Kavalukas S L, Yang F, Wexner S D, Nogueras J J
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
Colorectal Dis. 2020 Nov;22(11):1597-1602. doi: 10.1111/codi.15244. Epub 2020 Aug 17.
The incidence of anal squamous cell carcinoma (SCC) has increased dramatically in the USA. The squamous intraepithelial lesion has been identified as a precursor lesion to SCC, stratifying the abnormality into low grade or high grade. There have been studies on the prevalence of incidentally found SCC in haemorrhoidectomy specimens, but there are no studies to date on the incidence of dysplasia. The purpose of this study was to establish a baseline incidence of dysplasia that provides helpful information for future epidemiological studies.
This is a retrospective review of patients who underwent haemorrhoidectomy from 2005 to 2019. Pathology regarding the type of dysplasia, medications, and diagnoses that may predispose to immunosuppression were collected.
In all, 810 patients with a mean age of 51.7 (range 20-91) years underwent haemorrhoidectomy. Eighteen (2.2%) of the patients had abnormal pathology (low-grade squamous intraepithelial lesion, 3; high-grade squamous intraepithelial lesion, 12; SCC, 2; adenocarcinoma, 1). Thirty-seven (4.5%) of the entire cohort had some risk factors for immunosuppression: chronic steroid use (nine), human immunodeficiency virus (HIV) (13), biologic medications (six), transplant recipients (two) and immunocompromising diseases (four). Only 4/18 patients had an immunosuppression risk in that all four of these patients were HIV-positive. Surveillance following excision was undertaken for an average of 6 (range 1-12) months, during which time four patients underwent a repeat biopsy.
Anal dysplasia found in an otherwise asymptomatic population has a prevalence of 2.2%. This finding supports the routine examination of benign anorectal specimens undergoing microscopic examination. Interestingly, the majority of the patients identified had no immunosuppressant risk factors.
在美国，肛门鳞状细胞癌（SCC）的发病率急剧上升。鳞状上皮内病变已被确认为SCC的前驱病变，可将异常分为低级别或高级别。已有关于痔切除术标本中偶然发现的SCC患病率的研究，但迄今为止尚无关于发育异常发生率的研究。本研究的目的是确定发育异常的基线发生率，为未来的流行病学研究提供有用信息。
这是一项对2005年至2019年接受痔切除术患者的回顾性研究。收集了有关发育异常类型、药物以及可能易导致免疫抑制的诊断的病理信息。
共有810例平均年龄为51.7岁（范围20 - 91岁）的患者接受了痔切除术。18例（2.2%）患者病理异常（低级别鳞状上皮内病变3例；高级别鳞状上皮内病变12例；SCC 2例；腺癌1例）。整个队列中有37例（4.5%）有一些免疫抑制风险因素：长期使用类固醇（9例）、人类免疫缺陷病毒（HIV）（13例）、生物药物（6例）、移植受者（2例）和免疫妥协疾病（4例）。仅4/18例患者有免疫抑制风险，因为这4例患者均为HIV阳性。切除术后平均随访6个月（范围1 - 12个月），在此期间4例患者接受了重复活检。
在无症状人群中发现的肛门发育异常患病率为2.2%。这一发现支持对接受显微镜检查的良性肛肠标本进行常规检查。有趣的是，大多数被识别出的患者没有免疫抑制风险因素。
