Bump in Anal Canal

[tincup136]

I have had crohns for over 20 years that is limited to my rectum and anus.  Recently while inserting suppository in anal canal I noticed I have a place about an inch inside that felt raised.  It flapped and felt like a skin tag.  Went to Colorectal Surgeon and she performed a flex sig.  She saw the "lesions" (she said there were a few) and described it as scar tissue or warty like lesions.  I have anxiety issues and have now been worried about anal warts.  I do not really have any high risk factors.  I have been married for 7 years and only had 3 partners prior to marriage. Never had anal sex or foreplay.  Regardless she sent a couple of biopsies to pathology.  The report came back and stated as follows:  "Anal squamous mucosa with focal superficial erosion.  There is background hyperkeratosis and chronic inflammation.  negative for dysplasia and neoplasm."  My doc said this path report ruled out cancer and the lesions being anal warts?  My question is for reassurance purposes.   If the doctor removed appropriate biopsy margins which I believe she did then do you agree that the pathology report has ruled out the possibility of an anal wart.  Are warts fairly easy to detect by pathology? and considering my Crohns isn't the chronic inflammation a more feasible explanation of hyperkeratosis.  Can things look like warts and not be warts?  Anxious please help me.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  But honestly I don't think we can help.

First, direct examination by a colorectal surgeon is far more reliable than anything that can be concluded or suspected from this distance.  Had you not told me that such an expert had already examined you, it is exactly what I would have recommended.

That said, I will add that these bumps don't really sound like warts; that in someone with Crohn's disease of the colon I would strongly suspect something related to that disorder than to any other explanation; and that a colorectal surgeon would easily recognize (visually) most if not all warts or other HPV-related lesions. Finally, the path report is definitive -- pathology is the ultimate gold stnadard in diagnosing HPV related lesions.

I think those comments answer all your specific questions.  You should also discuss them with the surgeon and/or your gastroenterologist (assuming you have one).  But from all I can tell from afar, you needn't be at all concerned about HPV.

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

Yes, if they were warts, the path report would have at least mentioned the possibility.

Thanks for the thanks.  I'm glad to have helped.

[tincup136]

I thank you for your answer you are very reassuring.  My doctor saying lesions looked like warts came from left field and stressed me.  Last thing and i will post no more.  If it had been a wart the path report would have at least stated "possible condyloma" right?  My doctor no longer believes it is a wart by the way but i just wanted your thoughts.  Thanks so much