Anal Intraepithelial Neoplasia
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Anal Intraepithelial Neoplasia
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 55-year-old man with HIV presents to your clinic complaining of severe itching around his anus that sometimes bleeds when he scratches. On physical examination, he has an excoriated and slightly raised area around the anus measuring about 50% of circumference on the right side. Biopsy shows confirmed high-grade squamous intraepithelial lesions. Which of the following is the best treatment option for this patient?
Anal Squamous Cell Cancers (Revised 2018)
Anorectal Disease- A 45-year-old man, who reports sex only with men (MSM), has been referred to you for evaluation of a whitish anorectal lesion identified on initial screening colonoscopy. Biopsies confirmed high-grade squamous intraepithelial lesion (HSIL), for which he ultimately underwent excision and fulguration. What is the recommended surveillance?
- A 64-year-old woman with history of cervical cancer treated with radical hysterectomy presents with anal itching and burning. Examination demonstrates a well-circumscribed hyperkeratosis/lichenification rash. Which of the following is the best next step in her management?
- A 30-year-old patient presents within 48 hours of anoreceptive intercourse, reporting pain, burning, and red macules and vesicles in the anus. What is the best next step for treatment of this patient?
- Anal Cancer
- Anorectal Disease
- A 53-year-old woman presents with a 3×2–cm pruritic, well-circumscribed, eczematous, tender lesion that does not involve the anal verge. A punch biopsy notes intradermal infiltration of cells with large, round, eccentric nuclei, with pale vacuolated cytoplasm, which stain positive for cytokeratin 7. Workup is negative for malignancy. What is the best step in management?
- A 53-year-old woman with a history of kidney transplantation 5 years ago presents with perianal itching and a painful lump. On examination, several perianal small cauliflowerlike lesions are noted. In addition to anoscopy what is the next step in management for this patient?
- Malignancy
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