Human papillomavirus-associated rectal adenocarcinoma

TL;DR

This paper reports a rare case of HPV-related rectal cancer in North America and its treatment with chemotherapy and radiation.

Contribution

The paper presents one of the first cases of HPV-mediated rectal adenocarcinoma managed with total neoadjuvant therapy in North America.

Findings

The tumor was strongly positive for p16 protein, indicating HPV mediation.

The patient is undergoing total neoadjuvant chemotherapy and radiation.

This case is likely among the first of its kind in North America.

Abstract

Human papillomavirus (HPV)-mediated rectal adenocarcinoma is a rare variant of colorectal adenocarcinoma that has only been described in a few case reports and series, with most originating from South America and the Middle East. This report, from North America, details the presentation, workup, and management of a 59-year-old Caucasian female who initially presented to her primary care with rectal bleeding who underwent interval colonoscopy and was found to have a T2 or early T3 rectal adenocarcinoma 1.2 cm from her anal verge. The tumor’s unique pathologic feature demonstrated adenocarcinoma strongly positive for p16 protein, suggesting mediation by HPV. She is currently undergoing total neoadjuvant chemotherapy and radiation for this pathology-proven, HPV-mediated low rectal adenocarcinoma. Based on a thorough literature review, she is likely one of the first patients with HPV-mediated adenocarcinoma to be managed with total neoadjuvant chemotherapy and radiation with hopes for a complete clinical response.