From Screening to Resection: Innovation in the Treatment of Anorectal HSIL Lesions in High-Risk Patients

Human papillomavirus (HPV) infection is linked to anal cancer and its precursor lesions, particularly high-grade squamous intraepithelial lesions (HSIL). The primary therapeutic options reported in guidelines have been ablative treatments and/or surgery. Recently, however, endoscopic submucosal dissection (ESD) has emerged as an innovative technique for treating HSIL, allowing en bloc R0 resections, though only a few cases have been reported to date. This is a case of a 58-year-old female patient with a history of FIGO stage IA2 cervical cancer, previously treated with hysterectomy and lymphadenectomy. During routine colorectal cancer screening with colonoscopy, a non-granular, flat lesion (Paris classification 0-IIa), measuring 12 mm at its largest dimension, was identified, starting at the anorectal transition and extending into the perianal rectum. Biopsies confirmed the lesion as HSIL. After proctological evaluation and high-resolution anoscopy, the case was discussed at a multidisciplinary meeting, and the patient was recommended for treatment with endoscopic submucosal dissection (ESD). The procedure was completed without adverse events. Histopathological analysis confirmed HSIL with R0 resection. The patient remains under follow-up in the Endoscopic Resection and Proctology clinics. We present clinical case of high-risk HPV patient with a macroscopic anal canal HSIL successfully treated using ESD. This case includes complete iconography, including images and video documentation [1] [2] [3] [4] [5].

Publication History

Article published online:
27 March 2025

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