Photo of Mistrangelo MassimilianoProfessional title: MD, General Surgeon

Year of primary qualification: 1994

Current institution: Digestive and Colorectal Surgical Department, Centre of Minimal Invasive Surgery, University of Turin, Città della Salute e della Scienza di Torino Hospital, Turin, Italy

Title of presentation: Treatment of anal condilomata (Core Subject Update)

Learning objectives: My presentation will focus on treatment options for anal condilomata, also considering costs, results, complications and recurrences. Moreover the risk of degeneration and its implications in the diagnosis and treatment is debated.

Clinical/research background

Ano-genital warts, also known as condylomata acuminata or venereal warts, are one of the most common types of sexually transmitted diseases. The incidence of this disease is increased significantly over the past 30 years. The prevalence estimated in United States is 15%, equal to 24 million of individuals; and 500,000 to 1 million new cases of genital warts are believed to occur annually, resulting in 600,000 health care provider visits per year. Currently, more than 100 different HPV types have been sequenced and officially classified, about 30 of which have been found to infect genital epithelium.

Many treatment options exist for ano-genital warts, and physicians should be able to offer one or more treatments tailored to the patient and the extent of the disease. Anal warts are not usually a serious medical problem, but frequently they cause emotional distress to patient and physician alike because of their marked tendency to recur. In fact for some patients the psychological impact of warts is the worst aspect of the disease. Where psychological distress is apparent, referral for counselling may be appropriate. Despite the fact that guidelines for management have been published by the Medical Society of Venereal Diseases of the United Kingdom and the European Course on Human Papilloma Virus Associated Pathology Group, optimal treatment for anal warts is still undecided. All therapies present a high recurrence rate varying from 20 to 50%. Surgery (laser and diatermocoagulation) and imiquimod seem to be the most effective treatments.

Relevant peer-reviewed publications

  1. Castellano I., Mistrangelo M., Crudo V., Chiusa L., Lupo R., Ricardi U., Morino M., Mussa A., Cassoni P. YKL-40 expression in anal carcinoma predicts shorter overall and disease free survival. Histopathology 2009 Aug. 55 (2): 238-240.
  2. Mistrangelo M. Surgical Treatment of Anal Condylomata Acuminata. Letters to the Editor. Dis Colon Rectum 2009; 52 (10): 1803.
  3. Mistrangelo M., Pelosi E., Bellò M., Castellano I., Cassoni P., Ricardi U., Munoz F., Racca P., Contu V., Beltramo G., Morino M., Mussa A. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of inguinal node metastases in patients with anal cancer. Int J Radiat Oncol Biol Phys 2010; 77 (1): 73-78.
  4. Sarzo G., Mistro A., Finco C., Frayle-Salamanca H., Marino F., Franzetti M., Ferrara R., Mistrangelo M., Savastano S., Vecchiato M., Merigliano S. Extensive anal condylomatosis: prognosis in relation to viral and host factors. Colorectal Dis. 2010; 12: e128-e134.
  5. Mistrangelo M., Cornaglia S., Pizzio M., Rimonda R., Gavello G. Dal Conte I., Mussa A. Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial. Colorectal Dis. 2010; Aug; 12 (8): 799-803. Epub 2009 Jun; 22.
  6. Mistrangelo M., Tonello P., Allaix M.E., Borroni R., Canavesio N., Corno F. Perineal stapled prolapse resection for complete external rectal prolapse: preliminary experience and Literature review. Dig Surg 2012; 29: 87-91.
  7. Mistrangelo M., Pelosi E., Bellò M., Ricardi U., Milanesi E., Cassoni P., Baccega M., Filippini C., Racca P., Lesca A., Munoz FH., Fora G., Skanjeti A., Cravero F., Morino M. Role of positron emission tomography-computed tomography in the management of anal cancer. Int J Radiat Oncol Biol Phys 2012; Sep 1: 84 (1): 66-72.
  8. Mistrangelo M., Dal Conte I., Gregori G., Castellano I., Famiglietti F., de Vries HJC. Rectal Lymphogranuloma Venereum. Colorectal Dis 2012; 14: e792-e793.
  9. Giani I., Mistrangelo M., Fucini C. The treatment of squamous anal carcinoma: guidelines of the Italian Society of Colo-Rectal Surgery. Tech Coloproctol 2013; 17: 171-179.
  10. Mistrangelo M., Bellò M., Cassoni P., Milanesi E., Racca P., Munoz F., Fora G., Rondi N., Gilbo N., Senetta R., Ricardi U., Morino M. Value of staging squamous cell carcinoma of the anal margin and canal using the sentinel lymph node procedure: an update of the series and a review of the Literature. Br J Cancer 2013; 108 (3): 527-532.

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