Poster-01-060Aggressiveness of the Human Papillomavirus in a young inmunocompetent woman: A case report Objective: Introduction: incidence of vulvar intraepitelial neoplasia (VIN) has been doubled in recent decades. Immunosuppression is a risk factor for the development of VIN and invasive carcinoma relapses after treatment. It is estimated that 90% of anal cancers are associated with High Rish-HPV. Method: Case report: Patient of 29 years old with no relevant medical history, nulligravida. Diagnosed of condylomas, VIN III and CIN III in February 2003 with affection for the vaginal margin and endocervical lesion free. During the 18 following months checkings are made and reveal persistent VIN III and CIN III.Conization is performed and reports affection of the surgical limit. HPV 16 and 33 are positive. Some controls can not be performed because of the patient‘s intense pain. In December 2004 the patient wants a simple vulvectomy and it is performed with removal of the clitoral hood, with pathological report: in situ vulvar carcinoma with extension into clitoroideo hood and perianal condyloma. Over the next year she has perianal lesions treated with Aldara and Inmunoferon and a year later presented HPV 16 +, 71 + and 66 +. 6 months later, she presented CIN III cytology suspicious. In 2007 he performed new wide local excision of perineal injury, and in successive controls is objectified persistence of HPV. At the end of 2008 13 serotypes of HPV are positive. The patient, aged 35, really affected psychologically by the course of her illness, wants simple total hysterectomy and it is performed without incident. Also a excision of an anal lesion is made which resulted to be a in situ anal carcinoma. Results: Discussion: Most HPV infections are spountaneously resolve due to the host immune response. The cases of persistence are a high risk group for malignant transformation. Different factors have been described as associated with viral category, genetic, and environmental sexual behavior. The persistence of HPV and surgical margins affected are the greatest predictors of disease recurrence after treatment. Conclusion: There are some cases where it is unknown what causes and determinates the persistence of HPV after successive treatments in an immunocompetent patient. The ubiquity of HPV in the genital tract causes that the disease can simultaneously affect the cervix, vulva, vagina and anus. |
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