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Spinelli L, Martini S, Solla SD, Vigna Taglianti R, Olivero F, Gianello L, Reali A, Merlotti AM, Franco P. Nodal Elective Volume Selection and Definition during Radiation Therapy for Early Stage (T1-T2 N0 M0) Perianal Squamous Cell Carcinoma: A Narrative Clinical Review and Critical Appraisal. Cancers (Basel) 2023; 15:5833. [PMID: 38136378 PMCID: PMC10741760 DOI: 10.3390/cancers15245833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Distinction between anal canal and perianal squamous cell carcinomas (pSCCs) is essential, as these two subgroups have different anatomical, histological, and lymphatic drainage features. Early-stage true perianal tumors are very uncommon and have been rarely included in clinical trials. Perianal skin cancers and aCCs are included in the same tumor classification, even though they have different lymphatic drainage features. Furthermore, pSCCs are treated similarly to carcinomas originating from the anal canal. Radiation therapy (RT) is an essential treatment for anal canal tumors. Guidelines do not differentiate between treatment volumes for perianal tumors and anal cancers. So far, in pSCC, no study has considered modulating treatment volume selection according to the stage of the disease. We conducted a narrative literature review to describe the sites at higher risk for microscopic disease in patients with early-stage perianal cancers (T1-T2 N0 M0) to propose a well-thought selection of RT elective volumes.
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Affiliation(s)
- Lavinia Spinelli
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Stefania Martini
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Salvatore Dario Solla
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Riccardo Vigna Taglianti
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Francesco Olivero
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Luca Gianello
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Alessia Reali
- Radiation Oncology Department, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
| | - Anna Maria Merlotti
- Radiation Oncology Department, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (L.S.); (S.M.); (S.D.S.); (R.V.T.); (F.O.); (L.G.); (A.M.M.)
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, 28100 Novara, Italy
- Department of Radiation Oncology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy
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2
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Parkin E, Kallipershad S, Nasser A, Al-Mudhaffer M, Rosero D, Haston J, Williamson D, Mitchell P. Predictors of recurrence following local excision for early-stage anal squamous cell carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107093. [PMID: 37801832 DOI: 10.1016/j.ejso.2023.107093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/01/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION There is increasing use of local excision (LE) for definitive treatment of early-stage anal squamous cell carcinoma (ASCC) to avoid the morbidity associated with chemoradiotherapy (CRT). However, the importance of different histological variables on risk of recurrence is poorly understood. METHODS A detailed analysis of patient characteristics, histology results, recurrence patterns and salvage treatment was conducted in consecutive T1/T2N0 ASCC patients treated by LE 2010-2021 across a UK regional cancer network multi-disciplinary team (MDT). Associations between potential predictors of disease recurrence were explored using chi-squared and Kruskal-Wallis tests for categorical and continuous variables respectively. RESULTS Of 621 ASCC patients discussed in the network MDT, 164 had early-stage disease (T1/T2 N0). Of these, 36 (22%) were deemed suitable for LE (median age 61 years, female to male ratio 2:1). Twenty-two LE tumours were T1; 14 were T2. There were 12 well-differentiated tumours, 21 moderate and 3 poorly-differentiated. Seven out of 36 LE patients (19.4%) developed recurrence, all of whom went on to have salvage treatment with CRT (n = 4), re-excision (n = 2) or radiotherapy (n = 1). Predictors of disease recurrence following LE were: tumour differentiation (p = 0.024), tumour depth (p = 0.033) and R1 resection margin (p = 0.034). Tumour stage and site (margin/canal) were non-significant. CONCLUSION LE for T1/T2 N0 ASCC of the margin or canal is a viable treatment strategy to avoid the morbidity associated with CRT and salvage treatments are still available for patients that develop recurrence. Tumour differentiation, depth and margin status are all important factors to consider when discussing management of early-stage ASCC.
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Affiliation(s)
- E Parkin
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - S Kallipershad
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - A Nasser
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - M Al-Mudhaffer
- Department of Histopathology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - D Rosero
- Department of Histopathology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - J Haston
- Department of Clinical Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - D Williamson
- Department of Clinical Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - P Mitchell
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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3
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Gracie J, Fortune EC, Morris CG, Leach DF, Mendenhall WM. Radiation Treatment for Cancer of the Anal Margin. Am J Clin Oncol 2023; 46:167-171. [PMID: 36820471 DOI: 10.1097/coc.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To identify best treatment practices by examining outcomes of anal margin cancer patients treated with radiotherapy. METHODS Relevant literature was compared with 38 patients at our institution treated 1979 to 2019 with curative radiotherapy. Median age was 51. Four patients had T1, 22 had T2, and 12 had T3 disease based on the American Joint Committee on Cancer (AJCC) staging at time of diagnosis. Nodal staging distribution was: N0=33; N1=2; N2=2; N3=1. Median radiation dose was 56 Gy/30 fractions. Five received nodal radiation for node positivity, 29 received elective nodal radiation, and 29 had perineal boost. Twenty-seven received concurrent chemotherapy. RESULTS Three patients experienced isolated local recurrence, 2 had isolated inguinal node recurrences, and 2 developed distant metastases, 1 of whom also had local and regional recurrence. Ten-year disease-free survival (DFS), cause-specific survival, and overall survival were 87%, 92%, and 68%, respectively. One patient did not complete radiation, and 4 had unexpected treatment breaks. Two received salvage abdominoperineal resections. At last follow-up, 17 were alive with no evidence of disease, 2 were alive with anal margin cancer present, 3 had died with anal margin cancer present at 11, 18, and 21 months from radiation therapy, and 16 had died from intercurrent disease. Median follow-up was 6.6 years (range 0.9 to 29.0 y). Age ≥51 was associated with worse locoregional control ( P =0.018) and DFS ( P =0.0233), males had worse DFS ( P =0.0311), and HIV-positive patients had worse overall survival ( P =0.006). CONCLUSIONS Radiation provides high locoregional control of anal margin cancer with good long-term outcomes.
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Affiliation(s)
- Jayden Gracie
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - E Charles Fortune
- Department of Radiation Oncology, John B. Amos Cancer Center, Piedmont Columbus Regional, Columbus, GA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Daniel F Leach
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
- Department of Internal Medicine, Southeast Health, Dothan, AL
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
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4
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Anal Cancer: The Past, Present and Future. Curr Oncol 2023; 30:3232-3250. [PMID: 36975459 PMCID: PMC10047250 DOI: 10.3390/curroncol30030246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Anal cancer is a rare cancer that accounts for about 2% of all gastrointestinal tract malignancies. Among anal cancer, squamous cell cancer is the most common malignancy. The incidence of all stages of anal squamous cell cancer has been increasing. Human papillomavirus infection and immunosuppression are major risk factors for anal cancer. The management of anal cancer has evolved over the past several decades and continues to do so. Chemoradiation therapy remains the mainstay for treatment for most patients with early-stage disease, whereas systemic therapy is the primary treatment for patients with metastatic disease. Patients with persistent disease or recurrence following chemoradiation therapy are treated with salvage surgery. Access to novel cytotoxic combinations and immunotherapy has improved the outcomes of patients with advanced disease. This review provides an overview of advances in the management of anal cancer over the past two decades. This paper reviews the epidemiology, risk factors, pathology, diagnosis, and management of localized and advanced anal squamous cell cancer, highlights current knowledge gaps in the management of anal cancer, and discusses future directions.
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5
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Kwan SY, Castillo DR, Aka AA, Kandala G, Tsai JY, Zmaj K, Reeves ME, Yang GY. Perianal basosquamous carcinoma treated with radiation therapy, a case report. J Gastrointest Oncol 2023; 14:463-467. [PMID: 36915436 PMCID: PMC10007913 DOI: 10.21037/jgo-22-1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
Background Perianal basal cell carcinoma (BCC) is very rare and estimated to account for 0.08% of all BCC and 0.02% of all anorectal neoplasms. Perianal lesions are more likely to be squamous cell carcinoma (SCC) as BCC usually develops on areas of skin exposed to ultraviolet (UV) light such as the face and arms. Proper diagnosis with the assistance of immunohistochemistry (IHC) stains to distinguish the two entities can help inform the suitable course of treatment. Case Description Our case is an 82-year-old male with a history of cutaneous BCC on the arms and trunk presenting with a symptomatic perianal lesion. Initial biopsy demonstrated BCC with subsequent IHC studies differentiating from basaloid SCC. Standard treatment includes wide local excision (WLE) but given his poor performance status, radiation only was recommended. He was successfully treated and tolerated 30 Gy in 5 daily fractions. Conclusions Radiation only is a unique and feasible non-surgical treatment for basosquamous carcinoma of the anus.
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Affiliation(s)
- Stephanie Y Kwan
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dani Ran Castillo
- Division of Hematology/Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Allison A Aka
- Division of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gokul Kandala
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - James Y Tsai
- Division of Hematology/Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kristine Zmaj
- Department of Surgery, Loma Linda VA Medical Center, Loma Linda, CA, USA
| | - Mark E Reeves
- Division of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gary Y Yang
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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6
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Mirza W, Rajan R, Petersson J, Kulendran K, Ratinam R, Clark D. Teardrop flap for a perianal lesion - A video vignette. Colorectal Dis 2022; 24:1630-1631. [PMID: 35801625 DOI: 10.1111/codi.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Wasif Mirza
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Ruben Rajan
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Josefin Petersson
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Krish Kulendran
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Ratheesraj Ratinam
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - David Clark
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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7
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Squamous cell skin carcinoma due to chronic sacrococcygeal diseases. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210405014g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. Sacrococcygeal region squamous cell cancers (SCC) due
to chronic sacrococcygeal diseases of skin are rare malignancies. The
anatomical relation with the anus represents a challenge for diagnosis and
surgical treatment. The oncological treatment algorithm is still
controversial. Here, we investigated the clinicopathologic features of skin
cancer of the sacrococcygeal region in a total of 10 cases from a surgical
oncology reference center. Methods. We retrospectively analyzed the
patients who underwent surgery for sacrococcygeal region skin SCC between
January 2010 and July 2020. Results. All patients were male, and the mean
age was 52.9?10.5 years. In the etiology, five patients had hidradenitis
suppurativa, 2 had Human papillomavirus associated condyloma
(Buschke-Lowenstein tumor), and 3 had pilonidal sinus disease. The mean time
between the development of the lesion and malignancy diagnosis was 21.7?5.8
years. In the preoperative evaluation, three patients had bone invasion.
None of the patients had anal sphincter or rectal invasion. Also, no patient
had lymph node metastasis or distant metastasis. Wide local excision (WLE)
was performed in all patients; 3 of them with bone resection. Adjuvant
chemoradiotherapy was applied to five patients. In a 28.5?13.7 months
follow-up, local recurrence occurred in 5 patients and WLE has performed
again in these patients. Of these 5 patients, 2 eventually became
metastatic. Finally, 3 patients died due to disease and 6 patients are still
free of diseases. Conclusion. Sacrococcygeal region SCCs may rarely develop
after a long interval from hidradenitis suppurativa, pilonidal sinus
disease, and condyloma acuminata. Anal sphincter-sparing WLE can be applied,
but sphincter dysfunction may occur. The disease is associated with a high
risk of relapse and poor survival.
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8
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Eliachevsky C, Templeton E, Nanda AK. Perianal squamous cell carcinoma: A case report. Int J Surg Case Rep 2021; 81:105739. [PMID: 33743249 PMCID: PMC8010385 DOI: 10.1016/j.ijscr.2021.105739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
Perianal squamous malignancies are often misdiagnosed leading to delay in treatment. Surgical management aims to preserve sphincter function. Chemoradiation is preferred in cases of suspected sphincter involvement. Some superficial muscle fibers may be resected in select cases without loss of function.
Introduction and importance Perianal carcinomas, though rare, are usually squamous cell carcinoma. Current literature recommends surgical excision for tumors staged T1-T2, N0 without external anal sphincter involvement, however our case demonstrated that tumors with superficial involvement of external sphincter fibers can be resected completely. Case presentation A 45-year-old Caucasian male presented with a perianal mass found to be squamous cell carcinoma. Initial imaging suggested the anal sphincter was spared, however intraoperatively tumor cells were found involving superficial external sphincter fibers and a portion was excised to ensure complete removal. Clinical discussion Perianal squamous malignancies are often misdiagnosed as more benign conditions. Treatment aims to preserve sphincter function and depends on tumor stage along with anatomical involvement. Conclusion Despite superficial muscle infiltration, the T2N0 perianal lesion was curable with surgical resection alone without recurrence or functional deficits reported one year later. This suggests surgical management may be possible in some cases with sphincter involvement.
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Affiliation(s)
| | - Erin Templeton
- Medical Student, St. George's University School of Medicine, Grenada.
| | - Atul K Nanda
- Chairman of Surgery, Humboldt Park Health, Chicago, IL, 60622, USA; Associate Professor of Surgery, St. George's University School of Medicine, Grenada.
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9
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Mufti A, Maliyar K, Sachdeva M, Cyr J, Doiron P, Dahlke E. Full Body Skin Examination Practices Among Canadian Dermatologists: Results of a Nationwide Survey. J Cutan Med Surg 2020; 25:212-215. [PMID: 33242985 DOI: 10.1177/1203475420974648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Asfandyar Mufti
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada
| | | | | | - Janelle Cyr
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada
| | - Philip Doiron
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada
| | - Erin Dahlke
- 7938 Department of Medicine, Division of Dermatology, University of Toronto, Canada.,10070 Mohs Micrographic Surgery Clinic, Medical Education Teaching Clinic, St. Joseph's Health Centre Toronto, Canada
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10
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Gouvas N, Gourtsoyianni S, Kalogeridi MA, Sougklakos J, Vini L, Xynos E. Hellenic society of medical oncology (HESMO) guidelines for the management of anal cancer. Updates Surg 2020; 73:7-21. [PMID: 33231836 DOI: 10.1007/s13304-020-00923-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 01/01/2023]
Abstract
Despite considerable improvement in the management of anal cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centres in Greece and Cyprus. The aim was to elaborate a consensus on the multidisciplinary management of anal cancer, based on European guidelines (European Society of Medical Oncologists-ESMO), considering local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralisation, care by a multidisciplinary team (MDT) and adherence to guidelines are emphasised.
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Affiliation(s)
- Nikolaos Gouvas
- Colorectal Surgeon, Nicosia General Hospital, Medical School, Shacolas Educational Centre for Clinical Medicine, University of Cyprus, Palaios Dromos Lefkosias Lemesou No.215/6Aglantzia, 2029, Nicosia, Cyprus.
| | - Sophia Gourtsoyianni
- Abdominal Radiologist, "Aretaieion" Hospital, Faculty of Medicine, University of Athens, Athens, Greece
| | | | - John Sougklakos
- Medical Oncologist, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Louisa Vini
- Clinical Oncologist/Radiotherapist, "Iatriko" Hopsital of Athens, Athens, Greece
| | - Evangelos Xynos
- Colorectal Surgeon, Creta Inter-Clinic Hopsital, Heraklion, Greece
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11
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Provini A, Ruggeri S, Mazzanti C, Pilla MA, Ricci F, Panebianco A, Abeni D, Fania L. Successful treatment of two cases of perianal Bowen disease with photodynamic therapy followed by imiquimod cream. Dermatol Ther 2020; 33:e13759. [PMID: 32495969 DOI: 10.1111/dth.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alessia Provini
- First Dermatology Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Salvatore Ruggeri
- First Dermatology Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Cinzia Mazzanti
- First Dermatology Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | | | - Francesca Ricci
- Laboratory of Dermatopathology, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | | | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Luca Fania
- First Dermatology Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
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12
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Local Excision of a Mucinous Adenocarcinoma of the Anal Margin (Extramammary Paget's Disease) and Reconstruction with a Bilateral V-Y Flap. Case Rep Surg 2019; 2019:9073982. [PMID: 31886008 PMCID: PMC6915020 DOI: 10.1155/2019/9073982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
The case of a 75-year-old female with invasive extramammary Paget's disease of the anal margin, without involvement of the anal canal, is reported. The patient underwent wide local excision of the lesion with reconstruction with a double V-Y flap, a biopsy of the inguinal sentinel node, and a laparoscopic temporary colostomy. No guidelines exist on the treatment of this rare disease, and both wide local excision and abdominoperineal resection have been proposed. In the present case, the absence of invasion of the anal canal, also confirmed by intraoperative biopsies on the resection margins, and of local lymph node metastasis, as confirmed by the sentinel lymph node biopsy, allowed a sphincter-sparing operation with good functional and oncological results.
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13
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Almaazmi H, Taylor JP, Stem M, Yu D, Lo BD, Safar B, Efron JE. Anal Squamous Cell Carcinoma: Radiation Therapy Alone Must Be Avoided. J Surg Res 2019; 247:530-540. [PMID: 31648811 DOI: 10.1016/j.jss.2019.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/07/2019] [Accepted: 09/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anal squamous cell carcinoma (ASCC) is the most common histological subtype of anal cancer. Rates have been observed to increase in recent years. Combined chemoradiotherapy (CCRT) is currently the gold standard of treatment. The aim of this study is to assess ASCC prevalence, treatment trends, and overall survival (OS) in the United States. METHODS Patients diagnosed with stage I-IV ASCC were identified from the National Cancer Database from 2004 to 2015. The primary outcome was 5-year OS, which was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. RESULTS 34,613 cases were included (stage I: 21.45%; II: 41.00%; III: 31.62%; IV: 5.94%), with an increasing trend in prevalence. CCRT was the most used treatment. Multimodal treatment, combining surgery with CCRT, offered the best OS rates for stage I, II, and IV cancers (I: 84.87%; II: 75.12%; IV: 33.08%), comparable with survival of stage III patients treated with CCRT (III: 61.14%). Radiation alone had the worse OS rates, and on adjusted analysis, radiation treatment alone had the greatest risk of mortality (I: hazard ratio, 2.01; 95% confidence interval, 1.14-3.54; P = 0.016; II: 2.05, 1.44-2.93, P < 0.001; IV: 1.99, 0.99-4.02, P = 0.054). CONCLUSIONS ASCC has increased in prevalence, notably in stage III and IV disease. Although CCRT is the most commonly used treatment type for all stages of ASCC, multimodal treatment offers better OS in stages I, II, and IV. Treatment with radiation alone offers the worst OS no matter the stage and should no longer be used as a solitary treatment modality.
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Affiliation(s)
- Hamda Almaazmi
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James P Taylor
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miloslawa Stem
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Yu
- Department of Surgery, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Brian D Lo
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan E Efron
- Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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14
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Bignell M, Chave H, Branagan G. Outcome of surgery for recurrent anal cancer: results from a tertiary referral centre. Colorectal Dis 2018; 20:771-777. [PMID: 29573536 DOI: 10.1111/codi.14098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/01/2018] [Indexed: 12/20/2022]
Abstract
AIM Chemoradiotherapy remains the first line of treatment for anal cancer with surgery reserved for cancer recurrence or persistence. The low incidence of anal cancer means that the numbers undergoing surgery is small with centralization for excision to regional cancer centres. We present our experience of abdominal perineal excision, with reconstruction of the perineal defect (APERR), within a tertiary centre. METHOD Over a 15-year period, data were collected retrospectively from notes of patients who underwent an APERR. The aim was to look at disease-free and overall survival and complications associated with flap reconstruction. RESULTS In the study period, 29 patients [median age = 62 (range: 42-81; interquartile range: 54-68) years] underwent APERR. Median follow-up was 77 (4-200) months. Thirteen patients died during follow-up; eight from their disease, with a median survival time of 16 (4-63) months. Five-year survival was 67%. Nine (31%) patients had recurrence during the follow up period; this was local (n = 2), regional (n = 4), distant (n = 2) or a combination (n = 1). Sixteen (55%) patients developed 24 complications, including nine (31%) flap complications and 10 (34%) parastomal hernias. Flap complications were flap failure (n = 1) requiring direct closure, flap dehiscence (n = 2), necrosis of flap tip (n = 1), wound infection (n = 4) and a bulky flap (n = 1) requiring liposuction. CONCLUSION APERR of anal cancer is a feasible technique with excellent oncological treatment and acceptable long-term complications, although a higher than expected rate of parastomal hernia was noted.
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Affiliation(s)
- M Bignell
- Department of Colorectal Surgery, Salisbury District Hospital, Salisbury, UK
| | - H Chave
- Department of Colorectal Surgery, Salisbury District Hospital, Salisbury, UK
| | - G Branagan
- Department of Colorectal Surgery, Salisbury District Hospital, Salisbury, UK
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The treatment of perianal skin horseshoe melanoma by advancement flap (Y-V shaped) and the assessment of outcome over a long-term follow-up. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, Moran B, Bower M, Alfa-Wali M, Adams R. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Anal Cancer. Colorectal Dis 2017; 19 Suppl 1:82-97. [PMID: 28632308 DOI: 10.1111/codi.13709] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ian Geh
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Andrew Renehan
- University of Manchester and Christie Hospital, Manchester, UK
| | - John Scholefield
- University of Nottingham and Queens Medical Centre, Nottingham, UK
| | - Vicky Goh
- King's College and Guy's & St Thomas' Hospital, London, UK
| | | | - Brendan Moran
- Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Mark Bower
- Imperial College and Chelsea & Westminster Hospital, London, UK
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
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Surabhi VR, Menias CO, Amer AM, Elshikh M, Katabathina VS, Hara AK, Baughman WC, Kielar A, Elsayes KM, Siegel CL. Tumors and Tumorlike Conditions of the Anal Canal and Perianal Region: MR Imaging Findings. Radiographics 2016; 36:1339-53. [DOI: 10.1148/rg.2016150209] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Raptis D, Schneider I, Matzel KE, Ott O, Fietkau R, Hohenberger W. The differential diagnosis and interdisciplinary treatment of anal carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:243-9. [PMID: 25891807 DOI: 10.3238/arztebl.2015.0243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anal carcinoma accounts for 2-4% of all cases of colorectal and anorectal carcinoma. Its peak incidence is from age 58 to age 64; women are affected somewhat more commonly than men. Its incidence has risen markedly in the past three decades. METHODS This article is based on a selective review of the literature, including the guidelines of the National Comprehensive Cancer Network and the European Society of Medical Oncology. RESULTS Anal carcinoma is often an incidental finding. About 85% of newly diagnosed cases are associated with an HPV infection with strain 16, 18, or 33. Radiochemotherapy with 5-fluorouracil and mitomycin C is the treatment of choice. The 5-year survival rate is 80-90%. Primary surgery with curative intent is indicated only for well-differentiated carcinoma of the anal margin (T1, N0). 10-30% of patients now undergo radical resection. The utility of endosonography and positron emission tomography for staging is debated and needs further study. CONCLUSION The treatment of patients with anal carcinoma requires a specialized multidisciplinary approach in accordance with the current evidence-based guidelines. The potential role of prophylactic vaccination against oncogenic types of HPV in the prevention of anal carcinoma merits further investigation.
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Affiliation(s)
- Dimitrios Raptis
- Department of Surgery, Universitätsklinikum Erlangen, Department of Radiation Oncology, Universitätsklinikum Erlangen
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Gami B, Kubba F, Ziprin P. Human papilloma virus and squamous cell carcinoma of the anus. Clin Med Insights Oncol 2014; 8:113-9. [PMID: 25288893 PMCID: PMC4179600 DOI: 10.4137/cmo.s13241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 12/26/2022] Open
Abstract
The incidence of anal cancer is increasing. In the UK, the incidence is estimated at approximately 1.5 per 100,000. Most of this increase is attributed to certain at-risk populations. Persons who are human immunodeficiency virus (HIV)-positive and men who have sex with men (MSM), Organ transplant recipients, women with a history of cervical cancer, human papilloma virus (HPV), or cervical intraepithelial neoplasia (CIN) are known to have a greater risk for anal cancer. This paper will focus on HPV as a risk factor for anal intraepithelial neoplasia (AIN) and discusses the etiology, anatomy, pathogenesis, management of squamous cell carcinoma (SCC) of the anus.
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Affiliation(s)
- Bhavna Gami
- Department of Bio Surgery and Surgical Technology, St Mary’s Hospital, London, UK
| | - Faris Kubba
- Histopathology Department. Ealing Hospital UK
| | - Paul Ziprin
- Department of Bio Surgery and Surgical Technology, St Mary’s Hospital, London, UK
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20
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Siegel EM, Eschrich S, Winter K, Riggs B, Berglund A, Ajidahun A, Simko J, Moughan J, Ajani J, Magliocco A, Elahi A, Hoffe S, Shibata D. Epigenomic characterization of locally advanced anal cancer: a radiation therapy oncology group 98-11 specimen study. Dis Colon Rectum 2014; 57:941-57. [PMID: 25003289 PMCID: PMC4100249 DOI: 10.1097/dcr.0000000000000160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Radiation Therapy Oncology Group 98-11 clinical trial demonstrated the superiority of standard 5-fluorouracil/mitomycin-C over 5-fluorouracil/cisplatin in combination with radiation in the treatment of anal squamous cell cancer. Tumor size (>5 cm) and lymph node metastases are associated with disease progression. There may be key molecular differences (eg, DNA methylation changes) in tumors at high risk for progression. OBJECTIVE The objectives of this study were to determine whether there are differences in DNA methylation at individual CpG sites and within genes among locally advanced anal cancers, with large tumor size and/or nodal involvement, compared with those that are less advanced. DESIGN This was a case-case study among 121 patients defined as high risk (tumor size >5 cm and/or nodal involvement; n = 59) or low risk (≤5 cm, node negative; n = 62) within the mitomycin-C arm of the Radiation Therapy Oncology Group 98-11 trial. DNA methylation was measured using the Illumina HumanMethylation450 Array. SETTINGS The study was conducted in a tertiary care cancer center in collaboration with a national clinical trials cooperative group. PATIENTS The patients consisted of 74 women and 47 men with a median age of 54 years (range, 25-79 years). MAIN OUTCOME MEASURES DNA methylation differences at individual CpG sites and within genes between low- and high-risk patients were compared using the Mann-Whitney test (p < 0.001). RESULTS A total of 16 CpG loci were differentially methylated (14 increased and 2 decreased) in high- versus low-risk cases. Genes harboring differentially methylated CpG sites included known tumor suppressor genes and novel targets. LIMITATIONS This study only included patients in the mitomycin-C arm with tumor tissue; however, this sample was representative of the trial. CONCLUSIONS This is the first study to apply genome-wide methylation analysis to anal cancer. Biologically relevant differences in methylated targets were found to discriminate locally advanced from early anal cancer. Epigenetic events likely play a significant role in the progression of anal cancer and may serve as potential biomarkers.
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Affiliation(s)
- Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL
| | - Steven Eschrich
- Department of Biomedical Informatics, Moffitt Cancer Center, Tampa, FL
| | - Kathryn Winter
- Department of Statistics, Radiation Therapy Oncology Group, Philadelphia, PA and San Francisco, CA
| | - Bridget Riggs
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL
| | - Anders Berglund
- Department of Biomedical Informatics, Moffitt Cancer Center, Tampa, FL
| | - Abidemi Ajidahun
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jeff Simko
- Department of Biospecimen Resource, Radiation Therapy Oncology Group, Philadelphia, PA and San Francisco, CA
| | - Jennifer Moughan
- Department of Statistics, Radiation Therapy Oncology Group, Philadelphia, PA and San Francisco, CA
| | - Jaffer Ajani
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX
| | | | - Abul Elahi
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - David Shibata
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL,Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
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Gulcu B, Ozer A, Nazlioglu HO, Ozturk E, Yilmazlar T. Perianal mantle cell lymphoma mimicking an external thrombosed hemorrhoid: a case report. J Med Case Rep 2014; 8:40. [PMID: 24499548 PMCID: PMC3930018 DOI: 10.1186/1752-1947-8-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Malignancies of the anal margin and perianal skin are relatively uncommon, and account for approximately 2% to 3% of all anorectal malignancies. Despite the fact that gastrointestinal presentation of lymphoma is not uncommon, primary localization of mantle cell lymphoma to the perianal region is rare. CASE PRESENTATION We present the case of a 64-year-old Turkish man with a rapidly progressive perianal mass. Our patient had previously required medical treatment on multiple occasions for hemorrhoidal disease; however, the treatment was ineffective and gross lymph nodes were noted in his left inguinal region. Following excision of the mass and his lymph nodes, the pathological diagnosis of both tissues was mantle cell lymphoma. CONCLUSION Although gastrointestinal presentation of non-Hodgkin lymphoma is common, the literature includes only a few cases of perianal localization. Our case illustrates the importance of suspicion and complete examination of perianal masses. In practice, examination of the inguinal region should be a part of routine proctological examination.
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Affiliation(s)
| | | | | | | | - Tuncay Yilmazlar
- Department of General Surgery, Uludag University Faculty of Medicine, Görükle 16059, Bursa, Turkey.
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23
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Imai H, Inafuku K, Wakuda K, Ono A, Taira T, Kenmotsu H, Watanabe R, Naito T, Murakami H, Ito I, Endo M, Tanabe H, Nakajima T, Takahashi T. Perianal metastasis of non-small cell lung cancer. Intern Med 2014; 53:1149-52. [PMID: 24881739 DOI: 10.2169/internalmedicine.53.1155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present the case of a 36-year-old woman who developed perianal metastasis of non-small cell lung cancer that was diagnosed based on the presence of symptoms mimicking a hemorrhoid. The patient initially underwent radiotherapy for a left superior sulcus tumor, then subsequently complained of a perianal mass that had prolapsed and bled. The tumor was removed via resection. Histologically, the mass was diagnosed as poorly differentiated carcinoma and considered to be a metastatic lesion arising from the primary lung cancer.
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Affiliation(s)
- Hisao Imai
- Division of Thoracic Oncology, Shizuoka Cancer Center, Japan
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Abstract
Diagnosis, follow up, and treatment of anal intraepithelial neoplasia are complex and not standardized. This may be partly caused by poor communication of biopsy and cytology findings between pathologists and clinicians as a result of a disparate and confusing terminology used to classify these lesions. This article focuses on general aspects of epidemiology and on clarifying the current terminology of intraepithelial squamous neoplasia, its relationship with human papilloma virus infection, and the current methods that exist to diagnose and treat this condition.
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Abstract
Anal cancer accounts for only 1.5% of gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years. Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature.
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Affiliation(s)
- Sajad Ahmad Salati
- Department of Surgery, College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia
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Perianal giant condyloma acuminatum-buschke-löwenstein tumor: a case report. Case Rep Surg 2012; 2012:507374. [PMID: 23213594 PMCID: PMC3508531 DOI: 10.1155/2012/507374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/23/2012] [Indexed: 11/18/2022] Open
Abstract
Condyloma acuminatum caused by Human Papillomavirus is the most commonly occurring sexually transmitted infection in the anogenital region. Buschke-Löwenstein tumor (BLT) known also as giant condyloma acuminatum is a rare disease. The disease, for which the most important treatment method is the surgical excision, differs from normal condyloma acuminatum cases with its high degree of malignancy. The purpose of this paper is to present the case that reached huge dimensions in the perianal region and that was treated with wide resection in the literature.
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CostaPinto L, Grassi MFR, Serravalle K, Travessa ACV, Olavarria VNO, Santiago MB. Giant disseminated condylomatosis in SLE. Lupus 2012; 21:332-334. [DOI: 10.1177/0961203311421207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction: Females with systemic lupus erythematosus (SLE) have higher prevalence of human papillomavirus (HPV) infection, which can lead to the development of warts. Herein we report the first case of giant disseminated condylomatosis (GDC) in a SLE female on mycophenolate mofetil (MMF). Case report: The patient, a 33-year-old, Black female, was diagnosed with SLE during her first pregnancy in 2003 based on the features of arthritis, skin rash, seizures, nephritis and presence of antinuclear antibodies. Her pregnancy resulted in preterm delivery of a stillborn fetus at 28 weeks. Since that time she has been treated with steroids and different regimens of immunosuppressive drugs such as cyclophosphamide, azathioprine and lately MMF. In the last few years she presented GDC involving the genital area in addition to skin on the lower abdomen. Topical therapy with trichloroacetic acid, imiquimod and podophyllin was only partially effective. Different types of HPV were identified in the lesions, being HPV-11 in abdomen, HPV 6, 11, 42 in vulva, HPV-6, 11 in vagina and HPV-6, 11 in endocervix. Conclusions: GDC may be a complication of SLE, secondary to the disease itself, its treatment or other factors not yet identified.
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Affiliation(s)
- L CostaPinto
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
- Departamento de Obstetrícia e Ginecologia, Universidade Federal da Bahia, Brazil
| | - MFR Grassi
- Centro de Pesquisas Gonçalo Moniz/Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - ACV Travessa
- Departamento de Obstetrícia e Ginecologia, Universidade Federal da Bahia, Brazil
| | - VNO Olavarria
- Centro de Pesquisas Gonçalo Moniz/Fundação Oswaldo Cruz, Salvador, Brazil
| | - MB Santiago
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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Battaglia L, Vannelli A, Belli F, Rampa M, Milione M, Gasparini P, Leo E. Giant Condyloma Acuminatum of the Anorectum: Successful Radical Surgery with Anal Reconstruction. TUMORI JOURNAL 2011; 97:805-7. [DOI: 10.1177/030089161109700620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Buschke-Löwenstein tumor, or giant condyloma acuminatum, is a relatively uncommon lesion of the anus with aggressive local invasive behavior which may present as a large warty tumor of the genital region with expansive and destructive growth. Many sporadic reports have been published suggesting various therapeutic strategies. We report a case of Buschke-Löwenstein tumor treated with conservative surgery followed by reconstructive procedures without a loop colostomy.
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Affiliation(s)
- Luigi Battaglia
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Vannelli
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filiberto Belli
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Rampa
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Milione
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Unit of Molecular Cytogenetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ermanno Leo
- Division of General Surgery B, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Soós Z, Varga T, Vadinszky P, Hajós P, Vajda K, Kiss S, Winkler G. [Verrucous carcinoma of the anal margin. The importance of adequate biopsy technique]. Orv Hetil 2011; 152:344-8. [PMID: 21324806 DOI: 10.1556/oh.2011.29049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Buschke-Löwenstein tumor (verrucous carcinoma, giant condylomata) of the anal margin is a locally invasive, destructively growing carcinoma that does not metastasize. The lesions are rare despite the increased incidence of anal condylomata and anal carcinomas. Authors report a case of a 63-year-old woman suffering from verrucous carcinoma (Buschke-Löwenstein tumor) of the anal margin. The tumor invaded the rectal sphincter and extended beyond the muscle, infiltrating the lower abdomen. Infiltration of the perivesical soft tissue caused bilateral hydronephros. Because both under- and overdiagnosis of anal cancer and precancer may lead to inappropriate treatment, it is important to perform adequate sampling for histology. Non-representative superficial biopsies may result underdiagnosis of the disease.
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Affiliation(s)
- Zsuzsanna Soós
- Fővárosi Szent János Kórház és Észak-budai Egyesített Intézményei II. Belgyógyászat-Diabetológia Budapest Diósárok út 1-3. 1125
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Ramamoorthy S, Devaraj B, Miyai K, Luo L, Liu YT, Boland CR, Goel A, Carethers JM. John Cunningham virus T-antigen expression in anal carcinoma. Cancer 2010; 117:2379-85. [PMID: 24048785 DOI: 10.1002/cncr.25793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 10/07/2010] [Accepted: 10/11/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anal carcinoma is thought to be driven by human papillomavirus (HPV) infection through interrupting function of cell regulatory proteins such as p53 and pRb. John Cunningham virus (JCV) expresses a T-antigen that causes malignant transformation through development of aneuploidy and interaction with some of the same regulatory proteins as HPV. JCV T-antigen is present in brain, gastric, and colon malignancies, but has not been evaluated in anal cancers. The authors examined a cohort of anal cancers for JCV T-antigen and correlated this with clinicopathologic data. METHODS Archived anal carcinomas were analyzed for JCV T-antigen expression. DNA from tumor and normal tissue was sequenced for JCV with viral copies determined by quantitative polymerase chain reaction and Southern blotting. HPV and microsatellite instability (MSI) status was correlated with JCV T-antigen expression. RESULTS Of 21 cases of anal cancer (mean age 49 years, 38% female), 12 (57%) were in human immunodeficiency virus (HIV)-positive individuals. All 21 cancers expressed JCV T-antigen, including 9 HPV-negative specimens. More JCV copies were present in cancer versus surrounding normal tissue (mean 32.54 copies/μg DNA vs 2.98 copies/μg DNA, P = .0267). There was no correlation between disease stage and viral copies, nor between viral copies and HIV-positive or -negative status (28.7 vs 36.34 copies/μg DNA, respectively, P = .7804). In subset analysis, no association was found between JCV T-antigen expression and HPV or MSI status. CONCLUSIONS Anal carcinomas uniformly express JCV T-antigen and contain more viral copies compared with surrounding normal tissue. JCV and its T-antigen oncogenic protein, presumably through interruption of cell regulatory proteins, may play a role in anal cancer pathogenesis.
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Affiliation(s)
- Sonia Ramamoorthy
- Department of Surgery, University of California, San Diego, California; Moores Comprehensive Cancer Center, University of California, San Diego, California
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