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

Sao Paulo Medical Journal

Sergio Carlos Nahas¹  Caio Sergio Rizkallah Nahas¹  Edesio Vieira Da Silva Filho¹  Jose Eduardo Levi¹  Fabio Cesar Atui¹  Carlos Frederico Sparapan Marques¹ 

[1] ,Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasSão Paulo,Brazil

关键词: Carcinoma in situ;    Anal cancer;    Anus neoplasms;    AIDS serodiagnosis;    Human papillomavirus 16;    Carcinoma in situ;    Canal anal;    Câncer do ânus;    Sorodiagnóstico da aids;    Papillomavirus humano 16;   

DOI  :  10.1590/S1516-31802007000500009

来源: SciELO

【 摘 要 】

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.

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