Disagreement in high-grade/low-grade intraepithelial neoplasia and high-risk/low-risk HPV infection: clinical implications for anal cancer precursor lesions in HIV-positive and HIV-negative MSM  V.N. Pimenoff, M. Félez-Sánchez, S. Tous, O. Clavero, J.M. Godínez, J. Klaustermeier, M. Saunier, A. Molijn, L. Alemany, W. Quint, F.X. Bosch, S. de Sanjosé, J. McCloskey, I.G. Bravo  Clinical Microbiology and Infection  Volume 21, Issue 6, Pages 605.e11-605.e19 (June 2015) DOI: 10.1016/j.cmi.2015.02.009 Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 1 Schematic diagram. SIL samples used in this study. Condyloma (Condyloma acuminata), HPV X (unidentified HPV type), heterosexual women (Women), heterosexual men (Men) and MSM. Excluded from analysis were two HIV-negative homosexual women in both perianal and anal categories, three HIV-positive heterosexual men contributing three cases in the perianal category and one case in the anal category. For clinical diagnosis, each sample was clinically identified as condyloma and described by the operating clinician as perianal if the lesion was excised from perianal skin and as anal if the lesion was excised from colorectal, transitional or squamous zone regarding the dentate line of the surgical anal canal. For the histologic diagnosis, using hematoxylin and eosin staining, the biopsy samples were further evaluated by a pathologist in relation to the epithelial types present, thus affirming the origin of the lesion as perianal if a trace of skin tissue was observed in the sample. In parallel, samples stated as anal by the operating clinician and showing traces of glandular, squamous or anal transition zone epithelium where affirmed as anal lesions. In histologic review, each sample was further evaluated regarding the presence or absence of three-tier perianal/anal intraepithelial neoplasia (P/AIN) and as recommended [6,8] for anal lesion diagnosis, each sample was classified as either LSIL or LSIL with foci of HSIL (L + H SIL) for further analysis. Clinical Microbiology and Infection 2015 21, 605.e11-605.e19DOI: (10.1016/j.cmi.2015.02.009) Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions