Rectal Condyloma Acuminatum

Abstract

A woman between 70 and 80 years of age with a history of cervical cancer presented with changes in bowel habit. The patient took prednisolone for cardiac sarcoidosis. Colonoscopy revealed a 20-mm flat, whitish lesion with diffuse reddish speckles in the lower rectum (Figure 1). Based on the medical history and endoscopic findings, we suspected rectal condyloma acuminatum. However, biopsy results could not provide a definitive diagnosis; thus, we performed endoscopic submucosal dissection for excisional biopsy. The resected specimen revealed squamous epithelial cells with vacuolated cytoplasm (Figure 2). P16 staining, a marker of human papillomavirus infection, was diffusely stained. A final diagnosis of condyloma acuminatum was made. The patient was discharged uneventfully. No recurrence was observed 8 months after treatment.Figure 2Resected specimen showing squamous cells with vacuolated cytoplasm.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Condyloma acuminatum, a relatively common disease especially in young adults, has an annual incidence ranging from 160 to 289 per 100,000 individuals.1Patel H. Wagner M. Singhal P. Kothari S. Systematic review of the incidence and prevalence of genital warts.BMC Infect Dis. 2013; 13: 39Crossref PubMed Scopus (230) Google Scholar Condyloma acuminatum is a viral wart caused by human papillomavirus infection and can also be observed in immunocompromised patients, such as those taking immunosuppressive agents. Generally, condyloma acuminatum is detected in the perineum, labia, vagina, penis, perianal area, and anal canal. However, it rarely crosses the dentate line to grow into the rectum. Condyloma acuminatum has malignant potential, often developing into atypical epithelium or carcinoma; thus, surgical resection is the first-line treatment. However, recent reports have shown the efficacy of endoscopic submucosal dissection as a curative, minimally invasive option.2Matsumoto K. Sakamoto N. Murakami T. et al.Long-term relapse-free treatment with endoscopic submucosal dissection combined with magnifying narrow-band imaging for a pregnant patient with flat-type condyloma acuminatum: a case report.Clin J Gastroenterol. 2021; 14: 439-445Crossref Scopus (2) Google Scholar There is no consensus on surveillance of rectal condyloma acuminatum; thus, it is reasonable to apply the surveillance recommendations for anal condyloma acuminatum, with follow-ups every 6 to 12 months.3Long K.C. Menon R. Bastawrous A. Billingham R. Screening, surveillance, and treatment of anal intraepithelial neoplasia.Clin Colon Rect Surg. 2016; 29: 57-64Crossref Scopus (30) Google Scholar The authors report no potential competing interests.