Abstract
Background: Papillary immature metaplasia (PIM) has been well-described in the cervix, as a form of low-grade intraepithelial lesion (LSIL), which can cause diagnostic confusion with high-grade intraepithelial lesion (HSIL), both cytologically and histologically. However, PIM has not previously been specifically described in the anal canal.
Methods: In the Study of the Prevention of Anal Cancer (SPANC), a natural history study of human papillomavirus (HPV) infection and related lesions of the anal canal in homosexual men, we identifi ed examples of PIM in high-resolution anoscopy-guided biopsies. Clinical, morphological and molecular features are described.
Results: Of 482 men recruited to end 2014, 11 examples of PIM were identified in biopsies from 9 men (4 HIV positive), aged 40–61 years. Each PIM lesion had characteristic histological features of slender papillae covered by a multilayer of immature squamous cells. Variable degrees of nuclear atypia were present and the differential diagnosis included HSIL in 4 cases. Immunostaining for p16 was negative in each PIM lesion, thus excluding HSIL. In each biopsy, there was adjacent or admixed typical exophytic LSIL. Histologic HSIL was found in the same octant of the anal canal in 1 case and in a different octant in 5. HPV typing on 9 tissue samples following laser capture microdissection revealed the PIM-associated genotype to be HPV 6 in 5 cases and HPV 11 in 4.
Conclusions: Like its cervical counterpart, anal PIM is a form of LSIL, associated with low-risk HPV types. Increased awareness of this entity may prevent misdiagnosis as HSIL.
Methods: In the Study of the Prevention of Anal Cancer (SPANC), a natural history study of human papillomavirus (HPV) infection and related lesions of the anal canal in homosexual men, we identifi ed examples of PIM in high-resolution anoscopy-guided biopsies. Clinical, morphological and molecular features are described.
Results: Of 482 men recruited to end 2014, 11 examples of PIM were identified in biopsies from 9 men (4 HIV positive), aged 40–61 years. Each PIM lesion had characteristic histological features of slender papillae covered by a multilayer of immature squamous cells. Variable degrees of nuclear atypia were present and the differential diagnosis included HSIL in 4 cases. Immunostaining for p16 was negative in each PIM lesion, thus excluding HSIL. In each biopsy, there was adjacent or admixed typical exophytic LSIL. Histologic HSIL was found in the same octant of the anal canal in 1 case and in a different octant in 5. HPV typing on 9 tissue samples following laser capture microdissection revealed the PIM-associated genotype to be HPV 6 in 5 cases and HPV 11 in 4.
Conclusions: Like its cervical counterpart, anal PIM is a form of LSIL, associated with low-risk HPV types. Increased awareness of this entity may prevent misdiagnosis as HSIL.
Original language | English |
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Article number | 26 |
Pages (from-to) | 88-89 |
Number of pages | 2 |
Journal | Sexual Health |
Volume | 12 |
Issue number | 1 |
Publication status | Published - 2015 |
Externally published | Yes |
Event | International Anal Neoplasia Society Scientific Meeting: The Second Interdisciplinary Forum on Anal Neoplasia - Atlanta, United States Duration: 13 Mar 2015 → 15 Mar 2015 |