Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2016; 22(8): 2636-2641
Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2636
Condyloma acuminatum of the anal canal, treated with endoscopic submucosal dissection
Akiko Sasaki, Takeshi Nakajima, Hideto Egashira, Kotaro Takeda, Shinnosuke Tokoro, Chikamasa Ichita, Sakue Masuda, Haruki Uojima, Kazuya Koizumi, Takeshi Kinbara, Taku Sakamoto, Yutaka Saito, Makoto Kako
Akiko Sasaki, Hideto Egashira, Shinnosuke Tokoro, Chikamasa Ichita, Sakue Masuda, Haruki Uojima, Kazuya Koizumi, Takeshi Kinbara, Makoto Kako, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
Takeshi Nakajima, Taku Sakamoto, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
Kotaro Takeda, Diagnostic Pathology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
Author contributions: Sasaki A, Nakajima T, Egashira H, TakedaK, Tokoro S, Ichita C, Masuda S, Uojima H, Koizumi K, Kinbara T, Sakamoto T, Saito Y and Kako M made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.
Institutional review board statement: The study was approved by the Shonan Kamakura General Hospital Institutional Review Board. A copy of the approval has been uploaded.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akiko Sasaki, MD, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan. akikomontblanc@yahoo.co.jp
Telephone: +81-467-461717 Fax: +81-467-450190
Received: September 18, 2015
Peer-review started: September 19, 2015
First decision: November 5, 2015
Revised: November 19, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: February 28, 2016
Processing time: 160 Days and 2.8 Hours
Abstract

Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection. Not all individuals develop persistent, progressive disease, but careful follow up is required with moderate-to-severe dysplasia to prevent progression to malignancy. Standard therapies include surgical treatments (trans-anal resection and trans-anal endoscopic microsurgery) and immunotherapeutic and topical methods (topical imiquimod); however, local recurrence remains a considerable problem. Here, we report a case with superficial CA of the anal canal, treated with endoscopic submucosal dissection (ESD). A 28-year-old man presented with a chief complaint of hematochezia. Digital exam did not detect a tumor. Screening colonoscopy revealed 10-mm long, whitish condyles extending from the anal canal to the lower rectum. The lesion covered almost the whole circumference, and only a small amount of normal mucosa remained. Magnifying endoscopy with narrow band imaging showed brownish hairpin-shaped, coiled capillaries. Although histopathological diagnosis by biopsy revealed CA, accurate histological differentiation between CA, papilloma, and squamous cell carcinoma can be difficult with a small specimen. Therefore, we performed diagnostic ESD, which provides a complete specimen for precise histopathological evaluation. The pathological diagnosis was CA, with moderate dysplasia (anal intraepithelial neoplasia 2). There was no recurrence at 16 mo after the initial ESD. Compared to surgical treatment, endoscopic diagnosis and resection could be performed simultaneously and the tumor margin observed clearly with a magnifying chromocolonoscopy, resulting in less recurrence. These findings suggest that endoscopic resection may be an alternative method for CA that prevents recurrence.

Keywords: Condylomata acuminate; Recurrence; Endoscopy; Dissection; Carcinoma in situ

Core tip: We report a case of condyloma acuminatum (CA) in a patient who underwent endoscopic submucosal dissection (ESD). Although most cases of CA have been treated with surgery or immunotherapeutic techniques, the rate of local recurrence is high because of difficulty detecting a precise margin of the lesion, especially those located in the anal canal. ESD enables detection of the lesion with magnification chromoendoscopy and treatment in the endoscopic visual field; thereby achieving en-bloc resection. ESD provides precise histopathological evaluation and could be an alternative method for CA that prevents recurrence.