Post written by Fumihiro Inoue, MD, from the Gastrointestinal Center & Institute of Minimally-Invasive Endoscopic Care (i-MEC), Sano Hospital, Kobe, Japan.

Anal condyloma acuminatum (CA) is known as one of the most common sexually transmitted diseases. It is a disease that is occasionally seen in daily practice and is sometimes difficult to distinguish from anal squamous cell carcinoma (SCC). Therefore, we observed anal CA by endocytoscopy. Endocytoscopy is used to provide ultra-high magnification images of colorectal lesions in real time. We thought that the observation of endocytoscopy might be useful for the diagnosis of condyloma. As a result, cell nuclei were found to be enlarged and dense in the tumor cells, which led us to suspect that this case was anal SCC. Hence, the endoscopic submucosal dissection technique was applied to resect the lesion en bloc as a curative treatment. But this case was histopathologically diagnosed as CA with low-grade anal squamous intraepithelial neoplasia. Endoscopic diagnosis was different from histopathological diagnosis. This suggests that the endocytoscopic detection of irregular cell nuclei in anal CA might not necessarily signify anorectal cancer.

Endoscopic observation of anal CA has been reported; however, there have been no reports of cases observed by endocytoscopy, so we thought it was important to show this case. Even if anal lesions are suspected to be SCC from endocytoscopic findings, they may not be. Chronic inflammation as a result of stimulation and HPV infection might lead to the findings. This is the first case of observing anal CA by endocytoscopy. Future studies are needed to validate these endocytoscopic findings about anal CA and SCC, which will lead to the establishment of the utility and accuracy of those findings.

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