Carcinoma Epidermoide de Canal Anal. A propósito de un caso

El cáncer de canal anal y ano, es considerado como poco frecuente, sin embargo, ha aumentado ligeramente su incidencia representando del 1 al 2% de todas las neoplasias del intestino grueso. Dentro de los factores que se asocian a la génesis de estos tumores se encuentra la afección por el virus del papiloma humano. Se presenta el caso de una paciente femenina de 32 años que acude al servicio de Radioterapia del Hospital Clínico Quirúrgico Hermanos Ameijeiras, con antecedentes de Síndrome de Down y diagnóstico de un carcinoma epidermoide del ano y región perianal, variante exofítico y con antecedentes de infección por el virus del papiloma humano. Es evaluada en equipo multidisciplinario y no tiene criterio de cirugía por el tamaño tumoral, por lo que se decidió según estadiamiento la quimioradioterapia concurrente. La paciente presentó una respuesta completa al tratamiento con radioterapia, sin presentar complicaciones, con lo que se demuestra la efectividad de la radioterapia en los tumores del ano y canal anal.

Cancer of the anal canal and anus is considered rare, however, its incidence has slightly increased representing 1 to 2% of all neoplasms of the large intestine. Among the factors that are associated with the genesis of these tumors is the condition by the human papillomavirus. We present the case of a 32-year-old female patient who attends the Radiotherapy service of the Hermanos Ameijeiras Clinical Surgical Hospital, with a history of Down Syndrome and a diagnosis of a squamous cell carcinoma of the anus and perianal region, exophytic variant and with a history of infection by the human papillomavirus. It is evaluated in a multidisciplinary team and has no surgical criteria due to tumor size, so it was decided according to staging concurrent chemoradiotherapy. The patient presented a complete response to treatment with radiotherapy, without presenting complications, which demonstrates the effectiveness of radiotherapy in tumors of the anus and anal canal.

O câncer do canal anal e do ânus é considerado raro, porém, sua incidência aumentou ligeiramente representando 1 a 2% de todas as neoplasias do intestino grosso. Entre os fatores associados à gênese desses tumores está a condição pelo papilomavírus humano. Apresentamos o caso de uma paciente do sexo feminino de 32 anos que atende ao serviço de Radioterapia do Hospital Cirúrgico Clínico Hermanos Ameijeiras, com histórico de Síndrome de Down e diagnóstico de carcinoma celular escamoso do ânus e região perianal, variante exofítica e com histórico de infecção pelo papilomavírus humano. É avaliado em equipe multidisciplinar e não possui critérios cirúrgicos devido ao tamanho do tumor, por isso foi decidido de acordo com a chemoradioterapia simultânea. O paciente apresentou resposta completa ao tratamento com radioterapia, sem apresentar complicações, o que demonstra a eficácia da radioterapia em tumores do ânus e do canal anal.

Difference in toxicity between HIV-positive and HIV-negative patients with squamous-cell cancer of the anal canal treated with concomitant radio-chemotherapy.

BACKGROUND: The incidence of squamous cell carcinoma of the anal canal has been increasing over the last 30 years. HIV has been found to be a risk factor for the development of this disease; radio-chemotherapy (RTCT) may also be more toxic than in HIV-negative patients. The study aims at assessing whether there are any differences in terms of toxicity between HIV-positive and HIV-negative patients treated with concomitant RTCT. METHODS: Search in MEDLINE, EMBASE, CENTRAL (via Cochrane Library-Wiley), DARE, LILACS bibliographic databases. Experimental and analytical observational studies with at least two comparative arms were included: squamous-cell (SC) anal-canal cancer (ACC) treated with RTCT in HIV-positive vs. HIV-negative patients. RESULTS: Fifteen publications, 14 retrospective studies and 1 systematic review, were found. All radiotherapy (RT) techniques and all chemotherapeutic agents used to manage this disease were included. No differences were found in terms of duration (P=0.67) and dose (P=0.53) of RT, while CT results were contradictory. Acute and hematological toxicities were significantly higher in HIV-positive patients, while gastrointestinal, dermatological and chronic toxicities did not significantly differ between the two groups. Given the high heterogeneity of the studies, no objective comparison could be made between studies that included antiretrovirals and those that did not. CONCLUSIONS: HIV-positive patients may be at higher risk for acute and hematological toxicity than HIV-negative patients. A precise conclusion cannot be drawn on the use of antiretrovirals, given the high heterogeneity of data.

A comparative study between conventional and liquid-based cytology in screening for anal intraepithelial lesions in HIV-positive patients.

Anal intraepithelial neoplasia (AIN) is associated with HPV infection and can be detected by cytological screening. While conventional exfoliative cytology (CC) is a low-cost and nonaggressive method, liquid-based cytology (LBC) tends to give clearer readings. Although studies of the efficacy of anal cancer screening methods would be of great importance for groups at high risk for AIN, few such studies have been conducted. The aim of the present study was to assess the concordance of CC and LBC in diagnosing anal pre-neoplastic lesions, and to compare cytological results with anoscopy, histopathological, and molecular biology findings. Comparative study involving 33 HIV-positive patients, who underwent anoscopy and biopsy of suspected lesions. Concordance between the two cytology methods was calculated, as were the associations between cytology results and findings from other screening methods. A total of 54.5% of cases were considered AIN-negative by CC and LBC, and concordance between the two methods was statistically significant (P < 0.05). Anoscopy was negative in 15 of the 18 CC- and LBC-negative cases. CC identified 75% of patients with positive biopsy, while LBC identified 85.71% of these patients. Molecular biology results showed that patients with LSIL tested positive for the highest number of HPV subtypes. The associations between positive biopsy and high grade HPV, HPV 16, and multiple HPV infections were not statistically significant. Conventional and liquid-based cytology are equally effective in screening for anal preneoplastic lesions.