Diagnostic Problems in Anal Pathology

Longacre, Teri A.; Kong, Christina S.; Welton, Mark L.

doi:10.1097/pap.0b013e318183234b

Cited by 83 publications

(60 citation statements)

References 67 publications

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“…61 ProEx C reagent (BD, Franklin Lakes, NJ) and other molecular markers used to aid the diagnosis of cervical disease are also being investigated. 53 …”

Section: Histology Of Ain and Anal Cancermentioning

confidence: 99%

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Anal cancer and cervical cancer screening: Key differences

Darragh

Winkler

2010

Cancer Cytopathology

193

203

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Cervical cancer and anal cancer share many similarities including causation by oncogenic human papillomaviruses; however, significant differences exist in their epidemiology, risk factors, biologic behavior, management, and treatment. Although rare, the incidence of anal cancer is alarmingly high and continues to increase in high-risk populations, particularly men who have sex with men regardless of their human immunodeficiency virus (HIV) status. There are no national screening guidelines for anal cancer. Using the success of cervical cancer screening as a model, anal cancer screening approaches apply anal cytology, highresolution anoscopy, and directed biopsy to guide treatment and management strategies. Although much has been learned about the natural history and epidemiology of anal intraepithelial neoplasia (AIN), the rate of progression of high-grade anal intraepithelial neoplasia (HGAIN) to invasive squamous cell carcinomas is not known. The impact of screening and treatment of HGAIN on morbidity and mortality from anal cancer are also unknown. Because the incidence of HGAIN and anal squamous cell carcinoma continue to increase, it is imperative to find pathways for effective screening, early detection, and therapeutic intervention. This article provides an overview of anal cancer screening while highlighting its differences from cervi- Compared with cervical cancer, anal cancer is rare. The National Cancer Institute estimates that 5260 patients will be diagnosed with anal cancer in 2010 and that 720 men and women will die of the disease. 1 Compare this to cervical cancer statistics in the United States for 2010: 12,200 will be diagnosed with cervical cancer and 4210 women will die and this is with successful opportunistic Papanicolaou (Pap) testing to screen for this cancer in the United States. Yet, in patients with the highest risk of anal cancer, its incidence was more than double that of cervical cancer prior to the initiation of Pap screening and is increasing, while rates for cervical cancer continue to decrease. As the incidence of anal carcinoma increases in populations at risk, cytologic screening, combined with early detection and treatment, has been proposed as a method to reduce the morbidity and mortality from invasive anal squamous cell carcinoma (ASCC).

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“…61 ProEx C reagent (BD, Franklin Lakes, NJ) and other molecular markers used to aid the diagnosis of cervical disease are also being investigated. 53 …”

Section: Histology Of Ain and Anal Cancermentioning

confidence: 99%

“…The use of related antiquated terminology engenders confusion and should be avoided. 53 In the anal canal, there is no defined counterpart to microinvasive cervical carcinoma with its specific treatment and prognostic implications.…”

Section: Histology Of Ain and Anal Cancermentioning

confidence: 99%

Anal cancer and cervical cancer screening: Key differences

Darragh

Winkler

2010

Cancer Cytopathology

193

203

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“…Anal condyloma, LSIL and HSIL were diagnosed according to well established morphological parameters 10 .…”

Section: Biopsy Proceedingsmentioning

confidence: 99%

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

et al. 2011

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Purpose:To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. Methods: 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 -HIV-positive men-who-have-sex-with-men (101); Group 2 -HIV-positive females (49); Group 3 -patients without any at risk condition for anal cancer (53); Group 4 -HIV-positive heterosexual men (38); Group 5 -HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 -HIV-negative men-who-have-sex-with-men (26); and Group 7 -HIVnegative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. Results: The point-prevalence of ASIL for all the patients studied was 93/344 (27%), the difference between HIV-positive and negative patients being statistically significant (38.3% versus 13.5%; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5%, Group 2 = 28.6%, Group 3 = 3.8%, Group 4 = 21.1%, Group 5 = 11.1%, Group 6 = 30.8% and Group 7 = 18.8%. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). Conclusions: In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender. Key words: Anal Canal. Anus Neoplasms. Epidemiology. HIV. Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in BrazilActa Cirúrgica Brasileira -Vol. 26 (1) (101); Grupo 2 -mulheres HIV-positivas (49); Grupo 3 -pacientes sem condição de risco para o câncer anal (53); Grupo 4 -homens heterossexuais HIV-positivos (38); Grupo 5 -pacientes HIV-negativos, sem hábitos sexuais anorreceptivos, mas com outras condições de risco para o câncer anal (45); Grupo 6 -homens-que-fazem-sexo-com-homens HIV-negativos (26); e Grupo 7 -mulheres HIV-negativas, com hábitos sexuais anorreceptivos (32). Os resultados histopatológicos das biópsias anais dirigidas pela colposcopia anal foram analisados por meio de estatística frequentista e bayesiana para a determinação da prevalência-ponto de ASIL/câncer e verificar eventual preponderância estatística de um grupo sobre o outro. Resultados: A prevalência-ponto de ASIL para t...

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“…Entre os homossexuais masculinos com sorologia positiva para o vírus da imunodeficiência humana (HIV), a prevalência é superior a 90% e a infecção por múlti-plos tipos virais do HPV é comum. 2,3 Acredita-se que a neoplasia intraepitelial anal (NIA), provocada pelo HPV, seja lesão precursora do carcinoma anal. 3,4 Histologicamente, na NIAB (de baixo grau), são vistos coilócitos, células superficiais e intermediárias altas.…”

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“…2,3 Acredita-se que a neoplasia intraepitelial anal (NIA), provocada pelo HPV, seja lesão precursora do carcinoma anal. 3,4 Histologicamente, na NIAB (de baixo grau), são vistos coilócitos, células superficiais e intermediárias altas. A binucleação é comum, a membrana nuclear é angulada e irregular, e as células paracetóticas atípicas são numerosas.…”

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Manejo dos portadores das neoplasias intraepiteliais anais

Nadal

Manzione

2008

Rev bras. colo-proctol.

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RESUMO: Acredita-se que a neoplasia intraepitelial anal (NIA), provocada pelo HPV, seja a lesão precursora do carcinoma anal. Segundo a literatura, são encontradas entre 11% e 52% dos homens infectados pelo HIV, entre 6% a 20% dos homens e 1% a 2,8% das mulheres sem essa infecção. Entre 8,5% e 13% das NIA de alto grau evoluirão para carcinoma invasivo, indicando a necessidade do rastreamento e do seguimento desses doentes para prevenção. Não há tratamento satisfatório com baixos índices de morbidez e a recidiva é comum. Em geral, as formas de tratamento podem de ser divididas em tópicas, entre elas, ácido tricloroacético, podofilina, podofilotoxina, imiquimod, terapia fotodinâmica, e ablativas, ou seja, excisão cirúrgica, ablação pelo LASER, coagulação pelo infravermelho e eletrofulguração. A infecção pelo papilomavírus humano (HPV) é atualmente a doença sexualmente transmissível mais comum. Esse vírus penetra pelas lesões de continuidade do epitélio, instala-se nas células da camada basal, podendo permanecer em latência, ou se replicar e provocar doença clínica ou subclínica. São descritos vários tipos virais e o sistema imunológico pode eliminá-los com o decorrer do tempo, nos imunocompetentes, todavia, ele tende a persistir, 1,2 determinando doença crônica e recidivante. Entre os homossexuais masculinos com sorologia positiva para o vírus da imunodeficiência humana (HIV), a prevalência é superior a 90% e a infecção por múlti-plos tipos virais do HPV é comum. 2,3 Acredita-se que a neoplasia intraepitelial anal (NIA), provocada pelo HPV, seja lesão precursora do carcinoma anal. 3,4 Histologicamente, na NIAB (de baixo grau), são vistos coilócitos, células superficiais e intermediárias altas. A binucleação é comum, a membrana nuclear é angulada e irregular, e as células paracetóticas atípicas são numerosas. Na NIAA (de alto grau), observa-se células escamosas anormais do epitélio inferior ou do tipo metaplásico e imaturo. Os núcleos são irregulares, estão aumentados e possuem cromatina espessa. Os termos doença de Bowen e carcinoma in situ do ânus são sinônimos de NIAA, devendo ser evitados para não criar confusão ou gerar tratamentos equivocados. 5 Segundo a literatura, as NIAA, entre os portadores do HPV, são encontradas entre 11% e 52% nos homens infectados pelo HIV 6-9 e entre 6% e 20% naqueles sem essa infecção. 6,9 Já, em mulheres HIV-negativo, a taxa é de 1 a 2,8%. 6,10 Apesar da melhora da imunidade dos portadores do HIV conferida pelo tratamento com os atuais esquemas de drogas antivirais, o número de NIA mantém-se similar ao período em que os inibidores da protease não eram disponíveis,(nadal) indicando a necessidade de prevenção do câncer anal nesses doentes, estejam ou não recebendo esse esquema terapêutico. 11,12 Em geral, o diagnóstico é conseguido pela biópsia. 13 Não há tratamento satisfatório para erradicar

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Diagnostic Problems in Anal Pathology

Cited by 83 publications

References 67 publications

Anal cancer and cervical cancer screening: Key differences

Anal cancer and cervical cancer screening: Key differences

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

Manejo dos portadores das neoplasias intraepiteliais anais

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