{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:07:10Z","timestamp":1760058430092,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Fund for VQR improvement, University of Palermo, Italy","award":["VQR C-D25"],"award-info":[{"award-number":["VQR C-D25"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Men who engage in anal fisting may experience full rectal and colon thickness injury resulting in an endoscopic emergency. The endoscopist does not routinely question patients about their sexual habits, nor are patients compliant with counseling during the endoscopy procedure as indicated by the infectious disease clinician. Case Presentation: A 47-years-old HIV- and monkeypox virus (MPXV)-negative Caucasian gay man underwent colonoscopy because of changes in bowel habits with anal discomfort and rectal bleeding. The first colonoscopy showed a vegetative annular neoformation of the anal canal. There was a concentric stenosis of the lumen. The endoscopist suspected the diagnosis of anal squamous cell carcinoma and a histopathology investigation was requested. Biopsy histology excluded a frank neoplasm or anal intraepithelial neoplasia (AIN). Then, the patient was referred to a multidisciplinary team. With adequate counseling, the patient disclosed his habitual anal fisting. Laboratory identification of L1\u2013L3 Chlamydia trachomatis (CT) genovars was positive for CT L1, L2, real-time PCR for Neisseria gonorrhoeae (NG), and Mycoplasma hominis. Human Papillomavirus (HPV)-DNA detection identified HPV type 70, 68, and 61. We illustrate this case with plenty of histology and immunohistochemistry. We also review the differential diagnosis of AIN according to the 5th edition (2019) WHO Classification of Digestive System Tumours. Conclusions: Our patient emphasizes two important aspects of endoscopy and pathology: first, the significance of understanding patients\u2019 sexual behaviors in diagnosing rectal and colon injuries, as well as the need for sexually transmitted infections (STI) screening especially for CT; and second, the effectiveness of a multidisciplinary communication model that encourages private discussions to alleviate patients\u2019 fears and improve prevention efforts.<\/jats:p>","DOI":"10.3390\/diagnostics15070885","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T16:26:31Z","timestamp":1743611191000},"page":"885","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inflammatory Pseudotumor of the Anal Canal Mimicking Colorectal Cancer: Case Report and Hints to Improve a Patient\u2019s Fitness for Treatment and Prevention"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1409-4207","authenticated-orcid":false,"given":"Vito","family":"Rodolico","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4418-5855","authenticated-orcid":false,"given":"Paola","family":"Di Carlo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8239-9830","authenticated-orcid":false,"given":"Girolamo","family":"Geraci","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in the Medical, Surgical and Critical Care Areas, University of Palermo, Via Liborio Giuffr\u00e8 5, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1407-7282","authenticated-orcid":false,"given":"Giuseppina","family":"Capra","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cinzia","family":"Cal\u00e0","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Costantino","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5168-2676","authenticated-orcid":false,"given":"Maria","family":"Meli","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2779-7879","authenticated-orcid":false,"given":"Consolato M.","family":"Sergi","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada"},{"name":"Anatomic Pathology, Children\u2019s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s00148-025-01077-4","article-title":"Health and relationship quality of sexual minorities in Europe","volume":"38","author":"Berlingieri","year":"2025","journal-title":"J. Popul. Econ."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ryan, P., Dolengevich-Segal, H., Ramos-Ruperto, L., Cabello, A., Sanchez-Conde, M., Vergas, J., Valencia, J., Cuevas, G., Sanz, J., and Curto-Ramos, J. (2023). Patterns of Sexualized Drug Use among Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV: Insights from a Comprehensive Study\u2014The U-SEX-2 GESIDA 9416 Study. J. Clin. Med., 12.","DOI":"10.20944\/preprints202309.0069.v1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1080\/00918369.2023.2275299","article-title":"No Cock Needed: Exploring the Hapto-Erotic Assemblage of Fist-Play in Gay Men\u2019s Anal Fisting","volume":"71","author":"Martin","year":"2023","journal-title":"J. Homosex."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s12024-021-00433-6","article-title":"Fatal anogenital exenteration of the intestine","volume":"18","author":"Preuss","year":"2022","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1080\/00224499.2024.2339521","article-title":"Fisting Subjectivity: Narratives of Sexual Subjectivity Among Gay Fist-Fuckers","volume":"62","author":"Martin","year":"2024","journal-title":"J. Sex Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jflm.2016.08.013","article-title":"Variability in findings of anogenital injury in consensual and non-consensual fisting intercourse: A systematic review","volume":"44","author":"Cappelletti","year":"2016","journal-title":"J. Forensic Leg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e28560","DOI":"10.1002\/jmv.28560","article-title":"Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients","volume":"95","author":"Ciccarese","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually Transmitted Infections Treatment Guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR. Recomm. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1093\/infdis\/jiy276","article-title":"Detection of Incident Anal High-Risk Human Papillomavirus DNA in Men Who Have Sex With Men: Incidence or Reactivation?","volume":"218","author":"Twisk","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_10","unstructured":"(2025, February 02). Available online: https:\/\/intranet.policlinico.pa.it\/pub\/documenti\/browse.do?dispatch=documentRead&documentId=1323c0545872ac910158731923c50019."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1136\/sextrans-2020-054851","article-title":"SPANC study team. Sexual behaviours associated with incident high-risk anal human papillomavirus among gay and bisexual men","volume":"98","author":"Wong","year":"2022","journal-title":"Sex. Transm. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fasciana, T., Capra, G., Di Carlo, P., Cal\u00e0, C., Vella, M., Pistone, G., Colomba, C., and Giammanco, A. (2021). Socio-Demographic Characteristics and Sexual Behavioral Factors of Patients with Sexually Transmitted Infections Attending a Hospital in Southern Italy. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094722"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ofae563","DOI":"10.1093\/ofid\/ofae563","article-title":"A Case of Syphilis With Ocular Involvement: Persistent Negative Serology in a Patient With Multiple Sclerosis","volume":"11","author":"Ganci","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bosco, L., Serra, N., Fasciana, T., Pistoia, D., Vella, M., Di Gregorio, L., Schillaci, R., Perino, A., Calagna, G., and Firenze, A. (2021). Potential impact of a nonavalent anti HPV vaccine in Italian men with and without clinical manifestations. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-83639-6"},{"key":"ref_15","first-page":"28","article-title":"Death after anal \u201cfisting\u201d","volume":"221","author":"Preuss","year":"2008","journal-title":"Arch Kriminol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1520\/JFS15345J","article-title":"Fatal anorectal injuries: A series of four cases","volume":"40","author":"Orr","year":"1995","journal-title":"J. Forensic Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/00000433-198512000-00009","article-title":"Rectal fist insertion. An unusual form of sexual behavior","volume":"6","author":"Shook","year":"1985","journal-title":"Am. J. Forensic. Med. Pathol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bitzer, J. (2024). Sexual and Reproductive Healthcare for LGBTI. Textbook of Contraception, Sexual and Reproductive Health, Cambridge University Press.","DOI":"10.1017\/9781108961097"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2300520","DOI":"10.2807\/1560-7917.ES.2024.29.19.2300520","article-title":"Anorectal lymphogranuloma venereum among men who have sex with men: A 3-year nationwide survey, France, 2020 to 2022","volume":"29","author":"Peuchant","year":"2024","journal-title":"Euro Surveill."},{"key":"ref_20","first-page":"9981631","article-title":"Severe Gastrointestinal Hemorrhage due to Monkeypox Virus-Associated Proctocolitis","volume":"2023","author":"Taj","year":"2023","journal-title":"Case Rep. Gastrointest. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1006\/gyno.1999.5650","article-title":"Stage IIa cervix carcinoma with metastasis to the heart: Report of a case with immunohistochemistry, flow cytometry, and virology findings","volume":"76","author":"Sergi","year":"2000","journal-title":"Gynecol. Oncol."},{"key":"ref_22","unstructured":"ARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2024, March 08). Human Papillomaviruses, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK321760\/."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cabibi, D., Napolitano, C., Giannone, A.G., Micciulla, M.C., Porcasi, R., Lo Coco, R., Bosco, L., Vinciguerra, M., and Capra, G. (2021). Predictive Role of the p16 Immunostaining Pattern in Atypical Cervical Biopsies with Less Common High Risk HPV Genotypes. Diagnostics, 11.","DOI":"10.3390\/diagnostics11111947"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3802\/jgo.2014.25.1.3","article-title":"Cervical preneoplasia biomarkers: A conundrum for the community based gynecologic surgical pathologist","volume":"25","year":"2014","journal-title":"J. Gynecol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.humpath.2017.06.014","article-title":"Using p16 immunohistochemistry to classify morphologic cervical intraepithelial neoplasia 2: Cor-relation of ambiguous staining patterns with HPV subtypes and clinical outcome","volume":"66","author":"Liu","year":"2017","journal-title":"Hum. Pathol."},{"key":"ref_26","first-page":"e20216","article-title":"Lymphogranuloma Venereum Mimicking Locally Metastatic Rectal Cancer in an HIV-Negative Man","volume":"13","author":"Soliman","year":"2021","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1093\/cid\/ciz606","article-title":"Infection with Chlamydia trachomatis Increases the Risk of High-grade Anal Intraepithelial Neoplasia in People Living With Human Immunodeficiency Virus","volume":"70","author":"Padilla","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S1473-3099(17)30653-9","article-title":"Human papillomavirus types from infection to cancer in the anus, according to sex and HIV status: A systematic review and meta-analysis","volume":"18","author":"Lin","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_29","unstructured":"WHO Classification of Tumours Editorial Board (2019). Digestive System Tumours, International Agency for Research on Cancer. [5th ed.]. Available online: https:\/\/publications.iarc.fr\/579."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.5858\/arpa.LGT200570","article-title":"The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology","volume":"136","author":"Darragh","year":"2012","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4081","DOI":"10.1007\/s10620-023-08095-w","article-title":"Irritable Bowel Syndrome-Like Symptoms in Quiescent Inflammatory Bowel Disease: A Practical Approach to Diagnosis and Treatment of Organic Causes","volume":"68","author":"Lim","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1001\/jamadermatol.2017.5980","article-title":"Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts","volume":"154","author":"Maverakis","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1097\/MIB.0b013e3182813365","article-title":"De Novo Inflammatory Bowel Disease and Its Mimics After Organ Transplantation","volume":"19","author":"Nepal","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Dapaah, J.M., and Senah, K.A. (2016). HIV\/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana. BMC Med. Ethics, 17.","DOI":"10.1186\/s12910-016-0123-3"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gazzetta, S., Valent, F., Sala, A., Driul, L., and Brunelli, L. (2024). Sexually transmitted infections and the HPV-related burden: Evolution of Italian epidemiology and policy. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1336250"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ranabhotu, A., Habibian, N., Patel, B., Farrell, E., Do, J., Sedghi, S., and Sedghi, L. (2023). Case Report: Resolution of high grade anal squamous intraepithelial lesion with antibiotics proposes a new role for syphilitic infection in potentiation of HPV-associated ASCC. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1226202"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1002\/ijc.34850","article-title":"International Anal Neoplasia Society\u2019s consensus guidelines for anal cancer screening","volume":"154","author":"Stier","year":"2024","journal-title":"Int. J. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"15262","DOI":"10.3748\/wjg.v20.i41.15262","article-title":"Sexually transmitted infections of the anus and rectum","volume":"20","author":"Assi","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1136\/pmj.2006.048488","article-title":"Sexually transmitted proctitis","volume":"82","author":"Hamlyn","year":"2006","journal-title":"Postgrad. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1037\/ser0000498","article-title":"Motivational interviewing to reduce risky sexual behaviors among at-risk male youth: A randomized controlled pilot study","volume":"19","author":"Bassett","year":"2022","journal-title":"Psychol. Serv."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1080\/13648470.2013.876355","article-title":"The importance of contextualization. Anthropological reflections on descriptive analysis, its limitations and implications","volume":"21","author":"Andersen","year":"2014","journal-title":"Anthr. Med."},{"key":"ref_42","unstructured":"Bernstein, B. (1990). Class, codes and control. The Structuring of Pedagogic Discourse, Routledge."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Eerdmans, S., Prevignano, C., and Thibault, P. (2002). Language and Interaction. Discussions with J. J. Gumperz, Benjamins.","DOI":"10.1075\/z.117"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Gumperz, J.J. (1982). Discourse Strategies, Cambridge University Press.","DOI":"10.1017\/CBO9780511611834"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Gumperz, J.J. (1982). Language and Social Identity, Cambridge University Press.","DOI":"10.1017\/CBO9780511620836"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1016\/j.pragma.2005.08.004","article-title":"Learners\u2019 perception and interpretation of contextualization cues in spontaneous Japanese conversation: Back-channel cue Uun","volume":"38","author":"Ishida","year":"2006","journal-title":"J. Pragmat."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.pragma.2016.05.012","article-title":"Style-shifting in student-professor interactions","volume":"101","author":"Masuda","year":"2016","journal-title":"J. Pragmat."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: Updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi","year":"2023","journal-title":"Int. J. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/885\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:07:35Z","timestamp":1760029655000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":48,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["diagnostics15070885"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15070885","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}