Anal dysplasia stain for herpes
Human immunodeficiency virus HIV -infected men who have sex with men MSM are at increased risk of anorectal infection with high-risk human papillomavirus and subsequent high-grade squamous intraepithelial lesions HSIL , the putative precursor to anal cancer. Recently, an epidemic of sexually transmitted hepatitis C virus HCV has emerged that shares this anorectal route of transmission. Anal cancer incidence rates are 30 times higher in human immunodeficiency virus HIV -infected individuals compared with the general population [ 1 , 2 ], with the highest reported rates among HIV-infected men who have sex with men MSM. The current anal cancer screening algorithms are based on the cervical cancer screening algorithms that have resulted in a significant decrease in cervical cancer mortality [ 3 ]. The most common anal cancer screening algorithm is to perform annual anal cytology, and if abnormalities are found, to perform high-resolution anoscopy HRA with biopsy of abnormal-appearing areas [ 4 ].
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Previous reports from our laboratory have shown that antiserum to "pure" AG-e, a type-common HSV antigen, specifically stains atypical cervical cells in indirect immunofluorescence. These observations have been confirmed and extended. Antisera to pure AG-e, ICP 12 and ICP 14 specifically stained exfoliated cervical cells from patients with herpetic cervicitis and atypical cells from patients with atypia, carcinoma in situ CIS or invasive cancer. However, both the number of patients with a positive response and the number of staining atypical cells were greater with antiserum to pure AG-e than with antisera to ICP 12 or ICP 14, suggesting that AG-e is a superior marker.
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Herpes simplex virus HSV typically infects oral or anogenital squamous epithelium and causes blisters and ulcerations. Here we reported an unusual case of HSV induced exuberant rectal inflammatory pseudotumor with vascular endothelial involvement. A year old man with HIV presented with abdominal pain, rectal drainage and constipation. Repeated biopsies showed exuberant lymphoplasmacytic inflammation with rich eosinophils and necrosis in the submucosa and scattered single or multi-nucleated viral inclusions in vascular endothelial cells that were positive for HSV by immunostains. There was no evidence of malignancy on histology or by immunostains.
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