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A woman between 70 and 80 years of age with a history of cervical cancer presented with changes in bowel habit. The patient took prednisolone for cardiac sarcoidosis. Colonoscopy revealed a 20-mm flat, whitish lesion with diffuse reddish speckles in the lower rectum (Figure 1). Based on the medical history and endoscopic findings, we suspected rectal condyloma acuminatum. However, biopsy results could not provide a definitive diagnosis; thus, we performed endoscopic submucosal dissection for excisional biopsy. The resected specimen revealed squamous epithelial cells with vacuolated cytoplasm (Figure 2). P16 staining, a marker of human papillomavirus infection, was diffusely stained. A final diagnosis of condyloma acuminatum was made. The patient was discharged uneventfully. No recurrence was observed 8 months after treatment.
Condyloma acuminatum, a relatively common disease especially in young adults, has an annual incidence ranging from 160 to 289 per 100,000 individuals.
Condyloma acuminatum is a viral wart caused by human papillomavirus infection and can also be observed in immunocompromised patients, such as those taking immunosuppressive agents. Generally, condyloma acuminatum is detected in the perineum, labia, vagina, penis, perianal area, and anal canal. However, it rarely crosses the dentate line to grow into the rectum. Condyloma acuminatum has malignant potential, often developing into atypical epithelium or carcinoma; thus, surgical resection is the first-line treatment. However, recent reports have shown the efficacy of endoscopic submucosal dissection as a curative, minimally invasive option.
There is no consensus on surveillance of rectal condyloma acuminatum; thus, it is reasonable to apply the surveillance recommendations for anal condyloma acuminatum, with follow-ups every 6 to 12 months.