P4526 - Rectal Condyloma Acuminatum Treated with Endoscopic Submucosal Dissection

Bassel Dakkak, MD, Yasmeen Obeidat, MD, Leen Kayali, MD, Ahmed Sherif, MD, Wesam M. Frandah, MD
Marshall University Joan C. Edwards School of Medicine, Huntington, WV

Introduction: Condyloma acuminatum, primarily associated with human papillomavirus (HPV), is a condition often found in the anogenital region and related to sexual activity. While surgical excision has been the traditional approach to management, there is emerging interest in less invasive methods, aiming to find techniques with lower recurrence rates that offer precise removal with minimal damage, as opposed to well-known treatments. This case report highlights a successful, less invasive endoscopic treatment approach for condyloma acuminatum.

Case Description/Methods: A 59-year-old female with a history of iron deficiency anemia was discovered to have a fungating mass during a colonoscopy for colorectal cancer screening. The mass was partially obstructing the proximal rectum and was classified as Paris 0-IIa and Kudo IIIs. Originating at the dentate line, it extended 4 cm in length with a 20 mm diameter [Figure 1]. The mass was removed through endoscopic submucosal dissection (ESD). This technique involves marking the borders with chromoscopy and methylene blue, which separates the lesion from the muscularis propria [Figure 2]. A circumferential incision was made into the submucosa using a dual J knife, followed by dissection from the deeper layers with an electrocautery knife and en-bloc retrieval without bleeding [Figure 3]. Histological analysis revealed papillary squamous proliferation at the anorectal junction with koilocytes, classical for condyloma acuminatum, but without high-grade dysplasia or invasive carcinoma. The lesion was positive for low-risk HPV in situ hybridization but negative for HPV E6/E7. A follow-up colonoscopy six months later showed a healed 15 mm healthy scar in the rectum [Figure 4]. Lastly, recognizing the importance of comprehensive care, the patient was referred for gynecological evaluation to assess for any concurrent cervical pathology.

Discussion: Our case highlights the potential of ESD as a viable alternative to conventional surgical approaches for treating condyloma acuminatum, especially for lesions in challenging and uncommon locations such as the rectum. The technique offers significant advantages, including preservation of rectal anatomy and function, in addition to avoiding surgery-related morbidities. Additionally, this report contributes to the body of evidence supporting the effectiveness of endoscopic techniques in managing HPV-related lesions, advocating for further exploration and adoption in clinical practice.
ChatGPT improved grammar; content by authors.



Disclosures:


Bassel Dakkak, MD, Yasmeen Obeidat, MD, Leen Kayali, MD, Ahmed Sherif, MD, Wesam M. Frandah, MD. P4526 - Rectal Condyloma Acuminatum Treated with Endoscopic Submucosal Dissection, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.