Management of Anal Dysplasia
11 results
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Anorectal Disease- You evaluate a patient with a 3-month history of pruritis ani. Examination reveals perianal erythema and excoriation. You treat the patient with dietary modification and calamine-zinc barrier. The patient returns in 3 months reporting no symptomatic improvement. What is the next step in management?
- A 56-year-old HIV positive man with anal condyloma acuminata undergoes excision and fulguration of these lesions under general anesthesia. The pathology shows foci of high-grade dysplasia related to human papillomavirus. What is the next step in the management?
- A 35-year-old HIV-positive man who has sex with men presents with chronic debilitating rectal pain. He has not been receiving any treatment for HIV. Examination under anesthesia reveals an ulcer bed at the anal verge in the right lateral quadrant. Biopsy reveals no dysplasia. Which of the following is the best next step in management?
- A 25-year-old HIV-positive man underwent high-resolution anoscopy (HRA) and was found to have 3 small, flat, plaquelike lesions at the anal verge and in the anal canal. Biopsies indicated high-grade dysplasia. Which is the next step in management?
- Benign Disease
- A 47-year-old male patient with a history of ulcerative colitis, who is currently taking vedolizumab, presents for routine screening colonoscopy. He has mild proctosigmoiditis, and a 5-mm semipedunculated polyp is noted in the sigmoid colon. What is the best management approach for this polyp?
- A 50-year-old man has longstanding ulcerative colitis diagnosed at age 20 years is presently asymptomatic and is receiving maintenance treatment with infliximab and 6-mercaptopurine. His bowel function is stable, at 6 nonbloody stools per day without any associated complaints. He undergoes colonoscopy which demonstrates minimal evidence of inflammation. Random biopsies reveal low-and high-grade dysplasia 2 cm, 30 cm, and 50 cm from the anal verge. The remainder of the biopsies reveal no dysplasia. What is the best next step in management?
- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 35-year-old woman is taken to the operating room for a proctocolectomy with end ileostomy for Crohn’s disease–related colonic dysplasia. What is the most appropriate surgical management of the perineal dissection?
- A 55-year-old woman presents to your office for surgical consultation. Colonoscopy had demonstrated hundreds of adenomas carpeting the colon and 30 polyps in the rectum. She has never had a problem with fecal incontinence. What is the best next step in management?
- Malignancy
- A 64-year-old woman with a history of cervical intraepithelial neoplasia presents with a firm 3-cm mass protruding at the anal verge. Anoscopy shows a fixed mass just distal to the dentate line. A biopsy of the lesion is performed, which has the findings shown in the Figure. Colonoscopy findings are unremarkable and computed tomography of the chest, abdomen, and pelvis reveals no evidence of distant disease. Magnetic resonance imaging reveals no locoregional nodal or sphincter involvement. The next best step in management for this patient is:
- A 52-year-old man is diagnosed with a 1.5-cm anal canal squamous cell cancer. He is HIV positive and has been taking highly active antiretroviral therapy for several years; his CD4 count is 225 while his viral load is undetectable. Which of the following is the most appropriate management for this patient?