Examination of 93 cases of perianal warts and suggestion of a new classification.

PURPOSE: The anatomical distribution of perianal warts is associated with patient characteristics such as sexual orientation. The purpose of this study is to confirm this experiential knowledge using a quantitative classification system and analysis and to obtain findings useful for future treatment. METHODS: From January 2014 to December 2020, 93 patients with perianal warts presented to our hospital. Patients were analyzed for age, sex, lesion site, and recurrence type, among other factors. The lesion site was divided into skin (S) and anal epithelium (anoderm, A), and the number and degree of each were classified into grades 0 to 3. The higher grade between S and A determines its dominant type, such as type S (e.g., S3A1) and type A (e.g., S0A2). RESULTS: The average age of the patients was 39.6 years, and the percentage of patients who were not married was 54.8%. In all, 95.8% of patients were positive for low-risk human papillomavirus (HPV). Type S accounted for 80.6%, whereas type A accounted for 9.7%. Type A cases were all male and were all presumed to be men who have sex with men (MSM). This indicates that the determination of type A may be highly specific for MSM. The type at the time of recurrence was the same type at the time of the first surgery in almost all cases. CONCLUSION: In cases of perianal warts, it is useful to analyze the lesion by considering the range and grade separately for daily clinical practice on proctologist.

[A case of multiple metastatic giant rectal GIST successfully treated with surgical intervention after administration of imatinib mesylate].

A 69-year-old man was admitted with difficulty in defecation and urination. CT showed a giant tumor connected with the rectum in the lower pelvic cavity, and also the presence of 4 smooth surfaced tumors, 3 of which were in the abdominal cavity, while the other one was in the left inguinal region. A core needle biopsy was performed in the left inguinal region indicated the presence of gastrointestinal stromal tumor (GIST), and we clinically diagnosed this case as having multiple metastatic rectal GISTs. The patient was treated with imatinib mesylate, and CT showed the size of the rectal GIST to have dramatically decreased, with only one metastatic tumor remaining in the abdominal cavity. Therefore, an abdominoperineal resection and metastasectomy were performed, and the tumors were completely excised. The patient is alive without recurrence at 18 months after surgery, while continuing to receive imatinib mesylate.

[Paroxetine treatment of 3 cases of cholestatic pruritus due to gastrointestinal malignancy].

Recently, the antipruritic activity of the selective serotonin reuptake inhibitor paroxetine has been reported. We report 3 patients with severe cholestatic pruritus due to gastrointestinal malignancy. All of them were successfully treated with 10 mg oral paroxetine. The onset of the antipruritic action of paroxetine was observed at from several hours-two days. Paroxetine seems to be an effective, well-tolerated treatment for cholestatic pruritus due to gastrointestinal malignancy.