#ClinicalImage: Giant anal warts
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A 70 year old, HIV negative male presented with a neglected slow growing anal wart for many years with bleeding and pruritus. The examination confirmed a large anal mass with ulceration (Figure 1). Blood analysis revealed hemoglobin of 6.3 g/dL, and colonoscopy was normal. Computed tomography scan revealed a 14 × 10 × 8 cm mass with no metastasis.

A deep core biopsy of the tumor confirmed a high grade squamous intraepithelial lesion (HSIL) and carcinoma in situ with p16 positivity suggestive of high risk HPV subtype.

High grade squamous intraepithelial lesions (HSILs) are considered premalignant and can progress to anal cancer. The progression risk is elevated in certain high risk groups, including patients with infection with high risk HPV strains (types 16 and 18). Limited data are available comparing different treatment modalities in men with HSIL.

Multidisciplinary approach is necessary in large size anal tumors with the combination of neoadjuvant chemoradiation followed by wide excision of these. It is the responsibility of the treating physician, relying on independent experience and knowledge, to determine the best course of treatment for the patient.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3021?af=R
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