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Siatecka H, Al-Awami S, Siddiqi A, Diwan AH. A Rare Case of Varicella Zoster Infection in Hemorrhoids in a Patient With Inflammatory Bowel Disease. Am J Dermatopathol 2024; 46:159-161. [PMID: 38354383 DOI: 10.1097/dad.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
ABSTRACT Hemorrhoids are normal anatomical structures in the anus. When symptomatic, they prompt medical attention due to pain, rectal bleeding, and discomfort. Treatment includes dietary modifications, rubber band ligations, sclerotherapy, cryotherapy, or hemorrhoidectomy. Histologic examination is important to rule out incidental findings, such as perianal intraepithelial neoplasia, anal carcinoma, melanoma, or coexisting infections. Special attention should be given when patient is immunocompromised. We present a case of a 41-year-old man with a history of ulcerative colitis on adalimumab who presented with anal lesions. He was diagnosed with hemorrhoids and surgically treated. Microscopic examination confirmed the diagnosis of hemorrhoids. However, foci of epithelium with viral cytopathic effects were noted. A varicella zoster virus (VZV)-specific immunostain was positive in the areas of interest confirming the diagnosis of the VZV infection limited to the hemorrhoids. Combined herpes simplex virus type 1 and 2 (HSV 1 and HSV 2) immunostain was also performed and was negative. Anal herpes has been widely described in the literature, particularly in immunocompromised patients. However, isolated VZV infection in hemorrhoids to the best of our knowledge has never been reported.
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Affiliation(s)
- Hanna Siatecka
- Department of Pathology & Immunology, Houston, Texas; and
| | - Sarah Al-Awami
- Department of Pathology & Immunology, Houston, Texas; and
| | - Ahsan Siddiqi
- Department of Pathology & Immunology, Houston, Texas; and
| | - A Hafeez Diwan
- Department of Pathology & Immunology, Houston, Texas; and
- Department of Dermatology, Baylor College of Medicine, Houston, TX
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Patil N, Lewis S, Udupa CB, V RK, Sharan K. Perineal body squamous cell carcinoma treated with radical radiotherapy - a case report. Ecancermedicalscience 2023; 17:1534. [PMID: 37138957 PMCID: PMC10151084 DOI: 10.3332/ecancer.2023.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Indexed: 05/05/2023] Open
Abstract
Introduction Perianal tumours are a rare site of malignancy, and tumours primarily involving the perineal body without vaginal and anal canal involvement are uncommon. Case summary A 67-year-old woman presented with a lesion involving the perineum and rectovaginal septum without extension into vaginal or anorectal mucosa and with skip lesions in the vulva. Biopsy was confirmative of squamous cell carcinoma, with p16 positive. A complete metastatic workup with MRI of the pelvis and CECT thorax and abdomen was done. She was diagnosed with perianal carcinoma stage cT2N0M0 Stage II (American Joint Committee on Cancer 8th Edition of Cancer Staging) since the lesion reached the anal verge. Given the location of the tumour (perineal body), comorbidities and advanced age, she received radical radiotherapy with an intensity-modulated radiotherapy technique - 56 Gy in 28 fractions with the intention of organ preservation. The response assessment with MRI at 3 months showed a complete tumour response. She has been disease-free for 3 years and is on regular follow-ups. Conclusion Isolated perineal body squamous cell carcinomas are unusual, and synchronous vulvar skip lesion makes this case unique. Radical radiotherapy achieved organ preservation with tumour control and minimal toxicity in an elderly frail patient.
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Affiliation(s)
- Nikunj Patil
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Chethana B Udupa
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Rajagopal K V
- Department of Radiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Krishna Sharan
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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Aguirre-Allende I, Saralegui-Ansorena Y, Arana-Iñiguez I, Placer-Galan C, Enriquez-Navascués JM. Invasive and non-invasive extramammary perianal Paget's disease: Understanding of carcinogenesis determines individualized treatment. Cir Esp 2022; 100:175-177. [PMID: 35302935 DOI: 10.1016/j.cireng.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ignacio Aguirre-Allende
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain.
| | - Yolanda Saralegui-Ansorena
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
| | - Iñigo Arana-Iñiguez
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
| | - Carlos Placer-Galan
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
| | - Jose María Enriquez-Navascués
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
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HPV-driven anal neoplasia: review and recent developments. Pathology 2021; 54:184-194. [PMID: 34645567 DOI: 10.1016/j.pathol.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 01/04/2023]
Abstract
A host of human papillomavirus (HPV)-associated squamous and glandular lesions may be identified in the anal canal in men and women. Given their relative rarity, familiarity with the morphological spectrum associated with HPV-driven anal neoplasia is important for proper identification and diagnosis. In this article, we review the classification and basic histopathological features of HPV-related squamous intraepithelial and invasive lesions as well as associated pitfalls. In addition, we provide an update on recently described HPV-driven, non-squamous tumours. As our experience with these lesions evolves, we expect the histological spectrum to further expand, particularly as it relates to non-squamous HPV-driven neoplasia.
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Aguirre-Allende I, Saralegui-Ansorena Y, Arana-Iñiguez I, Placer-Galan C, Enriquez-Navascués JM. Invasive and non-invasive extramammary perianal Paget's disease: Understanding of carcinogenesis determines individualized treatment. Cir Esp 2021; 100:S0009-739X(21)00046-4. [PMID: 33685631 DOI: 10.1016/j.ciresp.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Ignacio Aguirre-Allende
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain.
| | - Yolanda Saralegui-Ansorena
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
| | - Iñigo Arana-Iñiguez
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
| | - Carlos Placer-Galan
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
| | - Jose María Enriquez-Navascués
- General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital, Biodonostia Research Institute, Beguiristain Doktorea Pasealekua s/n, 20014 Donostia-San Sebastián, Spain
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Venables ZC, Autier P, Nijsten T, Wong KF, Langan SM, Rous B, Broggio J, Harwood C, Henson K, Proby CM, Rashbass J, Leigh IM. Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England. JAMA Dermatol 2020; 155:298-306. [PMID: 30484823 DOI: 10.1001/jamadermatol.2018.4219] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013. Objective To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015. Design, Setting, and Participants This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018. Main Outcomes and Measures Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC. Results Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7% male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95% CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95% CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1% of women and 2.4% of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95% CI, 1.07-1.43), 90 years or older (HR, 1.35; 95% CI, 1.09-1.66), male (HR, 1.79; 95% CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95% CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95% CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95% CI, 1.42-2.03) and lip (HR, 1.85; 95% CI, 1.29-2.63) were at highest risk of metastasis. Conclusions and Relevance This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.
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Affiliation(s)
- Zoë C Venables
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom
| | | | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Kwok F Wong
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brian Rous
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom
| | - John Broggio
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom
| | - Catherine Harwood
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Katherine Henson
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom
| | - Charlotte M Proby
- Department of Dermatology, School of Medicine, University of Dundee, Dundee, Scotland
| | - Jem Rashbass
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, United Kingdom
| | - Irene M Leigh
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
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Abstract
The histologic differential diagnosis of perianal Paget disease includes malignant melanoma, pagetoid spread of squamous cell carcinoma, and secondary involvement by colorectal carcinoma. While consideration of these entities is useful when establishing a diagnosis, it does not apply when patients with Paget disease undergo surveillance for recurrent disease. Treatment of perianal Paget disease consists of a combination of surgical excision with skin grafts and topical chemotherapeutic agents that induce cytologic alterations in benign cells and simulate recurrent malignancy. To evaluate the therapy-related changes and possible diagnostic pitfalls in patients with Paget disease, we reviewed 412 posttreatment tissue samples from 3 women with primary perianal Paget disease who underwent wide excision, skin grafting, and topical 5-fluorouracil therapy. Biopsy samples from engrafted skin often displayed single and clustered cells with hyperchromatic nuclei dispersed in the deep epidermis. Similar cells were scattered throughout all levels of the epidermis in biopsy samples following topical chemotherapy. The abnormal cells were negative for cytokeratin 7 (CK7) and mucicarmine in both situations. Disease ultimately recurred in all patients; some Paget cells showed classic features with eosinophilic or mucinous cytoplasm and eccentric nuclei, whereas others were smaller with less conspicuous atypia. All Paget cells showed strong, membranous CK7 staining. In short, treatment of perianal Paget disease can elicit cytologic abnormalities in benign epithelial cells that simulate the cytologic features of recurrent disease, and can diminish the atypia of Paget cells. Immunohistochemical stains for CK7 can be helpful when evaluating surveillance samples from these patients.
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Venables ZC, Nijsten T, Wong KF, Autier P, Broggio J, Deas A, Harwood CA, Hollestein LM, Langan SM, Morgan E, Proby CM, Rashbass J, Leigh IM. Epidemiology of basal and cutaneous squamous cell carcinoma in the U.K. 2013-15: a cohort study. Br J Dermatol 2019; 181:474-482. [PMID: 30864158 PMCID: PMC7379277 DOI: 10.1111/bjd.17873] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), together known as keratinocyte cancers (KCs), are the commonest cancer in white ethnic populations. Recent improvements to registry data collection in England has allowed more accurate analysis of the epidemiology of BCC and cSCC and for the first time we are able to provide an accurate (representative) tumour burden for KC in the U.K. OBJECTIVES To estimate the incidence of BCC and cSCC in the U.K. METHODS A cohort of patients with KCs between 2013 and 2015 were identified using linkage to diagnostic codes derived from pathology reports collected into the national cancer registry. Data from England's cancer registry were combined with data from Scotland, Northern Ireland and Wales. European age-standardized incidence rates (EASRs) of the first BCC and cSCC per patient per annum (PPPA) were calculated. RESULTS In the U.K, the EASR of the first BCC and cSCC PPPA in 2013-15 were 285 and 77 per 100 000 person years, respectively (211 120 KCs total in 2015). The mean annual percentage increase was 5% between 2013 and 2015 for both BCC and cSCC. By counting the first KC PPPA, we include an additional 51% KCs compared with the previous reporting technique which counts only the first BCC and cSCC in a patient's lifetime, yet it represents a probable underestimation of 5-11% of the true tumour count. CONCLUSIONS Based on an improved methodology, a more representative incidence of KC is presented, which is essential to healthcare planning and will lead to improved understanding of the epidemiology of KC. What's already known about this topic? Keratinocyte cancers (KCs) are the most common cancers affecting white ethnic populations. The incidence of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) is increasing worldwide including the U.K., most commonly in elderly male Caucasian patients. These cancers are traditionally substantially underreported and frequently excluded from national cancer statistics. What does this study add? Using improved data collection methods in England and validated tumour-reporting techniques, we report the most accurate BCC and cSCC incidence data for the U.K. ever published. Identifying the first BCC and cSCC per patient per annum, the incidence of BCC and cSCC in the U.K. (excluding Wales) was 285 and 77 per 100 000 person years, respectively, between 2013 and 2015, with more than 210 000 KCs in the U.K. in 2015.
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Affiliation(s)
- Z C Venables
- Department of Dermatology, Leicester Royal Infirmary, Leicester, U.K.,Public Health England London Region, London, U.K.,Barts and The London School of Medicine and Dentistry, London, U.K
| | - T Nijsten
- Department of Dermatology, Erasmus Medical Center, Burg Jacobsplein 51, Rotterdam, 3015CA, the Netherlands
| | - K F Wong
- Public Health England London Region, London, U.K
| | - P Autier
- International Prevention Research Institute, Lyon, France
| | - J Broggio
- Public Health England London Region, London, U.K
| | - A Deas
- Information Services Division, NHS National Services Scotland, Glasgow, U.K
| | - C A Harwood
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, U.K
| | - L M Hollestein
- Department of Dermatology, Erasmus Medical Center, Burg Jacobsplein 51, Rotterdam, 3015CA, the Netherlands
| | - S M Langan
- St John's Institute of Dermatology, Department of Dermatology, London, U.K
| | - E Morgan
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, U.K
| | - C M Proby
- School of Medicine, University of Dundee, Dundee, Scotland, U.K
| | - J Rashbass
- Public Health England London Region, London, U.K
| | - I M Leigh
- Barts and The London School of Medicine and Dentistry, London, U.K
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Rivera-Chavarría JP, Vargas-Villalobos F, Riggioni-Víquez S. Bilateral V-Y flap for a perianal basal cell carcinoma: A case report. Int J Surg Case Rep 2016; 24:153-5. [PMID: 27262348 PMCID: PMC4900434 DOI: 10.1016/j.ijscr.2016.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/25/2016] [Indexed: 02/07/2023] Open
Abstract
We describe basal cell carcinoma in the perianal area. Complete resection of perianal tumor with reconstruction of the area. Surgical management of perianal basal cell carcinoma.
Background Basal cell carcinomas are rare in non-sun-exposed skin, and are even rarer in the perianal region. Alertness to the unusual occurrence of this tumor at perianal site, with understanding of its clinical course, can prevent delay in its diagnosis and morbid aggressiveness in the management of the disease. Presentation of case A 93 year old female, referred to our hospital because of a three month bleeding ulcerative lesion, with a diameter approximately of 4.5 × 3.2 cm, located in the perianal region. Discussion Tumors of the anus and perianal are infrequent neoplasms of the digestive tract. There are many diseases that can be confused with this diagnosis and it is commonly delayed because the tumor is rarely thought of in this particular cutaneous topography. Suspicion and early diagnosis, give the opportunity for a timely and appropriate treatment and also prevent tumor extension. Conclusion Treatment modalities include early wide local excision to clear margins, ensuring further local recurrence and distant metastasis. The use of local V-Y advancement fasciocutaneous flaps may be another valid option for the reconstruction of perianal skin defects, with less morbidity than other flaps described in the literature.
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Affiliation(s)
- José P Rivera-Chavarría
- Colorectal Unit, Department of General Surgery, México Hospital, Caja Costarricense Seguro Social, San José, Costa Rica.
| | - Francisco Vargas-Villalobos
- Department of Plastic and Reconstructive Surgery, México Hospital, Caja Costarricense Seguro Social, San José, Costa Rica
| | - Silvia Riggioni-Víquez
- Department of Dermatology, Centro Diagnóstico y Tratamiento de Alergias CMH, Heredia, Costa Rica
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