1
|
Wang M, Xiang Y, Wang Y, Zhang J, Zhao H, Wang C, Qiao L, Yang B. Adjuvant chemoradiotherapy does not improve outcomes in patients with fistula-associated anal adenocarcinoma undergoing abdominoperineal resection. Front Oncol 2022; 12:1061513. [PMID: 36439430 PMCID: PMC9682013 DOI: 10.3389/fonc.2022.1061513] [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: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Abdominoperineal resection (APR) is currently established as a standard treatment regimen for fistula-associated anal adenocarcinoma (FAAA), however, the efficacy of chemoradiotherapy (CRT) remains unclear. The aim of this study is to evaluate the role of CRT in patients with FAAA treated with APR through single-center experience and literature review. METHODS A retrospective review was performed on patients with FAAA consecutive treated in our institution from 2005 to 2022. In addition, a systematic literature search was performed using PubMed and MEDLINE. All patients with FAAA who received APR in our institution and reported in the literature were included and divided into three categories for statistical analysis: APR alone (APR group), neoadjuvant therapy combined APR (CRT+APR group), and APR combined postoperative therapy (APR+CRT group). RESULTS Fifteen patients with FAAA were identified from our retrospective charts review. At a median follow-up time of 18 months, the recurrence-free survival rate was 53.3% and the survival rate was 73.3%. Eight patients underwent APR and 6 received postoperative chemotherapy. Among them, one died, one developed recurrence and the remaining six patients were alive with disease free. We found 37 publications describing 62 patients with FAAA treated with APR. Clinical data from these articles were analyzed together with the 8 cases in our institution. The overall survival rates were 94.1%, 70.8%, and 38.5% at 1-, 3-, 5-years respectively. Combining (neo)adjuvant therapy did not appear to improve outcomes in FAAA treated with APR (CRT+APR vs. APR, p=0.977; APR+CRT vs. APR, p=0.351). Lymph node involvement was shown to be significantly associated with poor outcomes by multivariate analysis (p=0.020). CONCLUSIONS For patients with FAAA without lymph node involvement, APR is adequate to control disease and the addition of CRT does not appear to prolong survival.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Bolin Yang
- Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| |
Collapse
|
2
|
Rubbino F, Greco L, di Cristofaro A, Gaiani F, Vetrano S, Laghi L, Bonovas S, Piovani D. Journey through Crohn's Disease Complication: From Fistula Formation to Future Therapies. J Clin Med 2021; 10:jcm10235548. [PMID: 34884247 PMCID: PMC8658128 DOI: 10.3390/jcm10235548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/19/2022] Open
Abstract
Crohn’s Disease (CD) is a chronic inflammatory disorder in which up to 50% of patients develop fistula within 20 years after the initial diagnosis, and half of these patients suffer perianal fistulizing disease. The etiopathogenesis of CD-related perianal fistula is still unclear, and its phenotypical and molecular characteristics are even more indefinite. A better understanding would be crucial to develop targeted and more effective therapeutic strategies. At present, the most accredited theory for the formation of CD-related fistula identifies the epithelial-to-mesenchymal transition (EMT) as the driving force. It has been well recognized that CD carries an increased risk of malignancy, particularly mucinous adenocarcinoma is often associated with long-standing fistula in CD patients. Despite the availability of multiple treatment options, perianal fistulizing CD represents a therapeutic challenge and is associated with an important impact on patients’ quality of life. To date, the most effective management is multidisciplinary with the cooperation of gastroenterologists, surgeons, radiologists, and nutritionists and the best recommended treatment is a combination of medical and surgical approaches.
Collapse
Affiliation(s)
- Federica Rubbino
- Laboratory of Molecular Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.G.); (A.d.C.); (L.L.)
- Correspondence: (F.R.); (S.B.)
| | - Luana Greco
- Laboratory of Molecular Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.G.); (A.d.C.); (L.L.)
| | - Alessio di Cristofaro
- Laboratory of Molecular Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.G.); (A.d.C.); (L.L.)
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy;
- Gastroenterology and Endoscopy Unit, University-Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Stefania Vetrano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (S.V.); (D.P.)
| | - Luigi Laghi
- Laboratory of Molecular Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.G.); (A.d.C.); (L.L.)
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy;
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (S.V.); (D.P.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Correspondence: (F.R.); (S.B.)
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (S.V.); (D.P.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| |
Collapse
|
3
|
An SH, Kim IY. Management of large and surrounding tissue infiltrative anal fistula cancer: Two case reports. Int J Surg Case Rep 2020; 77:643-646. [PMID: 33395864 PMCID: PMC7708865 DOI: 10.1016/j.ijscr.2020.11.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/09/2022] Open
Abstract
We reported two cases of adenocarcinoma originating from anal fistula. High degree of clinical suspicion is crucial to diagnose anal fistula cancer. Histopathological evaluation should be performed on recurrent, incurable anal fistulas. Intensive surgical treatment with neoadjuvant or adjuvant therapy should be considered in advanced cases.
Introduction Adenocarcinoma originating from chronic perianal fistulas is a rare disease. Due to the lack of evidence of this malignancy, no definitive diagnostic and treatment guidelines have been established. We present two cases of anal fistula cancer and discuss the diagnostic and treatment strategies. Presentation of case A 79-year-old man was referred for a perianal mass. The patient had a history of chronic perianal fistula and was diagnosed with adenocarcinoma originating from a long-standing perianal fistula. The patient underwent laparoscopic abdominoperineal resection (APR) without any adjuvant therapy. The second case was a 42-year old man, who was referred for a prolapsed anal mass. The patient had recurrent perianal fistula over several years. He was diagnosed with mucinous adenocarcinoma originating from a long-standing perianal fistula, but he initially refused surgical treatment. Two years later, the patient revisited with a huge overgrown tumor and underwent laparoscopic APR with wide perineal skin excision, wound debridement and coverage with a bilateral V-Y advancement flap via a one-step procedure. Discussion High degree of clinical suspicion is crucial to diagnose this rare disease that can easily be missed at an early stage. Depending on the disease stage, surgical treatment, chemotherapy, and radiotherapy can be considered. Conclusion Histopathological evaluation should be performed on recurrent and incurable anal fistulas over a long period of time. Intensive surgical treatment with or without neoadjuvant and adjuvant therapy should be considered in advanced cases.
Collapse
Affiliation(s)
- Sang Hyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea.
| | - Ik Yong Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea.
| |
Collapse
|
4
|
Zhu X, Zhu TS, Ye DD, Liu SW. Magnetic resonance imaging findings of carcinoma arising from anal fistula: A retrospective study in a single institution. World J Clin Cases 2020; 8:5159-5171. [PMID: 33269252 PMCID: PMC7674754 DOI: 10.12998/wjcc.v8.i21.5159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is currently the standard investigation for suspected perianal diseases. Carcinoma arising from anal fistula is very rare, and early diagnosis is often difficult.
AIM To describe and summarize the MRI findings of carcinoma arising from anal fistula.
METHODS In this retrospective study, records of ten patients diagnosed with carcinoma arising from anal fistula and confirmed by surgery (n = 7) or biopsy (n = 3) between June 2006 and August 2018 were analyzed. All patients underwent preoperative pelvic MRI. Morphologic features, signal characteristics, fistula between the mass and the anus, contrast enhancement of mass, signal and enhancement of peritumoral areas, and regional lymphadenopathy were assessed.
RESULTS All ten tumors were solitary (8 mucinous adenocarcinomas and 2 adenocarcinomas). The maximum diameter of the tumors ranged from 3.4 cm to 12.4 cm (median: 4.15 cm; mean: 5.68 cm). Eight patients had a fistula between the mass and the anus. Contrast enhancement of the peritumoral areas was noted in three (3/5) patients. Perirectal or inguinal lymphadenopathy was noted in seven patients. Most lesions of mucinous adenocarcinoma were multiloculated and cauliflower-like, with a thin capsule and focally unclear boundary. They were markedly hyperintense on fat-suppressed T2WI, slightly hyperintense with focal hyperintensity on diffusion-weighted imaging (DWI), and hyperintense with focal hypointensity on apparent diffusion coefficient (ADC) map, with progressive mesh-like contrast enhancement. Adenocarcinomas had an infiltrative margin without a capsule and appeared heterogeneously hyperintense or slightly hyperintense on fat-suppressed T2WI, hyperintense on DWI, and hypointense on ADC map, with persistent heterogeneous enhancement.
CONCLUSION Our study highlighted several characteristic and potentially helpful MRI findings to diagnose carcinomas arising from anal fistula.
Collapse
Affiliation(s)
- Xin Zhu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Tian-Shu Zhu
- The First Clinical Medical College, Xuzhou Medical University, Xuzhou 221004, Jiangsu Province, China
| | - Dan-Dan Ye
- Department of Radiology, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou 362000, Fujian Province, China
| | - Shao-Wei Liu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| |
Collapse
|
5
|
Tahir M, Rahman J, Zubair T, Basit A. An Association of Mucinous Adenocarcinoma With Chronic Peri-Anal Fistula: A Brief Review of Pathophysiology of Rare Tumor. Cureus 2020; 12:e8882. [PMID: 32742849 PMCID: PMC7388812 DOI: 10.7759/cureus.8882] [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] [Indexed: 01/30/2023] Open
Abstract
An anal fistula is a condition that has been discussed by various authors without coming to a consensus. The fistula of the anus is a passage that leads from the rectum to the anus. A peri-anal adenocarcinoma is an abnormal growth of cells in the anal rectal area. Establishing the relationship between the two, a lot of information was obtained from the existing literature which has used to come up with solutions to the objective of the study. The review was conducted systematically and included observational retrospective, case studies, and case series to demonstrate the data of valuable research. The articles were searched in PubMed, MEDLINE, and Google scholar using the keywords “chronic perianal fistula”, “anal carcinoma”, “mucinous adenocarcinoma”, and “perianal mucinous adenocarcinoma”. Among 50 journal articles, we chose 33 studies describing the clinical sign and symptoms, pathophysiology, etiology, and association between mucinous anal adenocarcinoma and chronic peri-anal fistula. After quality assessment, eight case studies and series were selected, in which seven of them showed the origin of mucinous anal adenocarcinoma from chronic peri-anal fistula. The existence of a long history of fistula-in-ano and the exclusion of any additional carcinoma in the body necessitates the analysis of mucinous adenocarcinoma arising from benign fistula. Likewise, the presence of fistula ought to typically precede that of carcinoma by 10 years, and this is one of the criteria for diagnosis. However, more investigation should be conducted to gain full information about the connection between these two entities.
Collapse
Affiliation(s)
- Muhammad Tahir
- Pathology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jawaria Rahman
- Pathology, City of Hope, Comprehensive Cancer Center, Monrovia, USA
| | | | - Abdul Basit
- Internal Medicine, Coney Island Hospital, Brooklyn, USA
| |
Collapse
|
6
|
Díaz-Vico T, Fernández-Martínez D, García-Gutiérrez C, Suárez-Sánchez A, Cifrián-Canales I, Mendoza-Pacas GE, Sánchez-Farpón H, Truán-Alonso N. Mucinous adenocarcinoma arising from chronic perianal fistula-a multidisciplinary approach. J Gastrointest Oncol 2019; 10:589-596. [PMID: 31183213 DOI: 10.21037/jgo.2019.01.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Mucinous adenocarcinoma (MA) is a rare entity. Indeed, the pathogenesis of fistula-associated perianal MA is still controversial. Due to the lack of informed evidence regarding this malignancy, no guidelines have been established concerning diagnostic and treatment strategies. The aim of this article is to report our experience and outcomes after three cases of large perianal MA treated in our center. From our retrospective chart review, we identified three male patients with chronic perianal fistula-in-ano who progressively developed perianal MA, confirmed by pelvic magnetic resonance (MRI) and histopathological examination performed on biopsy. We hereby, in accordance with the Surgical CAse REport (SCARE) guidelines, describe the management and further follow-up of each patient. The three patients underwent preoperative chemoradiation therapy, followed by ischioanal abdominoperineal resection (APR). Perineal reconstruction was needed in every case, using a vertical rectus abdominis myocutaneous (VRAM) flap and, punctually, a left fasciocutaneous flap was used too. Also, two of three patients completed the treatment with adjuvant chemotherapy. Neither recurrences nor distant metastases have been observed during the follow-up in both cases that finished the multimodal treatment. MA arising from chronic perianal fistula has an indolent growth with locoregional aggressiveness and a high risk of local recurrence. Therefore, although an ischioanal APR remains the surgical treatment of choice, an aggressive multimodal approach combining preoperative chemoradiation and adjuvant chemotherapy may achieve favorable effectiveness and promising response rates.
Collapse
Affiliation(s)
- Tamara Díaz-Vico
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Daniel Fernández-Martínez
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Carmen García-Gutiérrez
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Aida Suárez-Sánchez
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Isabel Cifrián-Canales
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | | | - Herminio Sánchez-Farpón
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Nuria Truán-Alonso
- Department of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| |
Collapse
|
7
|
Prasad SN, Razik A, Siddiqui F, Lal H. Mucinous adenocarcinoma arising from chronic perianal fistula mimicking horseshoe abscess. BMJ Case Rep 2018; 2018:bcr-2017-223063. [PMID: 29622704 DOI: 10.1136/bcr-2017-223063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Perianal fistulae are commonly seen clinical entity. Development of malignancy within a perianal fistula is rare. Even rarer is the development of mucinous adenocarcinoma in a chronic fistula-in-ano. Only a handful of such cases have been reported in the past. A case of mucinous adenocarcinoma arising in chronic perianal fistula in a 34-year-old woman is being described. She presented with complaints of perineal fullness, pain and recurrent pus discharge from perianal fistula for 4 years. On radiological workup, a large solid-cystic pelvic mass was seen in relation to the fistula. On MRI, the lesion was mimicking a large horseshoe abscess. Transrectal ultrasound-guided biopsy and subsequent histopathological examination confirmed the presence of mucinous adenocarcinoma with tumour cells immunopositive for CK7 and CK20.
Collapse
Affiliation(s)
| | - Abdul Razik
- Department of Radiodiagnosis, All India Institute Of Medical Sciences, New Delhi, India
| | - Farhana Siddiqui
- Department of Pathology, Era's Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| |
Collapse
|
8
|
Perianal Mucinous Adenocarcinoma Diagnosed by Histological Study of Anorectal Abscess with Fistula. ACG Case Rep J 2018; 5:e21. [PMID: 29577055 PMCID: PMC5852302 DOI: 10.14309/crj.2018.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/04/2018] [Indexed: 11/17/2022] Open
Abstract
Perianal mucinous adenocarcinoma (PMA) is an oncologic rarity that poses a diagnostic and therapeutic dilemma for treating clinicians because there are few reported cases and an absence of definitive guidelines. We report a patient who had been treated with local surgery for recurrent perianal abscess with fistula for 3 years. Biopsy of the indurated tissue overlying his surgical scars revealed PMA. Neoadjuvant concurrent chemoradiotherapy followed by abdominoperineal resection was planned to address the locally advanced disease and ongoing sepsis. Our case is unique in that the fistula preceded carcinoma by only 3 years instead of the typical 10 years.
Collapse
|
9
|
Chrysikos D, Mariolis-Sapsakos T, Triantafyllou T, Karampelias V, Mitrousias A, Theodoropoulos G. Laparoscopic abdominoperineal resection for the treatment of a mucinous adenocarcinoma associated with an anal fistula. J Surg Case Rep 2018; 2018:rjy036. [PMID: 29593864 PMCID: PMC5841379 DOI: 10.1093/jscr/rjy036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/21/2018] [Indexed: 01/11/2023] Open
Abstract
Mucinous adenocarcinoma associated with an anal fistula is a rare oncologic entity which may pose diagnostic and therapeutic challenges for Surgeons and Medical Oncologists. Few reported cases without definite therapeutic guidelines exist. It represents 2-3% of all gastrointestinal malignancies and arises from chronic anal fistulas, ischiorectal or perianal abscesses. We report a case of perianal mucinous adenocarcinoma in a 65-year-old male initially surgically treated multiple times for a recurrent fistula in ano of 5 years duration. He presented with an ischiorectal and a perianal fistula. Incisional biopsy from fistulotomy revealed mucinous adenocarcinoma. Contrast enhanced computed tomography scan and magnetic resonance imaging showed a localized perianal growth of a tumor which was further evaluated with colonoscopy. With no evidence of metastasis, we performed a laparoscopic abdominoperineal resection (APR). Two years follow-up after APR and without adjuvant chemotherapy there is not any evidence of recurrence or distant metastasis.
Collapse
Affiliation(s)
- Dimosthenis Chrysikos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia 'Agii Anargiri', Athens, Greece
| | - Tania Triantafyllou
- Department of Propaedeutic Surgery, Hippokratio Hospital, Medical School University of Athens, Greece
| | - Vasileios Karampelias
- Department of Propaedeutic Surgery, Hippokratio Hospital, Medical School University of Athens, Greece
| | - Apostolos Mitrousias
- Department of Propaedeutic Surgery, Hippokratio Hospital, Medical School University of Athens, Greece
| | - George Theodoropoulos
- Department of Propaedeutic Surgery, Hippokratio Hospital, Medical School University of Athens, Greece
| |
Collapse
|
10
|
Morotti A, Busso M, Consiglio Barozzino M, Cinardo P, Angelino V, Familiari U, Veltri A, Guerrasio A. Detection and management of retroperitoneal cystic lesions: A case report and review of the literature. Oncol Lett 2017; 14:1602-1608. [PMID: 28789385 DOI: 10.3892/ol.2017.6323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/04/2016] [Indexed: 12/25/2022] Open
Abstract
The identification of cystic lesions within the retroperitoneal space is a rare event that poses clinicians the challenge of a difficult diagnosis and disease management. Retroperitoneal cystic lesions account for a group of lesions that range from common benign lesions (e.g., lymphoceles developing as a surgical complication) to rare aggressive malignant neoplasms. Currently, in the majority of cases, image-guided procedures allow for a pathological diagnosis to be achieved in these challenging lesions, thus offering the chance of an appropriate treatment; however, the overall clinical assessment of retroperitoneal cysts is highly demanding. The present study reports the management of a representative clinical case, presenting with a voluminous cystic mass able to dislocate cave vein, whose diagnosis was preceded by a deep vein thrombosis. Computed tomography-scan and ultrasound guided percutaneous drainage were performed to achieve the diagnosis. Following the discussion of the current case report, a review of the pathological and radiological characteristics of retroperitoneal cystic lesions is presented.
Collapse
Affiliation(s)
- Alessandro Morotti
- Division of Internal Medicine, University of Turin, Orbassano, I-10043 Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Marco Busso
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Maria Consiglio Barozzino
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Paola Cinardo
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Valeria Angelino
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Ubaldo Familiari
- Department of Pathology, San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Andrea Veltri
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Angelo Guerrasio
- Division of Internal Medicine, University of Turin, Orbassano, I-10043 Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| |
Collapse
|
11
|
Purkayastha A, Sharma N, Dutta V, Bisht N, Pandya T. Mucinous adenocarcinoma of perianal region: an uncommon disease treated with neo-adjuvant chemo-radiation. Transl Gastroenterol Hepatol 2016; 1:52. [PMID: 28138619 DOI: 10.21037/tgh.2016.06.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/12/2016] [Indexed: 11/06/2022] Open
Abstract
Mucinous adenocarcinoma of the perianal region is an oncologic rarity posing a diagnostic and therapeutic dilemma for treating oncologists due to very few reported cases without definite therapeutic guidelines. It accounts for 2% to 3% of all gastrointestinal malignancies and are historically known to arise from chronic anal fistulas and ischiorectal or perianal abscesses. We hereby report a sporadic and interesting case of perianal mucinous adenocarcinoma in a 56-year-old male initially treated with alternative medicines and local surgery for recurrent fistula in ano of 2 years duration. He presented with complaints of discharging growth in perianal region, painful defecation associated with occasional blood mixed stools of 6 months duration. Incisional biopsy from the ulcer revealed mucinous adenocarcinoma. Contrast enhanced computed tomography (CT) scan and whole body positron emission tomography (PET) scan showed a localized perianal growth which was further confirmed with colonoscopy. With no pre-set treatment protocol for this rare entity, he was managed with neo-adjuvant concurrent chemo-radiation (CCRT) followed by abdominoperineal resection (APR) and adjuvant chemotherapy. Presently he is on 3 monthly follow-up since last 1 year post APR and adjuvant chemotherapy without any evidence of recurrence or distant metastasis. To the best of knowledge, our report may be one of the rarest cases of this disease entity where the duration of anal fistula was merely 2 years in contrast to the established criteria that the fistula precedes carcinoma by at least 10 years.
Collapse
Affiliation(s)
- Abhishek Purkayastha
- Department of Radiation Oncology, Army Hospital Research & Referral, New Delhi, India
| | - Neelam Sharma
- Department of Radiation Oncology, Army Hospital Research & Referral, New Delhi, India
| | - Vibha Dutta
- Department of Pathology and Molecular Science, Army Hospital Research & Referral, New Delhi, India
| | - Niharika Bisht
- Department of Radiation Oncology, Army Hospital Research & Referral, New Delhi, India
| | - Tejas Pandya
- Department of Radiation Oncology, Army Hospital Research & Referral, New Delhi, India
| |
Collapse
|
12
|
Abstract
Perianal mucinous adenocarcinoma has been rarely reported. Here we describe a case of perianal mucinous adenocarcinoma in a male patient, who was referred to our hospital because of "mixed hemorrhoid and perianal mass". During the operation, the tumor was found to be grid-like and filled with jelly-like substance. Histological examination revealed a perianal mucinous adenocarcinoma. An abdominoperineal resection was performed. The patient healed well after operation, and he was discharged after postoperative chemotherapy. Since perianal mucinous adenocarcinoma usually has no specific clinical symptoms, it is difficult to diagnose early. Perianal mucinous adenocarcinoma has a low survival rate and poor prognosis, and clinicians should raise their awareness of this disease.
Collapse
|