case_images: PMC10580285_01
case_images: Detection and resolution of anal mass. (A, B) demonstrate views detected during sigmoidoscopy. A and P denote anterior and posterior positions, respectively. Arrows demonstrate areas that were biopsied. (C) demonstrates lesion resolution upon anal exam following treatment with penicillin.
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case_images: Three weeks later, a flexible sigmoidoscopy was performed, and a firm perianal mass was detected and superficially biopsied ( Figure 1A ). Upon follow up with gastroenterology, remarkable and surprising resolution of the suspected HPV actuated dysplastic lesion was observed ( Figure 1B ). Two subsequent EUAs were performed, 2- and 3- months following treatment, and were evaluated as normal with complete resolution of the lesion ( Figure 1C ).
case_images: Coinfection of HPV and T. pallidum in high- grade squamous intraepithelial lesion. (A) p16 staining demonstrates HPV positivity. (Mag=20X). (B) H&E staining of p16 positive tissue fragment confirms HPV infection. (Mag=20X). (C) Spirochete stain (red) confirms the presence of syphilitic coinfection with HPV. (Mag=40X).
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case_images: HPV infection ( Figures 2A, B ). HPV diagnosis was confirmed using a p16 immunohistochemical stain ( Figures 2A, B ); the efficacy of this technique has proven comparable to the historically used 16S rRNA sequencing. Additionally, immunohistochemical stain (rabbit polyclonal antibody, BioCare Medical) for spirochetes ( Figure 2C ) was positive.
case_images: Biopsy of recurrent lesion one year following initial detection. (A, B) H&E staining of lesion demonstrates low-grade dysplasia. (C, D) p16 immunohistochemical stain demonstrates focal p16 positivity indicative or AIN 1.
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case_images: The lesion was evaluated using Hematoxylin and Eosin stain ( Figures 3A, B ) as well as p16 immunohistochemical stain, which showed focal p16 positivity indicating low grade dysplasia/AIN 1 ( Figures 3C, D ).