Warty Squamous Cell Carcinoma of Anogenital Region: A Case Report in an HIV-positive Patient

Venereal infections significantly contribute to the development of anogenital cancers, and Human papillomavirus (HPV) is the most common sexually transmitted disease worldwide. Warty squamous cell carcinoma is an extremely rare aggressive variant that generally occurs in the severely immunosuppressed at sites like the anogenital and genito-urethral regions. Though its etiology is thought to be multifactorial, 95% cases are attributed to HPV infection. Of the various subtypes, the high-risk HPV serotypes, particularly HPV16 and18, are the main risk factors for warty carcinoma. We present the case of a 58-year-old male who came with complaints of a painful perineal lesion of three months duration. He is a known HIV-positive patient and has been on active antiretroviral therapy (HAART) regimen for the last 15 years. He was diagnosed with verrucous carcinoma of the perianal region five years ago for which an abdominoperineal resection was performed and now came with local tumor recurrence. Excision was done and histopathological evaluation showed an invasive carcinoma with papillomatosis, hyperkeratosis, and koilocytic atypia with brisk mitotic activity. Immunohistochemistry for p16 showed block positivity, confirming a diagnosis of HPV-associated warty squamous cell carcinoma. This case report highlights the relatively new variant of squamous cell carcinoma, its association with HPV, and the immunological implications of this virus in the development of squamous cell carcinoma. Preventive strategies to reduce such malignancies in the susceptible population have to be emphasized by creating awareness amongst the general public regarding the significance of HPV immunization and promoting the same in vulnerable groups.