A 63-Year-Old Man Comes to the Office Due to Intermittent

A 63-year-old man comes to the office due to intermittent rectal bleeding.  The bleeding worsens with defecation and is associated with itchiness.  Ten years ago, he had a kidney transplant for diabetic nephropathy and reports compliance with posttransplant immunosuppression medications.  Vital signs are normal.  Physical examination reveals a 2-cm ulcerated mass extending from the anal verge into the rectum.  Biopsy shows large, eosinophilic squamous epithelial cells arranged in islands; cells have hyperchromatic, irregular nuclei, and scant cytoplasm.  Significant keratinization is present.  Which of the following factors is most likely responsible for the development of this patient's anal lesion?

A) BRAF mutation
B) Human herpesvirus 8
C) Human papillomavirus
D) Mismatch repair gene mutation
E) Poxvirus
F) Treponema pallidum

Correct Answer:

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