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Submucosal variant anal squamous cell carcinoma
D.J. Wiley et al. / Papillomavirus Research 5 (2018) S1–S14
HPV16 had HPV16 positive biopsies (positive predictive value - 62%). 73 of 76 men without HPV16 detected on their swabs had only non-HPV16 HSIL biopsies (negative predictive value (NPV) - 96%).
S13
Laser Surgery Care/Icahn School of Medicine at Mount Sinai
Conclusions: In men with prevalent histologic HSIL, Cobas testing of a concurrent anal swab has high sensitivity for detecting those with HPV16associated HSIL and a high NPV. HPV testing with the Cobas platform may have a role in the identification and management of those with HSIL caused by HPV16 and who are at highest risk of development of anal carcinoma.
https://doi.org/10.1016/j.pvr.2018.07.031
31
A Yankee in King Arthur's court, or an anal dysplasia NP within a colorectal surgery practice Theresa M. Schwartz, MS, FNP, ANP-C Rochester Colon and Rectal Surgeons, Rochester, New York
Background: Having been an HIV NP in upstate NY between the years of 1998 and 2009, it became apparent that High Resolution Anoscopy (HRA), was needed.
Methods: The University of Rochester and NYS Department of Health AIDS Institute provided the means for me to learn HRA and Infrared Photocoagulation (IRC) ablation of High Grade Squamous Intraepithelial Lesions (HSILs). The task was then to find a “home” in Rochester for this practice.
Background: Squamous cell carcinoma of the anus (SCCA) is increasing in incidence. High-grade squamous intraepithelial lesion (HSIL), its immediate precursor, arises in the mucosa or perianal skin. SCCA without mucosal involvement is rare and diagnostically challenging. This phenomenon has been described in the cervix after HSIL treatment. We describe six cases of submucosal SCCA. Methods: All patients with SCCA seen in our practice from February 2014 through February 2018 were included in this study. We described all six who presented without mucosal involvement. Results: Six patients developed submucosal SCCA. The first case occurred in 2009 and all subsequent cases occurred within the past three years. The median age at diagnosis was 58 (range 41–83) years, 4 were male, 5 were HIV þ, and none had inflammatory bowel disease. Five patients had a prior or concurrent HSIL discrete from the SCCA. Two HIV þ patients (TJ and JG) developed SCCA within fistula tracts three years after initial abscess drainage. Two (JE and YW) developed submucosal SCCA after multiple HSIL ablations. Two HIVþ patients (LR and JP) developed submucosal SCCA remote from prior HSIL. LR was diagnosed with SCCA in a submucosal rectal nodule after hemorrhoid rubber band ligation and JP developed SCCA deep to the mucosa within an anal canal sinus tract diagnosed by PET/CT.
Conclusions: We described 6 cases of SCCA without apparent mucosal involvement. One must maintain a high index of suspicion in high risk individuals with submucosal nodules or recurrent abscesses/fistulae. Previous anal procedures may increase risk for submucosal variant SCCA.
https://doi.org/10.1016/j.pvr.2018.07.033
Results: Rochester Colon and Rectal Surgeons (RCRS), a private surgical practice, agreed in 2005 to let me establish an anal dysplasia practice within their eight surgeon group. 12 þ years later, this anal dysplasia practice has screened and treated over 2000 patients. Initially, all referrals were HIV þ MSM, followed by HIV- MSM, HIV þ women, and most recently HIV- women who have had cervical cancer or high grade dysplasia. Referrals come to me from HIV providers, Gynecologists, GYN Oncologists, Gastroenterologists, General Surgeons, Dermatologists, PCPs, and the colorectal surgeons within my own practice. In 2017, an monthly Anal Dysplasia Conference was convened to provide for citywide interdisciplinary (Pathologists, GYN Oncologists, Colorectal Surgeons and interested others) to review clinical findings, as well as to provide clinical correlation with projected cytology and pathology.
33
Results of a pilot management protocol for screening-detected ASIL in HIV-negative women with a history of HPV-related gynaecological neoplasia Richard C Turner, Joshua Teo, Devika Remash, Justin Rodrigues University of Tasmania
Conclusions: This anal dysplasia practice has resulted in the diagnosis, not only of HSILs and cancer, but also adenoma, lymphoma, primary squamous rectal cancers, molluscum, syphilis, as well as a plethora of the usual STDs. No regularly screened patient has developed squamous cell carcinoma within the anal canal, although two have developed squamous cell carcinomas of the anus.
https://doi.org/10.1016/j.pvr.2018.07.032
32
Submucosal variant anal squamous cell carcinoma Joseph Terlizzi MD, Stephen Goldstone MD
Background: Pending high-level evidence that ablative treatments of ASIL impact the incidence of anal cancer, it is appropriate to offer lowimpost office-based treatments for biopsy-proven HSIL, in combination with close follow-up to monitor for disease persistence or progression. Methods: As part of a pilot screening program for ASIL in women with a history of HPV-mediated gynaecological neoplasia, those with abnormal baseline cytology (PLSIL or greater) were invited to undergo HRA and biopsy. Biopsy-proven HSIL cases were offered a short course of topical trichloroacetic acid (TCA) applications, and then followed up with cytology, digital anorectal examination (DARE), and HRA with biopsy as indicated. Results: Of 163 screened women, 57 (35%) with ASIL cytology underwent HRA and biopsy. In 14 (24.6%), HSIL was confirmed by biopsy. Lesions were typically small, but in 5 cases (35.7%), more than one octant of the transformation zone was involved. Median overall follow-up from baseline visit was approximately 36 months, and 12 months after TCA treatment. Of the 14 patients treated with TCA, 7 (50%) developed either persistent
HPV16 had HPV16 positive biopsies (positive predictive value - 62%). 73 of 76 men without HPV16 detected on their swabs had only non-HPV16 HSIL biopsies (negative predictive value (NPV) - 96%).
S13
Laser Surgery Care/Icahn School of Medicine at Mount Sinai
Conclusions: In men with prevalent histologic HSIL, Cobas testing of a concurrent anal swab has high sensitivity for detecting those with HPV16associated HSIL and a high NPV. HPV testing with the Cobas platform may have a role in the identification and management of those with HSIL caused by HPV16 and who are at highest risk of development of anal carcinoma.
https://doi.org/10.1016/j.pvr.2018.07.031
31
A Yankee in King Arthur's court, or an anal dysplasia NP within a colorectal surgery practice Theresa M. Schwartz, MS, FNP, ANP-C Rochester Colon and Rectal Surgeons, Rochester, New York
Background: Having been an HIV NP in upstate NY between the years of 1998 and 2009, it became apparent that High Resolution Anoscopy (HRA), was needed.
Methods: The University of Rochester and NYS Department of Health AIDS Institute provided the means for me to learn HRA and Infrared Photocoagulation (IRC) ablation of High Grade Squamous Intraepithelial Lesions (HSILs). The task was then to find a “home” in Rochester for this practice.
Background: Squamous cell carcinoma of the anus (SCCA) is increasing in incidence. High-grade squamous intraepithelial lesion (HSIL), its immediate precursor, arises in the mucosa or perianal skin. SCCA without mucosal involvement is rare and diagnostically challenging. This phenomenon has been described in the cervix after HSIL treatment. We describe six cases of submucosal SCCA. Methods: All patients with SCCA seen in our practice from February 2014 through February 2018 were included in this study. We described all six who presented without mucosal involvement. Results: Six patients developed submucosal SCCA. The first case occurred in 2009 and all subsequent cases occurred within the past three years. The median age at diagnosis was 58 (range 41–83) years, 4 were male, 5 were HIV þ, and none had inflammatory bowel disease. Five patients had a prior or concurrent HSIL discrete from the SCCA. Two HIV þ patients (TJ and JG) developed SCCA within fistula tracts three years after initial abscess drainage. Two (JE and YW) developed submucosal SCCA after multiple HSIL ablations. Two HIVþ patients (LR and JP) developed submucosal SCCA remote from prior HSIL. LR was diagnosed with SCCA in a submucosal rectal nodule after hemorrhoid rubber band ligation and JP developed SCCA deep to the mucosa within an anal canal sinus tract diagnosed by PET/CT.
Conclusions: We described 6 cases of SCCA without apparent mucosal involvement. One must maintain a high index of suspicion in high risk individuals with submucosal nodules or recurrent abscesses/fistulae. Previous anal procedures may increase risk for submucosal variant SCCA.
https://doi.org/10.1016/j.pvr.2018.07.033
Results: Rochester Colon and Rectal Surgeons (RCRS), a private surgical practice, agreed in 2005 to let me establish an anal dysplasia practice within their eight surgeon group. 12 þ years later, this anal dysplasia practice has screened and treated over 2000 patients. Initially, all referrals were HIV þ MSM, followed by HIV- MSM, HIV þ women, and most recently HIV- women who have had cervical cancer or high grade dysplasia. Referrals come to me from HIV providers, Gynecologists, GYN Oncologists, Gastroenterologists, General Surgeons, Dermatologists, PCPs, and the colorectal surgeons within my own practice. In 2017, an monthly Anal Dysplasia Conference was convened to provide for citywide interdisciplinary (Pathologists, GYN Oncologists, Colorectal Surgeons and interested others) to review clinical findings, as well as to provide clinical correlation with projected cytology and pathology.
33
Results of a pilot management protocol for screening-detected ASIL in HIV-negative women with a history of HPV-related gynaecological neoplasia Richard C Turner, Joshua Teo, Devika Remash, Justin Rodrigues University of Tasmania
Conclusions: This anal dysplasia practice has resulted in the diagnosis, not only of HSILs and cancer, but also adenoma, lymphoma, primary squamous rectal cancers, molluscum, syphilis, as well as a plethora of the usual STDs. No regularly screened patient has developed squamous cell carcinoma within the anal canal, although two have developed squamous cell carcinomas of the anus.
https://doi.org/10.1016/j.pvr.2018.07.032
32
Submucosal variant anal squamous cell carcinoma Joseph Terlizzi MD, Stephen Goldstone MD
Background: Pending high-level evidence that ablative treatments of ASIL impact the incidence of anal cancer, it is appropriate to offer lowimpost office-based treatments for biopsy-proven HSIL, in combination with close follow-up to monitor for disease persistence or progression. Methods: As part of a pilot screening program for ASIL in women with a history of HPV-mediated gynaecological neoplasia, those with abnormal baseline cytology (PLSIL or greater) were invited to undergo HRA and biopsy. Biopsy-proven HSIL cases were offered a short course of topical trichloroacetic acid (TCA) applications, and then followed up with cytology, digital anorectal examination (DARE), and HRA with biopsy as indicated. Results: Of 163 screened women, 57 (35%) with ASIL cytology underwent HRA and biopsy. In 14 (24.6%), HSIL was confirmed by biopsy. Lesions were typically small, but in 5 cases (35.7%), more than one octant of the transformation zone was involved. Median overall follow-up from baseline visit was approximately 36 months, and 12 months after TCA treatment. Of the 14 patients treated with TCA, 7 (50%) developed either persistent