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].
