This is a 36 year old HIV+ male who presents for anal pap smear screening. A follow up anoscopy is done with biopsy.

Anal Pap Smear and Biopsy

Image 1-Liquid based Anal Pap smear showing atypical squamous cells
(400x magnification)


Image 2-Liquid based Anal Pap smear showing additional atypical squamous cells.
(400x magnification)


Image 3-Anoscopy was performed and a lesion was biopsied (100x magnification)


Image 4-Higher power magnification showing nuclear crowding
at the basal layer and significant cytologic atypia within the
superficial mucosa (200x magnification)

Image 5-Highest magnification (400x magnification).

What is your diagnosis?