E0111 - Human Papillomavirus-Associated Anal Adenocarcinoma

Brian M. Fung, MD, Joseph David, MD
University of Arizona College of Medicine, Phoenix, AZ

Introduction: Human papillomavirus (HPV) is an oncogenic virus typically associated with the development of anal squamous cell carcinoma. Its association with the development of glandular lesions, however, is significantly less common. In the following report, we describe a case of HPV-associated anal adenocarcinoma.

Case Description/Methods: A 59-year-old female with history of anxiety and depression presented to clinic with constipation and intermittent rectal bleeding. She reported having worsening constipation over the prior 4 months, occasionally requiring digital disimpaction. She never had a prior colonoscopy and reported daily tobacco and occasional alcohol use. Family history was significant for colon cancer in her father. An in-office rectal examination revealed a firm mass in the anal canal, and a colonoscopy was performed the next day. This revealed a 3 cm mass in the anal canal, with biopsies diagnostic of invasive adenocarcinoma, as well as a high-grade squamous intraepithelial lesion (HGSIL). Given the unusual finding of adenocarcinoma histology in the anal canal, as well as the presence of a HGSIL, in situ hybridization testing for HPV was performed and was strongly positive. The patient denied a history of sexually transmitted infections or abnormal Pap smear. The patient was referred to colorectal surgery and a full thickness excision of the mass was performed which revealed poorly differentiated adenocarcinoma and a focus of high-grade squamous dysplasia. Margins were positive and initial staging CT of the chest, abdomen, and pelvis revealed metastases in the liver only. Against medical advice, the patient sought care from a naturopath. She returned 6 months later with new onset cephalgia and back pain. Subsequent CT now showed multiple metastatic lesions in the skull, lungs, liver, and spine. The patient was offered palliative chemoradiation therapy, but she opted for comfort measures and died shortly thereafter.

Discussion: Very little is known about anal adenocarcinoma, and reports of cases associated with HPV are exceedingly rare. A recent publication reported on 9 cases of HPV related adenocarcinoma of the anogenital tract. Imaging data on presentation was available in 4 cases, including all 3 involving the anorectum. None of these patients presented with metastatic disease as our patient did. Our patient’s advanced disease may have been due to an aggressive nature of this poorly understood entity, but also due to her reluctance to pursue medical treatment.


Disclosures:


Brian M. Fung, MD, Joseph David, MD. E0111 - Human Papillomavirus-Associated Anal Adenocarcinoma, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.