PMC4921227_01
Left, Clinical presentation. A large, exophytic, cauliflowerlike perianal verrucous tumor is seen extending toward the perineum and scrotum. Right, Dramatic regression of the tumor is evident after 12 months of treatment.
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F1
At the patient's first visit in our clinic in 1996, physical examination demonstrated a smooth, exophytic, cauliflowerlike perianal verrucous tumor extending toward the perineum, scrotum, and buttocks (Figure 1, left).
Magnetic resonance imaging scans (short-time inversion recovery technique). Top, Before treatment, the tumor is seen infiltrating the internal obturator muscle, ischiorectal fossa, and perirectal space (arrows indicate the lateral tumor border). Bottom, After 12 months of treatment, the internal obturator muscle is again well defined (arrow).
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F2
A magnetic resonance imaging scan revealed that the tumor infiltrated deeply into the right side of the pelvis, including the ischiorectal fossa, internal obturator muscle, anal sphincter, perineum, and penile root (Figure 2, top).
Top, Pretreatment histologic section shows papillomatous tumor invading deeply into the underlying tissue, without penetration of the basement membrane (hematoxylin-eosin, original magnification x200). Bottom, The epidermis is hyperplastic and well stratified with few mitoses or koilocytes (hematoxylin-eosin, original magnification x400).
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F3
Histologic reevaluation of a previously obtained biopsy specimen showed a large papillomatous tumor infiltrating deeply into the underlying tissues, without penetration of the basement membrane (Figure 3, top). The epithelium was acanthotic with blunt rete ridges, well stratified without apparent cellular atypia, and contained few mitoses and koilocytes (Figure 3, bottom).