Annals of Coloproctology

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Anorectal benign disease

Examination of 93 cases of perianal warts and suggestion of a new classification: Jo Unotoro, Keigo Matsuo, Takehiro Arai, Shigeru Okada, Teruki Kawanishi, Ryoichi Ikegami, Shuzo Mori, Hiroshi Matsuno; Ann Coloproctol. 2023;39(3):242-249. Published online March 17, 2022; DOI: https://doi.org/10.3393/ac.2021.00969.0138

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Purpose
The anatomical distribution of perianal warts is associated with patient characteristics such as sexual orientation. The purpose of this study is to confirm this experiential knowledge using a quantitative classification system and analysis and to obtain findings useful for future treatment.
Methods
From January 2014 to December 2020, 93 patients with perianal warts presented to our hospital. Patients were analyzed for age, sex, lesion site, and recurrence type, among other factors. The lesion site was divided into skin (S) and anal epithelium (anoderm, A), and the number and degree of each were classified into grades 0 to 3. The higher grade between S and A determines its dominant type, such as type S (e.g., S3A1) and type A (e.g., S0A2).
Results
The average age of the patients was 39.6 years, and the percentage of patients who were not married was 54.8%. In all, 95.8% of patients were positive for low-risk human papillomavirus (HPV). Type S accounted for 80.6%, whereas type A accounted for 9.7%. Type A cases were all male and were all presumed to be men who have sex with men (MSM). This indicates that the determination of type A may be highly specific for MSM. The type at the time of recurrence was the same type at the time of the first surgery in almost all cases.
Conclusion
In cases of perianal warts, it is useful to analyze the lesion by considering the range and grade separately for daily clinical practice on proctologist.

Citations

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Clinical efficacy of CO2 laser combined with 5-aminolevulinic acid photodynamic therapy in treating periungual and plantar warts
Yuanyuan Li
American Journal of Translational Research.2024; 16(12): 7364. CrossRef

Association of Immune Status with Recurrent Anal Condylomata in Human Immunodeficiency Virus-Positive Patients: Ji Hyun Sung, Eun Jung Ahn, Heung-Kwon Oh, Sei Hyeog Park; J Korean Soc Coloproctol. 2012;28(6):294-298. Published online December 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.6.294

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Abstract PDF

Purpose

An anal condyloma is a proliferative disease of the genital epithelium caused by the human papillomavirus. This condition is most commonly seen in male homosexuals and is frequently recurrent. Some reports have suggested that immunosuppression is a risk factor for recurrence of a condyloma. Thus, we investigated the risk factors for a recurrent anal condyloma in human immunodeficiency virus (HIV)-positive patients.

Methods

We retrospectively analyzed 85 consecutive patients who were diagnosed with and underwent surgery for an anal condyloma from January 2007 to December 2011. Outcomes were analyzed based clinical and immunologic data.

Results

Recurrent anal condylomata were found in 25 patients (29.4%). Ten cases (40.0%) were within postoperative 3 months. At postoperative 6 months, the CD4 lymphocyte count in the recurrent group was lower than it was in the nonrecurrent group (P = 0.023).

Conclusion

CD4-mediated immunosuppression is a risk factor for recurrent anal condylomata in HIV-positive patients.

Citations

Citations to this article as recorded by

Effectiveness of physically ablative and pharmacological treatments for anal condyloma in HIV-infected men
Sandra Vela, Sebastian Videla, Arelly Ornelas, Boris Revollo, Bonaventura Clotet, Guillem Sirera, Marta Piñol, Francesc García-Cuyás, Magdalena Grce
PLOS ONE.2018; 13(8): e0199033. CrossRef
Efficacy of fulguration combined with imiquimod cream on condyloma acuminatum, and the effect on immune functions and serums levels of IL-2 and IL-10
Quan Chen, Ridong Yang, Aili Gao, Daoqing Zhong, Huilan Zhu
Experimental and Therapeutic Medicine.2017; 14(1): 131. CrossRef
Association of HIV Infection With Anal and Penile Low-Risk Human Papillomavirus Infections Among Men Who Have Sex With Men in Amsterdam
Camiel A.H. Welling, Sofie H. Mooij, Marianne A.B. van der Sande, Martijn S. van Rooijen, Wilma F. Vermeulen-Oost, Audrey J. King, Arne van Eeden, Daniëlle A.M. Heideman, Ineke G. Stolte, Maarten F. Schim van der Loeff
Sexually Transmitted Diseases.2015; 42(6): 297. CrossRef
Condylomes anaux dégénérés. A propos de 13 cas
R. Lalej, S. Nadir, W. Hliwa, F. Haddad, W. Badre, A. Bellabah, R. Alaoui
Journal Africain d'Hépato-Gastroentérologie.2013; 7(4): 196. CrossRef

Association of Human Papillomavirus with Human Colorectal Cancer.: Min, Byung Wook , Hong, Jeong Hoon , Lee, Kyung Bum , Moon, Hong Young; J Korean Soc Coloproctol. 2001;17(6):332-336.

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Abstract PDF: PURPOSE
The aim of this study is to confirm the association of human papillomavirus with colorectal cancer.
METHODS
We studied 44 patients who were received operation for colorectal cancer from 1, Jan. 1997 to 31, Dec. at Korea University Guro Hospital. We used paraffin- embedded tissue sections of colorectal adenocarcinomas and human cervical cell lines as a positive control. We also studied 10 cases of anal canal squamous cell carcinomas. The extracted DNA were analyzed by polymerase chain reaction and enzyme restriction method.
RESULTS
Human papillomavirus DNA was not detected in all specimen of colorectal adenocarcinomas. But in 3 of 10 (30%) of anal canal squamous carcinomas, human papillomavirus DNA was detected. We identified this human papillomvirus DNA as type 16 by enzyme restriction technique.
CONCLUSIONS
Human papillomavirus usually associated with malignant transformation are present in anal canal squamous cell carcinomas. This study also showed same result. But this association was absent from adenocarcinoma of the colon and rectum.

Human Papillomavirus Infection in Anal Carcinoma, Anal Condylomata and Rectal.: Kim, Toung Jin , Joo, Jae Hwan , Kim, Hyung Rok , Kim, Dong Yi; J Korean Soc Coloproctol. 1997;13(1):7-14.

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Abstract PDF: In order to examine the association of human papilloma virus(HPV) infection with anal carcinoma, the authors used polymerase chain reaction(PCR) and in situ hybridization technique to detect HPV DNA in formalin fixed, paraffin-embedded tissues from 46 anal carcinoma patients. At the same time, 28 condyloma accuminata specimens and 25 rectal adecarcinomas were examined for HPV DNA with in situ hybridization(ISH). By PCR analysis, using type specific primers and probes for HPV 6, 11, 16, 18 and 33, HPV type 16 DNA was demonstrated in 30(65.2%) of 46 anal carcinoma specimens, but HPV type 6, 11, 18 or HPV type 33 was not identified. HPV DNA Positivity was different according to the site of the anal carcinoma. In anal marginal squamous celt carcinoma, 3(27.3%) of 11 contained HPV DNA but 27(77.1%) of 35 anal canal carcinoma contained HPV DNA. Among the anal canal carcinomas, the cloacogenic carcinoma contained HPV DNA in 11(84.6%) of 13 and squamous cell carcinoma contained in 16(72.7%) of 22 specimens. Two of six local recurrences and three of nine lymph node metastases had HPV-16 DNA. When the anal carcinomas were analysed using ISH technique for HPV type 6, 11, 16, 18, the frequency of Positivity decreased to 4(11.4%) of 35 and stained only for HPV type 16/18. Among the 28 condyloma accuminata specimens, 24(85.7%) contained HPV DNA type 6/11 and only 2(7.1%) contained type 16/18 by ISH technique. In contrast to anal carcinoma, male was predominent in condyloma accuminata patient(82.1% of 28) and 6 patients were homosexual man. HPV DNA was not demonstrated in all the cases of rectal adenocarcinoma by ISH. We conclude that HPV infections are associated with the development of anal canal carcinoma but are not associated with adenocarcinoma of the rectum. In anal carcinomas, anal canal carcinoma is more closely associated with HPV infection than anal marginal carcinoma. Among the HPV types studied, type 16, 18 are more closely linked with malignant transformation.

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