Anal Verrucous Carcinoma: A Case Report and a Systematic Review of the Literature

Abstract

Background: Αn uncommon variant of squamous cell carcinoma is represented by verrucous carcinoma. Regarding the anal and perianal area, verrucous carcinoma is rarely described in the literature.

Methods: A systematic PubMed and Scopus search was performed, a propos of a case report.

Results: A 39-year-old man presented to our proctology practice, complaining of a palpable, perianal lump. A small size of the lesion was decided to be excised, under local anaesthesia. Pathology revealed the presence of verrucous carcinoma. Thirty patients from 17 studies were included. The mean age of the patients was 47.4 years (range: 33-77). The majority of them were males (24 out of 30, 80%). Considering the comorbidities of the included patients, only in 4 patients were mentioned to have a history of multiple perianal fistulas due to Crohn's disease, colorectal cancer, heart-lung transplantation and hidradenitis suppurativa, respectively. The most frequent symptoms at the time of presentation were painless perianal mass (7 out of 30, 23.3%), perianal pain (5 out of 30, 16.7%), ulcerated / exophytic mass (4 out of 30, 13.3%), pruritus ani (2 out of 30, 6.7%), perianal sepsis (1 out of 30, 10%) and bleeding (1 out of 30, 10%). The duration of the symptoms ranged between 2 months and 14 years. Regarding the surgical treatment of the included patients, local excision was the most common surgical option (76.7%). Combined chemoradiotherapy was administered in 5 out of 30 patients (16.7%). Recurrence of the disease was reported in 5 out of 30 patients (16.7%). Death was reported in 3 out of 30 cases (10%).

Conclusion: Αnal verrucous carcinoma (VC) is an extremely rare neoplasm of the perianal area. In most of the cases, early diagnosis of VC is difficult due to the fact that its appearance and its symptoms commonly mimic benign conditions. Histopathological confirmation is the principal requisite in any further therapeutic treatment. In general, the prognosis is relatively good, especially when an early and radical excision is performed.

Keywords: Anal; Anus; High resolution anoscopy; Perianal; Ultrasonography; Verrucous carcinoma.