New Screening Strategy Combining Anal Papanicolaou and Human Papillomavirus Tests for Human Papillomavirus-Related Anal Cancer: A Prospective, Single-Center Study.

BACKGROUND: The objective of this study was to evaluate the performance of a combined approach of liquid-based anal cytology and human papillomavirus (HPV) testing in predicting patients who should undergo high-resolution anoscopy for the early detection of anal cancer and anal intraepithelial neoplasia (AIN)-2+. METHODS: We conducted a prospective single-center quality improvement study. We consecutively enrolled men who had sex with men (MSM) attending our sexually transmitted disease clinic to undergo anal Papanicolaou (Pap) and HPV tests. All patients with an abnormal anal Pap test result and/or positive HPV test result underwent high-resolution anoscopy. RESULTS: We enrolled 217 MSM, 80 HIV-positive patients, and 137 HIV-negative patients. Cytology showed a sensitivity of 100%, a specificity of 64.1%, an accuracy of 66.7%, a positive predictive value (PPV) of 15.7%, and a negative predictive value (NPV) of 100% for the detection of AIN-2+. The high-risk (HR)-HPV test showed sensitivity, specificity, accuracy, PPV, and NPV of 100%, 36.4%, 40%, 9.4%, and 100%, respectively. The combination of abnormal cytology with identification of infection by at least 1 HR-HPV strain on the HPV test had a sensitivity of 100%, a specificity of 73%, an accuracy of 74.6%, a PPV of 19.1%, and an NPV of 100%. CONCLUSION: Anal HR-HPV testing, complementary to cytology, improves the diagnostic accuracy of screening for anal cancer.

Liquid-based anal cytology as a screening tool for prevention of anal cancer in at-risk populations: a single-center retrospective analysis on 111 patients

Objective: Squamous cell carcinoma of the anus (SCCA) is associated with human papillomavirus (HPV) infection in almost 90% of the cases. Its incidence is alarmingly high among men who have sex with men (MSM) and continues to increase at an average rate of 2% per year. The objective of the present study is to evaluate the usefulness and performance of liquid-based anal cytology as a screening tool for prevention and early detection of SCCA in a cohort of at-risk men. Method: We conducted a retrospective study including 111 MSM, aged between 22 and 62 years old, who underwent anal cytological screening with a liquid-based Pap test at our sexually transmitted diseases (STDs) clinic from January 2015 to March 2017. Results: Out of 111 anal smears, 57 (51,4%) resulted negative, 42 (37,8%) abnormal, and 12 (10,8%) unsatisfactory for the cytological evaluation. Only patients with an abnormal cytology underwent anoscopy and subsequent biopsy. The histological results were as follows: negative for squamous intraepithelial lesion (SIL) in 5 cases, low-grade SIL (L-SIL) in 21, high-grade SIL (H-SIL) in 5, SCCA in 1. Five patients had a normal anoscopy and biopsy was not taken. Conclusion: Liquid-based cytology, reducing the "darkening factors" typical for the conventional smears, has a higher positive predictive value than the traditional technique. Moreover, a cytological diagnosis of atypical squamous cells of undetermined significance (ASC-US) or L-SILmay hide a severe dysplasia or even a carcinoma. Thus, all patients with an abnormal anal cytology at any grade should be considered for anoscopy. (AU)

Photodynamic therapy with topical photosensitizers in mucosal and semimucosal areas: Review from a dermatologic perspective.

Photodynamic Therapy is a procedure based on the interaction between a Photosensitizer, a light source with a specific wavelength and oxygen. The aim of this review is to provide a brief and updated analysis of scientific reports on the use of PDT with topical PS in the management of oncological, infectious, and inflammatory disorders involving mucosal and semimucosal areas, with a specific focus on diseases of dermatologic interest.

Pap smear in the prevention of HPV-related anal cancer: preliminary results of the study in a male population at risk.

BACKGROUND: The aim of this work was to evaluate the role of human papillomavirus (HPV) testing and anal cytology, considering a population of HIV-positive and negative men who have sex with men (MSM), at high risk of sexually transmitted diseases (STD), in order to ascertain which of the methods examined is the best screening strategy for the prevention of anal cancer. METHODS: In the period 06/2013-07/2014 at the "MTS Centre" of the University of Florence, 87 male patients, homo/bi-sexual, of which 46 HIV-negative and 41 HIV-positive, were recruited for anal Pap smear and HPV testing. All patients with an "abnormal" cytological result underwent anoscopy with possible biopsy. RESULTS: HPV testing was positive in 73 patients (83.6%). Cytology was negative in 50 patients (57.5%), inconclusive in 14 patients (16.1%), abnormal in 23 patients (26.4%): 14 ASC-US (19.2%), 4 ASC-H (5.5%), 5 L-SIL (6.8%), 0 H-SIL. Anoscopy with biopsy led to diagnosis of AIN I in 10 cases, of which 6 ASC-US+ and 4L-SIL+, AIN II in only 1 case, LS-IL+. CONCLUSIONS: Anal HPV testing, when used in primary screening, lead to a high number of "false positives", given the too high prevalence of HPV infection in MSM, the highest risk population targeted for screening. So we propose a screening program with anal cytology which has a high sensitivity for detection of AIN while is a poor predictor of the severity of these lesions; therefore, all patients with abnormal anal Pap smear should undergo anoscopy with biopsy.

The psychological aspects in sexually transmitted infections.

BACKGROUND: Over the last years the number of sexually transmitted diseases has greatly increased. This can be attributed mainly to less rigidity in the gender role and to the ever growing sexual liberalization. Sexuality today as in the past, represents an important and complex dimension of the human being. With respect to the psychological area many authors think that there are specific personality traits that to a higher extent compared to others might push individuals to carry out inconsiderate behavior among which there has been found a higher risk of sexually transmitted diseases (STD). In the present paper preliminary data of a research carried out provides information about sexual habits among patients of the IST of Florence. METHODS: A sample of 344 individuals, from 15 to over 70-year-old, Italians and strangers, has been asked to fill up a self-administered questionnaire. RESULTS: Through these data the psychological aspects at the base of sexual habits in our reference sample are highlighted even more clearly. Through the analysis of these data it will be possible to get a larger number of information that can be used for the building of psychological support experiences that take into account the individual differences among patients one finds through consultations and support. CONCLUSIONS: The psychological support is very important for a lot of patients who belong to the center and show inappropriate sexual behavior and exposed to risky sexual behavior.

Mycetomatoid infection of the penis by Candida albicans.

BACKGROUND: Mycetoma is generally understood to be a chronic suppurative infection involving the skin and the underlying tissue. Mycetomas may be classified as those produced by true fungi (eumycetoma) versus those due to aerobic bacteria Actinomycetales (actinomycetoma). METHODS: We report the atypical case of a mycetomatoid infection of the penile shaft and glans in a 36-year-old man, originally from Senegal, affected by Takayasu's arteritis. RESULTS: Extensive investigations excluded any other causative pathogen other than Candida albicans, and the ailment accordingly healed after fluconazole monotherapy. CONCLUSION: The authors discuss the unusual site of the disease and the singular clinical features related to the fungal etiology and put forward considerations on the pathogenic role of common microorganisms.

Primary anetoderma and HIV infection: a case report.

Anetoderma is characterized by circumscribed areas of flaccid skin caused by the loss of elastic tissue in the dermis. It may be primary or secondary to various dermatoses. The primary form has been reported in patients with autoimmune diseases, increased levels of antiphospholipid antibodies, prothrombotic abnormalities, and recently, HIV-1 disease. The origin of anetoderma remains unknown. A case of primary anetoderma is reported in a 45-year-old man with asymptomatic HIV-1 infection who was receiving antiretroviral therapy. Laboratory research included the classic immunologic investigations and screening for prothrombotic abnormalities. Possible pathogenic mechanisms of anetoderma, especially with respect to HIV-1 infection and antiretroviral therapy, are discussed.

Pruritus ani.

In the anal region, pruritus may be both idiopathic (mainly of psychological/psychiatric origin) and secondary to an underlying disorder or related to local causes (mainly of dermatologic interest). Persistent pruritus ani is, in particular, a challenging experience for the dermatologist.

Eruptive multiple blue nevi of the penis: a clinical dermoscopic pathologic case study.

Multiple blue nevi have rarely been reported, and the majority of the lesions are located on the trunk and lower extremities. The blue nevus is a rare lesion on genital mucosa and may cause confusion in differential diagnosis with other pigmented lesions such as genital melanocytic macules, lentigo simplex, and malignant melanoma. Here, we describe an unusual patient who presented with a sudden onset in adulthood of multiple blue nevi on the glans penis. The epiluminescence examination revealed a substantially homogenous bluish pigmentation, which led us to favor a diagnosis of blue nevus, whereas not entirely excluding the possibility of a regressing melanoma or a metastatic melanoma. Because of the well-known diagnostic value of the blue hue in the diagnosis of malignancy by dermoscopy, a careful examination of these lesions should be made in order to minimize any risk of misclassification with melanoma.

Immunohistochemical study of carbonic anhydrase isozymes in human skin.

An increasing number of carbonic anhydrase (CA) isozymes have been discovered in human organs. However, there is little evidence concerning their expression in mammal skin, humans included, and the isozymes involved have not been identified yet. In this study, the distribution of three CA isozymes I, II and IX in human skin from healthy subjects was investigated using an immunohistochemical technique. Specific staining for CA I and II was detected in the basolateral plasma membrane of the epithelial cells of the spinous and basal layers of epidermis as well as in the endothelium of capillaries in the papillary dermis. A marked CA II immunoreactivity was mostly found in secretory cells of the sweat glands. No signal for CA IX was detected but on the plasma membranes and the cytoplasm of cells surrounding the hair shaft. The significance and biological role of CA isozymes expression in human skin is discussed.