Carcinoma of the anus

Carcinoma of the anus represents about 2% of cancers of the large bowel. From 1950 to 1970, 20 patients were treated for this condition. Included were 113 patients with squamous cell carcinoma (31 perianal), 64 with basalid squamous carcinoma, 8 with Paget’s disease of the anus, 7 with melanoma, 6 with basal cell carcinoma, and 6 with adenocarcinoma.

Combined abdomino-perineal resection was the treatment of choice except for perianal lesions; for these, local excision was used most frequently. Inguinal node dissection was used infrequently, and it is not possible to draw meaningful conclusions from the data. Overall survival rates for patients having anal squamous cell carcinoma are similar except when lymphatic invasion is present; then basaloid lesions have a significantly better prognosis.

For rare anal carcinomas, histopathologic findings dictate the end results- the better the findings and more satisfactory the results.

O H Beahrs and S M Wilson

Warty Carcinoma of the Anus: study

Warty carcinoma (WC) is a rare variant of squamous cell carcinoma primarily described in the vulva in younger women and classically associated with human papillomavirus (HPV) infection. The gross findings are similar to those of verrucous carcinoma with large, exophytic tumors with a papillomatous surface. Microscopically, the tumor is papillated and contains fibrovascular cores covered by hyperkeratotic epithelium showing presence of koilocytes.

We report a case of anal squamous cell carcinoma showing similar features, occurring in a young immunosuppressed male patient with a history of multifocal anal intraepithelial neoplasia (AIN). HPV-16 has been demonstrated both in the WC and in adjacent AIN, but the HPV status appears different in the two lesions: integrated in WC and episomal in AIN lesions. We also have demonstrated by immunohistochemistry that both WC and AIN are highly proliferative entities sharing the same MIB-1 pattern, and that WAF1/CIP1 protein expression is common in the two lesions irrespective of p53 protein expression.

Warty Carcinoma of the Anus: A Variant of Squamous Cell Carcinoma Associated with Anal Intraepithelial Neoplasia and Human Papillomavirus Infection
J.C. Noël, C. Sornin de Leysat, M.O. Pény, J. van de Stadt, I. Fayt, G. De Dobbeleer

Departments of Pathology, Dermatology and Digestive Surgery, Erasme University Hospital, Free University of Brussels, Belgium

Correlates of homosexual behavior and the incidence of anal cancer

To determine whether characteristics that are correlated with male homosexual behavior are associated with the incidence of cancer, the names of persons with a diagnosis of cancer in western Washington during 1974 to 1979 were linked to those in the state syphlis registry. Eight of 47 men with anal cancer were found to have had a reactive FTA test result; the expected number, based on the proportion of reactive cases among men with other sites of cancer, was only 0.40.

Among men with anal cancer identified through ten population-based cancer-reporting systems in the United States, 24.4% had never been married, compared with 7.8% of men with colon and rectal cancer. Neither of these relationships was observed for women with anal cancer. Because in men, but not in women, having had syphilis and being single are associated with the practice of anal intercourse, our data suggest that anal intercourse may be a risk factor for anal cancer.

J. R. Daling, N. S. Weiss, L. L. Klopfenstein, L. E. Cochran, W. H. Chow and R. Daifuku

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