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Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
Diagnostic problems in anal pathology
Teri A Longacre1, Christina S Kong, Mark L Welton
1Department of Pathology, Stanford University, Stanford, CA 94305, USA. longacre@stanford.edu
Anal squamous cell carcinoma incidence is rising, linked to high-risk human papilloma virus (HPV) and other factors. Accurate pathology diagnosis is crucial for effective screening and treatment of anal cancer and precursor lesions.
Area of Science:
- Oncology
- Pathology
- Virology
Background:
- Anal squamous cell carcinoma (SCC) and its precursor lesions show increasing incidence in the US and Europe.
- This rise is associated with persistent high-risk human papilloma virus (HPV) infection, lifestyle factors, and immunosuppression.
- Pathologists play a key role in diagnosing anal dysplasia and carcinoma, necessitating awareness of screening strategies and risk factors.
Purpose of the Study:
- To highlight the increasing incidence of anal squamous cell carcinoma and its precursor lesions.
- To emphasize the critical role of pathologists in the accurate diagnosis and evaluation of anal biopsies.
- To underscore the importance of standardized histologic criteria and terminology for reporting anal lesions.
Main Methods:
- Review of current screening strategies for at-risk patients.
- Histologic assessment of anal canal and perianal biopsies for dysplasia and invasive carcinoma.
- Evaluation of diagnostic adjuncts including HPV subtyping, anal cytology, and biomarkers (p16, ProEx C).
Main Results:
- Persistent high-risk HPV infection is strongly linked to anal SCC, particularly anal canal lesions.
- Histologic subtype generally does not predict prognosis, with classification as keratinizing or nonkeratinizing being key.
- Distinguishing poorly differentiated SCC from other malignancies and recognizing verrucous carcinoma are important for prognosis.
Conclusions:
- Accurate diagnosis of anal cancer and precancer by pathologists is vital to prevent under- or over-treatment.
- Standardized reporting and awareness of diagnostic limitations are essential.
- Careful histologic examination of all anal condylomata is required due to potential for high-grade dysplasia or invasive carcinoma.
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