Perianal Squamous Cell Research Articles

Definitive chemoradiotherapy for a patient with anal cancer after renal transplantation.

Patients after renal transplantation are susceptible to secondary malignancies, including anal squamous cell carcinoma. Chemoradiotherapy is the standard treatment for anal squamous cell carcinoma; however, typical irradiation fields for anal cancer encompass a transplanted kidney located in the right iliac fossa, which causes complete renal dysfunction. Thus, typical irradiation fields are not feasible for this population. Additionally, standard concurrent chemotherapy demonstrates nephrotoxicity. Here, we report a case of modified definitive chemoradiotherapy for a 40-year-old patient with locally advanced perianal squamous cell carcinoma after renal transplantation whose abdominoperineal resection was difficult because of a history of repeated open surgeries and long-term steroids. We modified the cranial side of the elective nodal irradiation fields in this case to spare the transplanted kidney, considering the lymph chains of the perianal tumor. We then used continuous 5-fluorouracil to avoid nephrotoxicity of mitomycin C, considering his life expectancy. Modified definitive chemoradiotherapy achieved complete remission with expected toxicities. Now, approximately five years after the procedure, the patient remains disease-free, preserving anal and renal function. Definitive chemoradiotherapy using modified irradiation fields and chemotherapy may be an option for patients with anal squamous cell carcinoma after renal transplantation.

Nodal Elective Volume Selection and Definition during Radiation Therapy for Early Stage (T1-T2 N0 M0) Perianal Squamous Cell Carcinoma: A Narrative Clinical Review and Critical Appraisal.

Distinction between anal canal and perianal squamous cell carcinomas (pSCCs) is essential, as these two subgroups have different anatomical, histological, and lymphatic drainage features. Early-stage true perianal tumors are very uncommon and have been rarely included in clinical trials. Perianal skin cancers and aCCs are included in the same tumor classification, even though they have different lymphatic drainage features. Furthermore, pSCCs are treated similarly to carcinomas originating from the anal canal. Radiation therapy (RT) is an essential treatment for anal canal tumors. Guidelines do not differentiate between treatment volumes for perianal tumors and anal cancers. So far, in pSCC, no study has considered modulating treatment volume selection according to the stage of the disease. We conducted a narrative literature review to describe the sites at higher risk for microscopic disease in patients with early-stage perianal cancers (T1-T2 N0 M0) to propose a well-thought selection of RT elective volumes.

Recurrent Perianal Squamous Cell Carcinoma in a Retroviral Patient

Anal squamous cell carcinoma is a cancer strongly associated among the immunocompromised and those infected with Human Papilloma Virus. We present a case of locally advanced recurrent anal cancer in a retroviral disease patient and the treatment planning involved in managing this patient.

Perianal squamous cell carcinoma in a Quarter Horse colt

Squamous cell carcinoma (SCC) is a squamous epithelial neoplasm. They are solitary tumors with indolent expansion, are locally invasive, and can be seen in any part of the body. The most commonly affected sites are the head, orbital region, and genitalia of horses. Solar irradiation is one of the main causes, especially in depigmented and hairless areas. SCC is the neoplasm most frequently described in equine species. Several treatments have been described in horses, usually associated with surgical excision with different adjuvant therapies, hoping for a better prognosis and a decrease in cancer-related morbidity. Since the recurrence rates are high, especially in regions that do not have an adequate safety margin after tumor removal, multimodality treatment is essential. The aim of this report was to describe a case of perianal SCC in a Quarter Horse colt clinically treated with the immunomodulatory drug imiquimod. A three-year-old, grey-haired, male Quarter Horse was examined for diagnosis and treatment of an ulcerative lesion in the perianal region. According to the owner's report, the lesion appeared approximately 16 months ago. Based on the medical history and clinical examination, SCC was suspected. To confirm the clinical diagnosis, a biopsy was performed. Histological examination showed infiltrative neoplastic proliferation from the epidermis, consisting of malignant keratinocytes associated with hyperkeratosis, neutrophilic infiltrate, and foci of ulceration. The underlying dermis exhibited an intense chronic inflammatory infiltrate. The findings were compatible with SCC. Due to the location and extension of the lesion, we decided to use immunomodulatory therapy with imiquimod. After 16 weeks of imiquimod application, the lesion completely regressed. The horse was clinically followed for two years, and no recurrence was identified.

Effects of radical radiotherapy combined with different regimens of chemotherapy on radiation intestinal injury in patients with non-metastatic anal squamous cell carcinoma

Objective: To investigate the effects of radical radiotherapy combined with different chemotherapy regimens (fluorouracil-based versus docetaxel plus cisplatin) on the incidence of radiation intestinal injury and the prognosis in patients with non-metastatic anal squamous cell carcinoma. Methods: A retrospective cohort study was conducted to recruit non-metastatic anal squamous cell carcinoma patients who underwent chemoradiotherapy in the Sixth Affiliated Hospital of Sun Yat-sen University and Nanfang Hospital from July 2013 to January 2021. Inclusion criteria: (1) newly diagnosed anal and perianal squamous cell carcinoma; (2) completed radical radiotherapy combined with concurrent chemotherapy; (3) tumor could be evaluated before radiotherapy. Exclusion criteria: (1) no imaging evaluation before treatment, or the tumor stage could not be determined; (2) patients undergoing local or radical resection before radiotherapy; (3) distant metastasis occurred before or during treatment; (4) recurrent anal squamous cell carcinoma. A total of 55 patients (48 from the Sixth Affiliated Hospital of Sun Yat-sen University and 7 from Nanfang Hospital) were given fluorouracil (the 5-FU group, n=34) or docetaxel combined with the cisplatin (the TP group, n=21). The evaluation of radiation intestinal injury, hematological toxicity and 3-year disease-free survival (DFS) rate were compared between the two groups. The effects of chemotherapy regimen and other clinicopathological factors on the incidence and severity of acute and chronic radiation intestinal injury were analyzed. The assessment of radiation intestinal injury was based on the American Cancer Radiotherapy Cooperation Group (RTOG) criteria. Results: During radiotherapy and within 3 months after radiotherapy, a total of 45 patients developed acute radiation intestinal injury, including 18 cases of grade 1 (32.7%), 22 cases of grade 2 (40.0%) and 5 cases of grade 3 (9.1%). No patient developed chronic radiation intestinal injury. Among the 34 patients in the 5-FU group, 21 had grade 2-3 radiation intestinal injury (21/34, 61.8%), which was significantly higher than that in the TP group (6/21, 28.6%) (χ(2)=5.723, P=0.017). Multivariate analysis showed that 5-FU chemotherapy regimen was an independent risk factor for radiation intestinal injury (HR=4.038, 95% CI: 1.250-13.045, P=0.020). With a median follow-up period of 26 (5-94) months, the 3-year DFS rate of patients in TP group and 5-FU group was 66.8% and 77.9%, respectively, whose difference was not significant (P=0.478). Univariate analysis showed that the DFS rate was associated with sex, age, tumor location, T stage, N stage, and induction chemotherapy (all P<0.05), while the DFS rate was not associated with chemotherapy regimen or radiation intestinal injury (both P>0.05). Multivariate analysis revealed that age ≥ 50 years old was an independent risk factor affecting the prognosis of patients (HR=8.301, 95% CI: 1.130-60.996, P=0.038). Conclusions: For patients with non-metastatic anal squamous cell carcinoma, radical radiotherapy combined with TP chemotherapy regimen can significantly reduce the incidence of radiation intestinal injury as compared to 5-FU regimen. However, due to the short follow-up time, the effect of different chemotherapy regimens on the prognosis is not yet clear.

Anogenital lichen sclerosus leading to perianal invasive squamous cell carcinoma

Anogenital lichen sclerosus leading to perianal invasive squamous cell carcinoma

Anal High-Grade Squamous Intraepithelial Lesions in Pharmacologically Immunocompromised Patients Followed in a Referral Center.

Information is lacking regarding anal/perianal precancerous lesions in referral cohorts of pharmacologically immunocompromised patients. The aim of this study is to evaluate the prevalence of anal/perianal high-grade squamous intraepithelial lesions in a referral cohort of patients on immunomodulator/immunosuppressive medications, who were assessed and followed with high-resolution anoscopy. This is a retrospective study. This study was conducted in a single anal neoplasia service from January 2012 to June 2017. Patients on chronic immunomodulator/immunosuppressive medications were included. Cases of concomitant immunosuppression due to HIV infection were excluded, and immunosuppression due to chemotherapy was not considered for this analysis. High-resolution anoscopy was performed. The primary outcome measured was the prevalence of anal/perianal high-grade squamous intraepithelial lesions in a referral cohort of pharmacologically immunocompromised patients. Fifty-four patients were included, of whom 40 were women (74%), with a mean age of 48 ± 17 years. A total of 232 high-resolution anoscopy examinations were performed in this cohort. At the first evaluation, 28 patients (52%) were diagnosed with anal and/or perianal high-grade squamous intraepithelial lesions (including 2 cases of perianal squamous cell carcinoma); 11 cases (20%) were new diagnoses. Ten of 46 patients (22%) with follow-up developed a new lesion (high-grade/cancer) during a median follow-up period of 17 (interquartile range, 6-28) months. Overall, 37 patients (69%) in our cohort had anal/perianal high-grade squamous intraepithelial lesions ever diagnosed (including previous history, first visit, and follow-up); 5 patients had perianal squamous cell carcinoma. At our center, 6% of the new referrals were known to be pharmacologically immunocompromised patients. The retrospective nature of this study, the heterogeneity of the cohort, and the absence of human papillomavirus testing were limitations of this study. The presence of anal and/or perianal high-grade squamous intraepithelial lesions or cancer detected by high-resolution anoscopy in this referral population was high, and the detection of new lesions suggests that long-term follow-up is needed. Patients on immunomodulator/immunosuppressive drugs represented only a small percentage of the new referrals to our center. See Video Abstract at http://links.lww.com/DCR/A748.

Perianal Paget's disease: three decades experience of a single institution.

Perianal Paget's disease is a rare intraepithelial adenocarcinoma of the perianal skin and the second most common localization of extramammary Paget's disease. This study was designed to evaluate long-term outcomes in patients with perianal Paget's disease. We identified patients who were treated for perianal Paget's disease between 1981 and 2013. Patient demographics, family history, associated malignancies, treatments, histopathological features, need for re-operations, and long-term outcomes were documented. Our study cohort consisted of 15 male and 10 female patients with a median age of 67 (40-83) years. Four patients had concurrent anorectal adenocarcinoma (two anal canal, two rectal) when perianal Paget's disease was diagnosed. Index operations performed were wide local excision (14 patients), local excision (five patients), abdominoperineal resection (four patients), and radiotherapy (two patients). Five patients developed invasive carcinoma (three anal canal, one vulvar, one perianal squamous cell carcinoma) during a median follow-up time of 60 (3-299) months. Thirteen patients were re-operated. Fifteen patients had a reconstructive procedure following excision. Overall survival was similar between the patients who were treated with wide local excision and local excision regardless of surgical margin status at index excision (P = 0.75). Since there is a risk for developing invasive carcinoma in the anal canal and perineum in patients with perianal Paget's disease, close follow-up is needed after R0 or R1 excision. Physicians should be aware of the risk of cancers associated with perianal Paget's disease and should rule out them during management.

進行期の肛門部有棘細胞癌に同時化学放射線療法が奏効した 1 例

進行期の肛門部有棘細胞癌に同時化学放射線療法が奏効した 1 例

The results of 21-year experience of treating anal squamous cell carcinomas.

Anal squamous cell carcinomas are one of the rare cancer types. Due to the developments in the past 35 years, surgery is no longer the first treatment of choice. The aim of this study was to retrospectively examine the outcomes of 24 patients treated in a single center in the last 21 years in terms of applied treatment, local relapse, distant metastasis, post-treatment complications, and survival. Data obtained from 24 anal squamous cell carcinoma patients, who were treated in Ankara Oncology Research and Education Hospital between 1990 and 2010, were retrospectively evaluated. Of the 24 patients, 16 had anal canal squamous cell carcinoma and eight had perianal squamous cell carcinoma. All of the patients with anal canal squamous cell carcinoma (n=16) received chemoradiotherapy. Three of these patients who did not respond to treatment, underwent abdominoperineal resection. The patients with perianal squamous cell tumors were treated by local excision. During the follow -ups, seven patients experienced local relapse, and one patient had distant organ metastasis. Only one patient died. Five-year disease free survival rate was found as 66%. Our findings suggest that the first alternative in the treatment of anal squamous cell tumors should be chemoradiotherapy; and surgery seems to be the appropriate approach for the non-responsive and relapsing cases.

Unsuspected Visceral Leishmaniasis Infiltrating a Squamous Cell Carcinoma

Amastigotes of the genus Leishmania have been observed in biopsies of apparently unrelated lesions in patients with AIDS and visceral leishmaniasis. We describe the case of a 40-year-old man with human immunodeficiency virus infection and severe immunodepression in whom the presence of the parasite was detected as an incidental finding on histological study of a perianal squamous cell carcinoma. This finding led to the diagnosis and subsequent treatment of previously unsuspected visceral leishmaniasis. In a review of the literature we have found no previous examples of this association.

Leishmaniasis visceral insospechada infiltrando un carcinoma epidermoide

Amastigotes of the genus Leishmania have been observed in biopsies of apparently unrelated lesions in patients with AIDS and visceral leishmaniasis. We describe the case of a 40-year-old man with human immunodeficiency virus infection and severe immunodepression in whom the presence of the parasite was detected as an incidental finding on histological study of a perianal squamous cell carcinoma. This finding led to the diagnosis and subsequent treatment of previously unsuspected visceral leishmaniasis. In a review of the literature we have found no previous examples of this association.

CO2 laser treatment of patients with anogenital lichen sclerosus – A retrospective study

Abstract Objective The lichen sclerosus is an inflammatory chronic disease most probably with autoimmunological genesis. Different conservative therapies exist, but the clinical presentation and the subjective complaints in some cases are not effectively improved by these conservative methods. Laser skin ectomy has been used in our department as an alternative to the now almost obsolete vulvectomy for several years. This article demonstrates the surgical technique and results achieved using this technology. Material and methods During the last eight years, 184 patients, aged between 17 and 84, have been treated who were suffering from anogenital lichen sclerosus. After histological confirmation of the diagnosis, the laser skin ectomy was performed with a CO 2 laser. The post-operative healing, the clinical course of the subjective complaints and the recurrence rate were evaluated. In the initial stages of the therapy the age spectrum, duration of conservative therapy as well as the diagnostic findings of genital synechiae and atrophies were determined. Furthermore, the occurrence of squamous cell carcinomas among our patients was investigated. Results The number of laser treatments per patient was between 1 and 10 treatments, i.e. 1.96±1.80 treatments on average. Fifteen percent of incoming patients showed synechiae, and genital atrophies were seen in 20% of the patients. Using laser skin ectomy, a precise separation of pre-existing synechiae was possible. The ablation of the affected layers maintaining the papillary region could also be achieved with high precision. A large wound results after laser ablation which is subject to intensive wound treatment. The average healing time was three weeks. A clear improvement in objective and subjective symptoms such as itching, erosions, rhagades and hemorrhage was achieved in most of the patients. A symptom-free interval of six months up to four years could be achieved. Four patients developed vulvar and perianal squamous cell carcinomas after a long-term persistently recurring lichen sclerosus. Conclusion Laser therapy is an effective option with good results showing clear improvement of objective and subjective symptoms, particularly in those patients where a conservative treatment was not successful. The main advantage of the treatment is the precise ablation of only those zones which are directly affected. With beginning recurrence, isolated affected zones can be ablated in the outpatient clinic. Our treatment method is simple to handle, shows no significant side-effects and helps our patients to obtain long symptom-free periods.

4.04] CO2-laser treatment of patients with anogenital lichen sclerosus

Objective The lichen sclerosus is a non-inflammatory, chronic disease most probably with auto-immunological genesis. Different conservative therapies exist: the local or systemic treatment with estrogens, corticosteroids and immunomodulators. The clinical presentation and the subjective complaints are not persistently improved by these conservative methods. For several years we have used laser skin ectomy as an alternative to the vulvectomy that has now become obsolete. In this presentation we will demonstrate the surgical technique and show the results achieved with our technology. Material and methods During the last 8 years we treated 184 patients aged between 17 and 84 years, who were suffering from an anogenital lichen sclerosus. After histological confirmation of the diagnosis, we performed the laser skin ectomy with a CO2 laser. The postoperative healing, the clinical course of the subjective complaints and the recurrence rate were evaluated. We investigated the spectrum of age, the duration of conservative therapy as well as the findings of genital synechiae and atrophies at the initial stage of our therapy. We furthermore investigated the occurrence of squamous cell carcinomas amongst our patients. Results The number of treatments per patient was between zero (recommendation of conservative treatment prior to laser surgery was successful) and ten treatments. The average number of treatments was 1.7. Fifteen percent of incoming patients showed synechiae; genital atrophies were seen on 20% of our new patients. Using laser skin ectomy a precise separation of pre-existing synechiae was possible. The ablation of the affected layers maintaining the papillary region can also be achieved with high precision. With the laser ablation a large wound area results and is subject to intensive wound treatment. The average healing time was 3 weeks. Two patients suffered retarded healing with subsequent super infection due to adiposity-related difficulties in wound treatment. The super infection was successfully treated with a five-day medication with oral cephalosporin. Success of the treatment was seen in all of our patients. A clear improvement of objective and subjective symptoms such as itching, erosions, rhagades and hemorrhage was achieved. The recurrence period was 6 months to 4 years. Not all patients returned for follow-up check-up. Four patients suffered vulvar and perianal squamous cell carcinomas after a long-term persisting recurrent lichen sclerosus. Conclusion Laser therapy is an effective option with good results showing clear improvement of objective and subjective symptoms, in particular for those patients where a conservative treatment had not been successful. The main advantage of our treatment is the precise ablation of only the directly affected zones. The patients did not have to undergo additional mutilating treatments. With beginning recurrence, single affected zones could be ablated in outpatient treatment. Our treatment method is relatively simple and helps our patients have long periods of time without recurrence of symptoms.

Coexisting perianal squamous cell carcinoma, Bowen's disease, and condylomata acuminata treated with topical imiquimod 5%

Coexisting perianal squamous cell carcinoma, Bowen's disease, and condylomata acuminata treated with topical imiquimod 5%

Perianal squamous cell carcinoma in-situ: a report of two human papilloma virus-negative cases

We are reporting two cases of perianal squamous cell carcinoma in-situ, negative for high-risk (HR) and low-risk (LR) human papilloma viruses. A brief review of anal and perianal squamous cell carcinoma and the role of HPV are presented.

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

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. 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.

Management of perianal squamous cell carcinoma with permanent colostomy in a mare

Management of perianal squamous cell carcinoma with permanent colostomy in a mare

Squamous carcinoma of the head and neck in organ transplant recipients: Possible role of oncogenic viruses

A consistently increased incidence of malignancies in renal transplant recipients has been attributed to the effect of chronic immunosuppression required to prevent transplant rejection. Tumors arising in such patients offer a unique opportunity to study the interactions of the immune system and tumor development. A series of three cases of head and neck squamous cell carcinoma arising in patients after renal, cardiac, or bone marrow transplantation are reported. Patient ages at tumor diagnosis were 18, 29, and 53 years, respectively. Time from transplant to diagnosis of tumor ranged from 7 months to 12 years. Only the youngest patient lacked a history of exposure to the traditional pre-disposing factors of tobacco and alcohol use. Histopathologic examination in all three tumors showed features of koilocytosis with hyperkeratosis and parakeratosis suggestive of papillomavirus infection. Squamous carcinoma cells from one of these patients have been successfully established in cell culture. Immune system impairments secondary to the use of antirejection drugs could allow the expression of oncogenic viruses. A recent report of human papillomavirus (HPV) DNA in a primary and metastatic perianal squamous cell carcinoma from a renal transplant recipient, as well as the reported presence of HPV in benign and malignant neoplasms of the upper aerodigestive tract suggests that HPV infection could play a role in the development of squamous carcinomas in transplant recipients. Further studies of HPV infection in cultured cell lines derived from head and neck tumors occurring in immunosuppressed patients are needed to define this relationship.

Depth of invasion, location, and size of cancer of the anus dictate operative treatment.

Review of 47 patients with carcinoma of the anus demonstrated that perianal squamous cell carcinoma (16 patients) occurred as a small, in situ/microinvasive lesion more often than did squamous/cloacogenic carcinoma of the anal canal (31 patients). Metastatic lymph node involvement was associated only with anal-canal lesions (13 of 31 patients). When survival time was examined as a function of tumor extent (depth of invasion, size), however, the prognosis was the same for both types of lesions. Grouping of the anal-canal lesions into those of the squamous cell and the cloacogenic variety did not demonstrate any differences in outcome. Local excision was successful in each instance for in situ/microinvasive tumors (all were 2 cm or less in diameter), but failed for invasive lesions, even if they were small. Abdominoperineal resection for invasive (26 patients) and for larger microinvasive lesions (three patients) was followed by a 59% five- to ten-year survival. When lesions with lymph node involvement were excluded, the survival rates for perianal (80%) and anal-canal carcinoma (82%) were similar. The addition of hypogastric lymph node dissection to abdominoperineal resection is indicated for invasive anal-canal carcinomas; we attribute the long-term survival of three patients with hypogastric-node involvement to this extended procedure. The presence of metastatic deposits in inguinal lymph nodes was a grave prognostic sign; all six patients with this finding died within five years. The study concludes that the operative treatment of anal carcinoma can be based on the size and, in particular, the depth of invasion of the lesion and that the histologic type is of limited significance. If local excision is considered, its choice must be guided, for technical reasons, by the location and size of the tumor.