@uol.com.br
Nahas
Caio Sergio Rizkallah
CS
Silva Filho
Edesio Vieira da
EV
Levi
Jose Eduardo
JE
Atui
Fabio Cesar
FC
Marques
Carlos Frederico Sparapan
CF
D001003:Anal Canal / Q000473:pathology / Q000821:virology; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001005:Anus Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D004279:DNA, Viral / Q000032:analysis; D006679:HIV Seropositivity / Q000188:drug therapy*; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D030361:Papillomavirus Infections / Q000473:pathology*
D004279:DNA, Viral