PubMed · 7157085
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P E Peters. 1982. [Lymphography--an obsolete method?].. https://pubmed.ncbi.nlm.nih.gov/7157085/
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PURPOSE: The purpose of this video is to illustrate the use of high resolution anoscopy in the diagnosis and treatment of anal high-grade squamous intraepithelial lesions. METHODS: Five patients with anal dysplasia were examined in the operating room with acetic acid and the operative microscope. Lugol's solution was used selectively. Acetic acid is generously applied to aide in the recognition of high-grade squamous intraepithelial lesions. Acetowhite regions are examined under the operative microscope to further distinguish lesions as either low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions. Acetowhite lesions with specific vascular characteristics like punctuate vessels or honeycomb patterns are highly suggestive of high-grade disease. These lesions are selectively destroyed under direct visualization with an effort to maintain normal mucosa and skin to prevent stenosis. Some pigmented lesions contain high-grade squamous intraepithelial lesions; the operative microscope is used in this setting to look for the vascular characteristics of high-grade disease. RESULTS: The video reports five male patients treated for high-grade squamous intraepithelial lesions with the aide of high resolution anoscopy. There were no intraoperative or postoperative complications. All lesions suspicious for high-grade squamous intraepithelial lesions based on observed vascular patterns were confirmed as such with permanent histopathology. CONCLUSION: The use of acetic acid and the operative microscope with selective use of Lugol's solution accentuates the visual characteristics of high-grade lesions, enhancing the surgeon's ability to target treatment to high-grade squamous intraepithelial lesions. High resolution anoscopy is useful in the targeted treatment of high-grade squamous intraepithelial lesions.
Anal intraepithelial neoplasia (AIN) is the likely precursor to anal cancer. AIN is associated with human papillomavirus (HPV) infection, and HPV-associated genomic instability may play an important role in the progression of squamous intraepithelial neoplasia to cancer. Microarray-based comparative genome hybridization (aCGH) was performed on DNA from AIN specimens to determine the host genomic alterations and their correlation with HPV DNA integration or rearrangement. Of 27 high-grade AIN specimens tested by CGH, 8 (30%) showed regional DNA copy number abnormalities (CNAs). Five additional cases previously identified by chromosome CGH to carry CNAs were reanalyzed by aCGH and pooled with the 8 new cases for analysis. The most common regions of gain were on chromosome arms 1p, 1q, 3q, 8p, and 20q. The most common regions of loss were on chromosome arms 2q, 7q, 11p, 11q, and 15q. HPV16 DNA integration or rearrangement correlated with CNAs in host cell DNA (P = 0.007). Although aCGH can resolve amplicons at the 1- to 2-megabase (Mb) regional resolution, the most common alteration on chromosome 3 could only be resolved to a 75-Mb region from 3q21 to qtel. Our data suggest that there may be several oncogenes in this region that are coactivated to contribute to progression to high-grade AIN.
Squamous cell carcinoma (SCC) of the anal canal is a rare condition with increasing incidence rates in the United States population in the past several decades. This review article provides a complete overview of the etiology, anatomy and the approach to the multidisciplinary management of the patient with anal SCC. Chemoradiation therapy for the treatment of SCC of the anal canal provides excellent disease control and survival while preserving anal sphincter function in the majority of patients. The surgeon plays a key role in the diagnosis and follow-up of this disease. Surgical salvage with APR for disease persistence or recurrence in carefully selected patients can result in reasonable 5-year survivals.