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Sioula M, Tsirozoglou K, Georgakopoulos P, Mavrommatis E. Charles Boyd Kelsey (1850-1917). The pioneer of rectal surgery in USA. Acta Chir Belg 2024:1-3. [PMID: 38676372 DOI: 10.1080/00015458.2024.2348857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
Charles Boyd Kelsey (1850-1917) was a pioneer rectal surgeon. His surgical career was dedicated in the surgery of the rectum, anus, hemorrhoids, and pelvis. He invented also surgical instruments. He managed to be recognized as a pioneer of Rectal surgery not only in America but worldwide. He was a prolific writer and a famous teacher.
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Affiliation(s)
- Maria Sioula
- Medical School, National and Kapodistrian University of Athens
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2
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Park MY, Yoon YS, Park JH, Lee JL, Yu CS. Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn's disease. World J Stem Cells 2024; 16:257-266. [PMID: 38577230 PMCID: PMC10989284 DOI: 10.4252/wjsc.v16.i3.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/25/2023] [Accepted: 02/18/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn's disease (CD). Anti-tumor necrotic factor (TNF) therapy combined with drainage procedure is effective as well. However, previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula closure. AIM This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn's perianal fistula (CPF) closure rates after stem cell transplantation with and without anti-TNF therapy, and to identify the factors affecting CPF closure and recurrence. METHODS The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were enrolled. Clinical data were compared according to anti-TNF therapy and CPF closure. RESULTS A total of 65 patients were included. The median age of females was 26 years (range: 21-31) and that of males was 29 (44.6%). The mean follow-up duration was 65.88 ± 32.65 months, and complete closure was observed in 50 (76.9%) patients. The closure rates were similar after stem cell transplantation with and without anti-TNF therapy (66.7% vs 81.6% at 3 year, P = 0.098). The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture (P = 0.027, 0.002, and 0.008, respectively). Clinical factors such as complexity, number of fistulas, presence of concurrent abscess, and medication were not significant for closure. The cumulative 1-, 2-, and 3-year closure rates were 66.2%, 73.8%, and 75.4%, respectively. CONCLUSION Anti-TNF therapy does not increase CPF closure rates in patients with stem cell transplantation. However, both refractory and non-refractory CPF have similar closure rates after additional anti-TNF therapy. Fistulous tract length, proctitis, and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.
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Affiliation(s)
- Min Young Park
- Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
| | - Jae Ha Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
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3
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Prétet JL, Touzé A, Pazart L, Boiteux G, Fournier V, Vidal C, Arnold F, Ducloux D, Lepiller Q, Mougin C. Anogenital distribution of mucosal HPV in males and females before and after renal transplantation. Infect Dis Now 2024; 54:104830. [PMID: 37949172 DOI: 10.1016/j.idnow.2023.104830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Immunosuppressive drugs taken by transplant recipients may favor HPV infection at anogenital sites. HPV-type prevalence was studied in males and females before and after renal transplantation. PATIENTS AND METHODS Anal, cervical and penile samples were taken from 62 patients before transplantation and from 41 patients after transplantation. HPV DNA was investigated using the INNO-LiPA HPV genotyping extra test and HPV-type distribution determined. RESULTS Before transplantation, up to 30% of analyzed samples harbored HPV DNA, with the highest prevalence found in cervical specimens (60%). After transplantation, a trend toward HPV clearance was observed in females. By contrast, a trend toward incident infections by a wide variety of HPV genotypes at the penis and anal level was documented in men. CONCLUSION High prevalence of HPV at anogenital sites was documented before and after renal transplantation. Immunosuppressive drugs taken after transplantation may impact HPV acquisition or reactivation, especially in males. Special attention should be paid in view of preventing HPV-associated diseases in this vulnerable population.
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Affiliation(s)
- Jean-Luc Prétet
- Université de Franche-Comté, Carcinogenèse associée aux HPV, F-25000, Besançon, France; CHU Besançon, Centre National de Référence Papillomavirus, F-25000, Besançon, France; CHU Besançon, CIC1431, F-25000, Besançon, France.
| | - Antoine Touzé
- UMR INRA ISP 1282, Équipe Biologie des infections à polyomavirus, Université de Tours, Tours, France
| | | | | | | | | | - Françoise Arnold
- UMR INRA ISP 1282, Équipe Biologie des infections à polyomavirus, Université de Tours, Tours, France
| | - Didier Ducloux
- Université de Franche-Comté, EFS, INSERM, inst RIGHT, F-25000, Besançon, France
| | - Quentin Lepiller
- Université de Franche-Comté, Carcinogenèse associée aux HPV, F-25000, Besançon, France; CHU Besançon, Centre National de Référence Papillomavirus, F-25000, Besançon, France
| | - Christiane Mougin
- CHU Besançon, Centre National de Référence Papillomavirus, F-25000, Besançon, France; Université de Franche-Comté, EFS, INSERM, inst RIGHT, F-25000, Besançon, France
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4
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Garcia LE, Tassinari S, Azadi J, Chung H, Gearhart S. Anorectal Anatomy Quiz: Practical Review. J Gastrointest Surg 2023; 27:2931-2945. [PMID: 38135807 DOI: 10.1007/s11605-023-05862-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
Understanding anorectal and pelvic floor anatomy can be challenging but is paramount for every physician managing patients with anorectal pathology. Knowledge of anorectal anatomy is essential for managing benign, malignant, traumatic, and infectious diseases affecting the anorectum. This quiz is intended to provide a practical teaching guide for medical students, medical and surgical residents, and may serve as a review for practicing general surgeons and specialists.
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Affiliation(s)
- Leonardo E Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stefano Tassinari
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javad Azadi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haniee Chung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Gearhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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5
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Smith D, Knight K, Sim J, Lim Joon D, Foroudi F, Khoo V. A planning-based feasibility study of MR-Linac treatment for anal cancer radiation therapy. Med Dosim 2023; 48:267-272. [PMID: 37507334 DOI: 10.1016/j.meddos.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
The hybrid magnetic resonance image (MRI) scanner and radiation therapy linear accelerator (MR-Linac) has the potential to enhance clinical outcomes for anal cancer (AC) patients with improved soft tissue visualization and daily plan adaption but has planning and delivery limitations due to the incorporation of MRI. We aimed to identify if Elekta Unity MR-Linac-based radiation therapy is feasible for anal cancer. Ten prospectively enrolled AC patients treated with radical chemoradiotherapy were replanned for MR-Linac treatment using departmental planning criteria. For comparison, and to reduce interobserver variability, volumetric modulated arc radiation therapy (VMAT) plans were also created for each patient by the same single senior radiation therapist. Plans were compared using departmental dosimetric plan criteria, as well as conformity and homogeneity indices, monitor units (MUs) and measured plan delivery (beam-on) time. Results were deemed clinically acceptable. Target and organ at risk (OAR) doses were comparable between MR-Linac plans and VMAT plans, although PTV45Gy D98% coverage was compromised in 3 of 10 MR-Linac plans due to caudocranial length exceeding the limits of the MR-Linac. MR-Linac plans had lower MUs, median of 689.1 vs 849.65 (p = 0.002), but took over twice as long to deliver, 529.5s vs 224s (p = <0.0001) as VMAT plans. MR-Linac planning and treatment of AC is feasible for a subset of patients. The current physical limitations of the Elekta Unity system mean patients with large caudocranial elective PTV45Gy target volumes may not be covered dosimetrically to the required clinical standard. Longer image verification and treatment delivery times of the MR-Linac also mean patient selection and intrafractional IGRT are likely to be integral to ensuring high quality clinical outcomes in this rare cancer.
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Affiliation(s)
- Drew Smith
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia.
| | - Kellie Knight
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
| | - Jenny Sim
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
| | - Vincent Khoo
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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6
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Keske A, Weisman PS, Xu J. Adenosquamous carcinoma in situ of the anus: a case series. Virchows Arch 2023:10.1007/s00428-023-03525-6. [PMID: 37004554 DOI: 10.1007/s00428-023-03525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023]
Abstract
While human papillomavirus (HPV)-associated adenocarcinoma of the anus resembling endocervical adenocarcinoma has recently been described, anal adenocarcinoma in situ/AIS has not. Moreover, to the best of our knowledge, truly biphasic anal adenosquamous carcinoma in situ (ADSQ-IS) is essentially non-existent in the literature. Here, we report four cases of anal ADSQ-IS including one with associated invasive adenosquamous carcinoma. Histologically, all cases of ADSQ-IS showed a basal/peripheral population of stratified, p40-positive dysplastic squamous cells adjacent to luminal, columnar, p40-negative dysplastic glandular cells, bearing a striking resemblance to the normal anal transitional epithelium. Both lesional components were diffusely and strongly positive for p16 and positive for high-risk HPV by RNA in situ hybridization. These cases expand the morphological spectrum of high-risk HPV-associated pre-invasive lesions and underscore the plasticity of HPV-associated neoplasia.
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Affiliation(s)
- Aysenur Keske
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Paul S Weisman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Jin Xu
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
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7
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Vyas M, Gonzalez RS. Anal intraepithelial neoplasia: a review of terminology, differential diagnoses, and patient management. Hum Pathol 2023; 132:56-64. [PMID: 35843339 DOI: 10.1016/j.humpath.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 02/07/2023]
Abstract
Despite the knowledge of etiological association with high-risk human papilloma viruses and high-risk patient cohorts, the incidence of anal squamous cell carcinoma has continued to rise. The known precursor lesion (in particular, high-grade squamous intraepithelial lesion) makes it amenable to screening and surveillance strategies. However, the diagnosis of anal intraepithelial neoplasia suffers from interpretation challenges leading to high interobserver variability, along with numerous differential diagnoses and lingering terminology issues. Proper treatment of anal lesions requires accurate diagnosis, and while a variety of modalities are available for treatment, the rate of recurrence remains high and each modality has its own set of side effects and complications. The aim of this review article is to outline the diagnostic considerations and provide practical tips for diagnosing anal squamous intraepithelial lesions.
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Affiliation(s)
- Monika Vyas
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA.
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8
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Fischer EG, Rai VK. HPV-associated carcinosarcoma of the anal canal: A rare case provides insight into the pathogenesis of these biphasic neoplasms. Pathol Res Pract 2022; 236:153992. [PMID: 35759939 DOI: 10.1016/j.prp.2022.153992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/10/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022]
Abstract
Carcinosarcomas are biphasic malignant neoplasms and are rare outside the corpus uteri. Here we report a carcinosarcoma arising in the anal canal in a 60 year-old female. This is only the fourth reported case of a carcinosarcoma arising at this site, the second reported case with molecular evidence of high risk HPV association, and the first case with reported cytogenetics analysis. The finding of high risk HPV in both the epithelial and mesenchymal components of the tumor provides important insight into the pathogenesis of the tumor, and strongly suggests that both components of this carcinosarcoma are derived from a common immature epithelial progenitor cell during tumorigenesis.
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Affiliation(s)
- Edgar G Fischer
- Division of Surgical Pathology and Cytopathology, Department of Pathology, University of New Mexico, 915 Camino de Salud NE, Albuquerque, NM 87106, USA.
| | - Vinay K Rai
- Department of Surgery, University of New Mexico, 915 Camino de Salud NE, Albuquerque, NM 87106, USA.
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9
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Stafrace S, Lobo L, Augdal TA, Avni FE, Bruno C, Damasio MB, Darge K, Franchi-Abella S, Herrmann J, Ibe D, Kljucevsek D, Mentzel HJ, Napolitano M, Ntoulia A, Ording-Müller LS, Perucca G, Petit P, Smets AM, Toso S, Woźniak MM, Riccabona M. Imaging of anorectal malformations: where are we now? Abdominal imaging task force of the European Society of Paediatric Radiology. Pediatr Radiol 2022; 52:1802-9. [PMID: 35648164 DOI: 10.1007/s00247-022-05395-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/11/2022] [Accepted: 05/03/2022] [Indexed: 10/31/2022]
Abstract
Anorectal and cloacal malformations are a broad mix of congenital abnormalities related to the distal rectum and anus. Confusion exists between all the forms in this large and heterogeneous group. The spectrum includes everything from anal stenosis, ventral anus, anal atresia (with and without fistula) and the full spectrum of cloacal malformations. Imaging in these conditions is done through the whole armamentarium of radiologic modalities, with very different imaging strategies seen across the centres where these conditions are managed. In 2017, the European Society of Paediatric Radiology (ESPR) abdominal imaging task force issued recommendations on the imaging algorithm and standards for imaging anorectal malformations. This was followed by further letters and clarifications together with an active multispecialty session on the different imaging modalities for anorectal malformations at the 2018 ESPR meeting in Berlin. Through this paper, the abdominal task force updates its guidelines and recommended imaging algorithm for anorectal malformations.
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10
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Shon D, Kim S, Kang SI. Assessment of normal anal sphincter anatomy using transanal ultrasonography in healthy Korean volunteers. Yeungnam Univ J Med 2021; 39:230-234. [PMID: 34852452 PMCID: PMC9273142 DOI: 10.12701/yujm.2021.01515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background To date, there have been no studies on the normal anatomic values of the anal sphincter in healthy Koreans. Therefore, this study aimed to determine the normal anatomic values of transanal ultrasonography (TAUS). Methods The thickness of the external anal sphincter (EAS) and internal anal sphincter (IAS) was measured by TAUS from healthy Korean volunteers between September 2019 and August 2021. Results Thirty-six volunteers with a median age of 37 years (range, 20–77 years) and a median body mass index (BMI) of 23.5 kg/m2 (range, 17.2–31.2 kg/m2) were examined. The median thickness of the EAS at 4 cm and 2 cm from the anal verge was 7.4 mm (range, 5.8–8.8 mm) and 6.5 mm (range, 5.6–8.0 mm), respectively. The median thickness of the IAS at 2 cm from the anal verge was 1.8 mm (range, 0.8-4.3 mm). There were no differences in sphincter muscle thickness between the sexes. However, the EAS tended to thicken as the BMI increased (EAS at 2 cm and 4 cm from the anal verge, Spearman rho=0.433, 0.363; p=0.008 and p=0.029, respectively). Conclusion In healthy Korean, the median thickness of the IAS at 2 cm from the anal verge was 1.8 mm and the median thickness of the EAS at 2 cm and 4 cm from the anal verge was 6.5 mm and 7.4 mm respectively. There were no differences in anal sphincter thickness between sexes, but BMI was related to EAS thickness.
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Affiliation(s)
- Daeho Shon
- Hwanggeumbit Surgery Clinic, Daegu, Korea
| | - Sohyun Kim
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Abstract
Gastrointestinal malignancies encompass a variety of primary tumor sites, each with different staging criteria and treatment approaches. In this review we discuss technical aspects of 18F-FDG-PET/CT scanning to optimize information from both the PET and computed tomography components. Specific applications for 18F-FDG-PET/CT are summarized for initial staging and follow-up of the major disease sites, including esophagus, stomach, hepatobiliary system, pancreas, colon, rectum, and anus.
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Affiliation(s)
- Brandon A Howard
- Division of Nuclear Medicine and Radiotheranostics, Department of Radiology, Duke University Medical Center, DUMC Box 3949, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Terence Z Wong
- Division of Nuclear Medicine and Radiotheranostics, Department of Radiology, Duke University Medical Center, DUMC Box 3949, 2301 Erwin Road, Durham, NC 27710, USA
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12
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Taank V, Lattanzio FA, Sultana H, Neelakanta G. Double anus in an Ixodes scapularis nymph, a medically important tick vector. Parasit Vectors 2021; 14:251. [PMID: 33975641 PMCID: PMC8112061 DOI: 10.1186/s13071-021-04757-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ixodes scapularis ticks are medically important arthropod vectors that transmit several pathogens to humans. The observations of morphological abnormalities, including nanism, missing leg, extra leg, and gynandromorphism, have been reported in these ticks. In this study, we report the presence of two anuses in a laboratory-reared I. scapularis nymph. RESULTS Larval ticks were allowed to feed on mice and to molt to nymphs. Two anuses were observed in one of the freshly molted nymphs. Stereo and scanning electron microscopy confirmed the presence of two anuses in one nymph within a single anal groove. CONCLUSIONS This report confirms the rare occurrence of double anus in I. scapularis.
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Affiliation(s)
- Vikas Taank
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA
| | - Frank A Lattanzio
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Hameeda Sultana
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA.,Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA.,Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996, USA
| | - Girish Neelakanta
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA. .,Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA. .,Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996, USA.
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13
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Shih AR, Zukerberg L. Advances and Annoyances in Anus Pathology. Surg Pathol Clin 2020; 13:557-566. [PMID: 32773199 DOI: 10.1016/j.path.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Anal lesions are commonly mistaken clinically for prolapse or hemorrhoids but span a wide spectrum of disorders. Anal lesions include squamous, glandular, melanocytic, infectious, and lymphoid tumors. This article provides a broad overview of anal disorders and highlights specific issues that may hinder diagnosis.
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Affiliation(s)
- Angela R Shih
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02144, USA
| | - Lawrence Zukerberg
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02144, USA.
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14
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Lafferre E, Abramowitz L, Walker F, Benabderrhamanne D, Laurain A, Duval X, Tubach F. Anal Dysplasia Among Patients With Multiple Human Papillomavirus Anal Lesions: Mosaic or Homogeneity? Ann Coloproctol 2020; 37:212-217. [PMID: 32777924 PMCID: PMC8391043 DOI: 10.3393/ac.2020.06.11.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Anal dysplasia is caused by chronic infection with the human papillomavirus and exposes to the risk of anal cancer. The aim of this study was to evaluate the distribution of dysplasia anal grade among patients operated on for multiple anal condylomas with no macroscopic differences. Methods This is a cross-sectional study of patients operated on for multiple anal condylomas including a mapping of dysplasia by performing systematically for each patient one biopsy on visible lesion from each of the 4 quadrants on anal margin and in anal canal. All biopsies were read independently by 2 different pathologists. Results Among 72 patients, 60 were men and 48 were human immunodeficiency virus (HIV)-infected with a median age of 37.5 years. The proportion of high-grade squamous intraepithelial lesion (HSIL) was higher in the anal canal (41.7%) compared to the margin (20.8%) (P = 0.004). HSIL frequency did not differ according to the quadrant (anterior, posterior, right, and left) of the 2 areas. HSIL on anal canal was not associated with HSIL on anal margin and vice versa (P = 0.390). Neither age nor sex was associated to HSIL but HIV positivity increased the risk of HSIL on the anal margin (P = 0.010). Conclusion Anal dysplasia is heterogeneously distributed in the anal canal as well as between anal canal and anal margin. The diagnostic of the grade of dysplasia for a person should require multiple biopsies on the canal and anal margin.
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Affiliation(s)
| | - Laurent Abramowitz
- Gastroenterology and Proctology Unit, Bichat University Hospital, Paris, France.,Ramsay GDS Blomet, Paris, France
| | - Francine Walker
- Université Paris-Diderot, Sorbonne Paris Cité, Laboratoire d'Excellence Inflamex, Faculté de Médecine, Site Bichat, Paris, France.,Service d'Anatomo-Pathologie, Hôpitaux Universitaires Paris Nord Val de Seine Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Anne Laurain
- Gastroenterology and Proctology Unit, Bichat University Hospital, Paris, France.,Ramsay GDS Blomet, Paris, France
| | - Xavier Duval
- Center of Clinical Investigations, Inserm CIC 1425, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,IAME, Inserm U1137, Paris-Diderot University, Paris, France
| | - Florence Tubach
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR 1136, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, CIC1421, France
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Saadaat R, Abdul-Ghafar J, Ud Din N, Haidary AM. Anal extraskeletal osteosarcoma in a man: a case report and review of the literature. J Med Case Rep 2020; 14:51. [PMID: 32312303 PMCID: PMC7171741 DOI: 10.1186/s13256-020-02365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteosarcoma is a common malignancy of bone that usually occurs in individuals in the age range of 0-24 years. Extraskeletal osteosarcoma is a rare tumor presentation which originates in non-bony tissues. Extraskeletal osteosarcoma comprises 2-5% of all osteosarcomas and less than 1% of all soft tissue sarcomas. As compared to bone-derived osteosarcoma, extraskeletal osteosarcoma occurs in older age groups. Extraskeletal osteosarcoma has a poorer prognosis than bone osteosarcoma. To the best of our knowledge, this is the first case of extraskeletal osteosarcoma in the anal region. CASE PRESENTATION A 70-year-old Hazara man presented to a private hospital with the chief complaints of constipation, bloody defecation, and pain during defecation of 1.5 months' duration. His past history was unremarkable. A digital rectal examination showed a solid growth in the middle part of his anus. A colonoscopic examination was done and showed a solid mass in his anal region. A computed tomography scan revealed an irregular mural thickening in the anal canal with heterogeneous enhancement. The maximum length of the involved segment was measured to be 4.5 cm. No suspicious lesions were noted in other organs. An abdominoperineal resection was performed on our patient. A 22 cm in length resected segment of his colon, consisting of the lower sigmoid, rectum, and anus was sent to us for histopathological examination. Gross examination revealed a polypoid dark-gray tumor measuring 5 × 3 × 2 cm. The cut section revealed gray and white appearance with firm-to-hard consistency and foci of ossification. Microscopic examination revealed normal anorectal mucosa and a spindle cell malignant neoplasm with osteoid formations. No evidence of epithelial carcinoma was noted. Immunohistochemical stains were positive for stabilin-2 and negative for cytokeratin, which confirmed the diagnosis of osteosarcoma. CONCLUSION Extraskeletal osteosarcoma of the colon is rare and presence of the tumor in the rectum and anal region is extremely rare. Radiology, colonoscopy, and histopathology with immunostaining are required for the diagnosis. The accurate diagnosis of extraskeletal osteosarcoma is important as it has a different regimen of treatment with poorer prognosis compared to primary osteosarcoma of the bone.
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Affiliation(s)
- Ramin Saadaat
- Department of Pathology and Laboratory Medicine, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Laboratory Medicine, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital (AKU-H), Karachi, Pakistan
| | - Ahmed Maseh Haidary
- Department of Pathology and Laboratory Medicine, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
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Hur H, Jung KW, Kim BW, Oh CM, Won YJ, Oh JH, Kim NK. Long-term Oncologic Outcome and Its Relevant Factors in Anal Cancer in Korea: A Nationwide Data Analysis. Ann Coloproctol 2020; 36:35-40. [PMID: 32146787 PMCID: PMC7069677 DOI: 10.3393/ac.2019.07.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/17/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Anal cancer is a rare disease in Korea, and thus survival analyses are limited by small sample sizes. This study used the Korea Central Cancer Registry (KCCR) for a survival analysis and for assessing characteristics of anal cancer in a large sample of Koreans. Methods From the KCCR, data on 3,615 patients who were diagnosed and treated for anal cancer from 1993 to 2015 were retrieved. Clinicopathologic variables including age, sex, histological type, and Surveillance Epidemiology and End Results (SEER) stage were reviewed, and a survival analysis was performed according to these variables. Results The 5-year relative survival rate improved from 39.7% in 1993–1995 to 66.5% in 2011–2015. Squamous cell carcinoma was the most common and showed the highest survival rate. Males and older patients (≥40 years and ≥70 years) showed poor prognoses. Conclusion The survival rate for anal cancer in Korea has improved steadily over time. The characteristics related to survival were the histological type, sex, and age. These statistics will be fundamental for future Korean anal cancer research.
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Affiliation(s)
- Hyuk Hur
- Korean Colorectal Cancer Study Group (KOCCS), The Korean Society of Coloproctology, Seoul, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Byung-Woo Kim
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Chang-Mo Oh
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Korean Colorectal Cancer Study Group (KOCCS), The Korean Society of Coloproctology, Seoul, Korea
| | - Nam Kyu Kim
- Korean Colorectal Cancer Study Group (KOCCS), The Korean Society of Coloproctology, Seoul, Korea
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Kim PH, Park SH, Jin K, Ye BD, Yoon YS, Lee JS, Kim HJ, Kim AY, Yu CS, Yang SK. Supplementary Anal Imaging by Magnetic Resonance Enterography in Patients with Crohn's Disease Not Suspected of Having Perianal Fistulas. Clin Gastroenterol Hepatol 2020; 18:415-423.e4. [PMID: 31352093 DOI: 10.1016/j.cgh.2019.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few data are available to guide the use of anal imaging for patients with Crohn's disease (CD) who are not suspected of having perianal fistulas. We aimed to evaluate the role of anal imaging supplementary to magnetic resonance enterography (MRE) in these patients. METHODS In a prospective study, we added a round of anal MR imaging (MRI), collecting axial images alone, to MRE evaluation of 451 consecutive adults who were diagnosed with or suspected of having CD but not believed to have perianal fistulas. Images were examined for perianal tracts; if present, colorectal surgeons reexamined patients to identify external openings or perianal inflammation or abscess. Patients were followed and data were collected on dedicated treatment for perianal fistulas or abscess. We calculated the diagnostic yield for anal MRI, associated factors, and outcomes of MRI-detected asymptomatic perianal tracts. RESULTS A total of 440 patients (mean age, 29.6±8.9 years) met the inclusion criteria. Anal MRI revealed perianal tracts in 53 patients (12%; 95% CI, 9.3%-15.4%). Surgeons however did not identify any lesions that required treatment. The asymptomatic tracts were mostly single unbranched (83%), inter-sphincteric (72%), or had a linear dark signal at the tract margin (79%). Younger age at MRE, female sex, and CD activity index scores of 220-450 were independently associated with detection of perianal tracts. MRI detection of asymptomatic tracts was independently associated with later development of perianal fistulas or abscess that required treatment: 17.8% cumulative incidence at 37 months and an adjusted hazard ratio of 3.06 (95% CI, 1.01-9.27; P = .048). CONCLUSIONS In a prospective study of patients with CD, we found that adding anal MRI evaluation to MRE resulted in early identification of patients at risk for perianal complications.
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Bertoli HK, Thomsen LT, Iftner T, Dehlendorff C, Kjær SK. Risk of vulvar, vaginal and anal high-grade intraepithelial neoplasia and cancer according to cervical human papillomavirus (HPV) status: A population-based prospective cohort study. Gynecol Oncol 2020; 157:456-462. [PMID: 32008794 DOI: 10.1016/j.ygyno.2020.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/19/2019] [Accepted: 01/19/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES All cervical cancers and some vulvar, vaginal and anal cancers are caused by high-risk human papillomavirus (hrHPV). However, little is known about the association between cervical HPV infection and subsequent intraepithelial neoplasia and cancer at other anogenital sites. In this prospective cohort study, we estimated the risk of vulvar, vaginal and anal intraepithelial neoplasia grade 2/3 or cancer (VIN2+, VaIN2+, AIN2+) according to cervical hrHPV status. METHODS Liquid-based cervical cytology samples were collected from 40,399 women screened against cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested for hrHPV using Hybrid Capture 2 (HC2) and genotyped using INNO-LiPA. We linked the cohort with Danish nationwide registries to identify cases of VIN2+, VaIN2+ and AIN2+ during up to 15 years of follow-up. We estimated age-adjusted hazard ratios (HRs) using Cox regression and cumulative incidences using Aalen-Johansen's estimator. RESULTS Women with cervical HPV16 infection had increased hazard of VIN2+ (HR = 2.6; 95% confidence interval [CI], 1.2-5.5), VaIN2+ (HR = 23.5; 95% CI, 6.8-81.6) and AIN2+ (HR = 3.7; 95% CI, 1.1-12.2) compared with HC2 negative women. Women with other hrHPV types than HPV16 also had increased hazard of VaIN2+ (HR = 7.1; 95% CI, 2.3-22.3) and a borderline statistically significantly increased risk of AIN2+ (HR = 2.2; 95% CI, 0.9-4.9) compared with HC2 negative women. The 10-year cumulative incidences of VIN2+, VaIN2+ and AIN2+ in women with cervical HPV16 were 0.3% (95% CI, 0.2%-0.7%), 0.2% (95% CI, 0.1%-0.5%) and 0.1% (95 CI, 0.0%-0.4%). CONCLUSIONS Cervical HPV16 infection is associated with increased risk of VIN2+, VaIN2+ and AIN2+.
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Affiliation(s)
- Hanna Kristina Bertoli
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Thomas Iftner
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tübingen, Tübingen, Germany
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Seo GJ, Seo JH, Cho KJ, Cho HS. Hidradenoma Papilliferum of the Anus: A Report of 2 Cases and Review of the Literature. Ann Coloproctol 2019; 35:361-363. [PMID: 31937076 PMCID: PMC6968723 DOI: 10.3393/ac.2018.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.
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Affiliation(s)
| | - Ju Heon Seo
- Geochang International School, Geochang, Korea
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Abstract
This article explains the pathogenesis of fistula-in-ano and details the different classifications of fistula encountered, describe their features on MR imaging, and explains how imaging influences subsequent surgical treatment and ultimate clinical outcome. Precise preoperative characterization of the anatomic course of the fistula and all associated infection via MR imaging is critical for surgery to be most effective. MR imaging is the preeminent imaging modality used to answer pertinent surgical questions.
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Affiliation(s)
- Steve Halligan
- UCL Department of Imaging, UCL Centre for Medical Imaging, Second Floor, Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK.
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21
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Wang D, Jia Y, Gao W, Chen S, Li M, Hu Y, Luo F, Chen X, Xu H. Relationships between Stigma, Social Support, and Distress in Caregivers of Chinese Children with Imperforate Anus: A Multicenter Cross-Sectional Study. J Pediatr Nurs 2019; 49:e15-e20. [PMID: 31378408 DOI: 10.1016/j.pedn.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was conducted to explore the relationships between stigma, social support, and distress in caregivers of children with imperforate anus (IA) and determine whether social support mediates the relationship between stigma and distress. DESIGN AND METHODS This cross-sectional study was conducted in three tertiary children's hospitals in Eastern China. Primary caregivers completed the Social Support Scale and the Chinese versions of the Parent Stigma Scale and Kessler Psychological Distress Scale, and provided their demographic information. The children's demographic and clinical data were also collected. The hypothesized relations were explored using structural equation modeling via the bootstrap method. RESULTS A total of 229 caregivers were enrolled. Distress was positively associated with stigma (r = 0.396, P < 0.01) and negatively associated with social support (r = -0.413, P < 0.01) in all dimensions (r = 0.314-0.346, P < 0.01). Stigma was also negatively correlated with social support (r = 0.280, P < 0.01). Furthermore, social support could partially mediate the relationship between stigma and distress (b = 0.135; 95% confidence interval: 0.072, 0.233). CONCLUSIONS Stigma can increase caregivers' distress, while social support can reduce it. Stigma can also negatively influence caregivers' social support. Therefore, stigma should be mitigated to enhance caregivers' social support and decrease their distress. PRACTICE IMPLICATIONS The study findings may aid in the identification of the psychological status of caregivers of children with IA, and also inform targeted intervention programs.
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Affiliation(s)
- Dan Wang
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yushuang Jia
- Nursing Department, the 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Wei Gao
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Anhui, China
| | - Shuohui Chen
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Mengting Li
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yan Hu
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Feixiang Luo
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaofei Chen
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Hongzhen Xu
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China.
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Samuk I, Gine C, de Blaauw I, Morandi A, Stenstrom P, Giuliani S, Lisi G, Midrio P. Anorectal malformations and perineal hemangiomas: The Arm-Net Consortium experience. J Pediatr Surg 2019; 54:1993-1997. [PMID: 30683447 DOI: 10.1016/j.jpedsurg.2018.10.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/28/2018] [Accepted: 10/30/2018] [Indexed: 11/16/2022]
Abstract
AIM Perineal hemangiomas rarely occur in patients with anorectal malformations (ARMs), but they can pose a significant challenge and warrant special attention. Surgical incision of posterior sagittal anorectoplasty (PSARP) may involve the hemangioma site resulting in hemorrhage, damage to blood supply, leading to complications and adversely affecting outcome. The aim of this study was to review the experience of the ARM-Net Consortium in the management of perineal hemangioma associated with ARM and evaluate treatment strategies. MATERIALS AND METHODS Data on all patients with ARM and a perineal hemangioma located in the planes of the PSARP dissection who were managed at participating ARM-Net centers were collected retrospectively by questionnaire, as follows: ARM type, hemangioma distribution and penetration, imaging findings, medical/surgical management, timing of definitive repair, complications and outcome. RESULTS Ten patients from eight centers were included. Three patients each had a rectobulbar or rectovestibular fistula, 2 had a rectoperineal fistula, and one had a rectoprostatic fistula; in one patient, the hemangioma was too disfiguring to determine malformation type. Mean follow-up time was 36.6 months (median 29 months). Colostomies were performed before definitive repair in 8 patients. Five patients received systemic beta-blockers before PSARP: 3 were operated uneventfully following partial/complete involution of the hemangioma, and 2 are awaiting surgery. The two patients with rectoperineal fistula were managed expectantly. The remaining 3 patients underwent surgery with no preoperative medical treatment, and all had complications: mislocated neoanus in three and complete perineal dehiscence in one. CONCLUSION Attempting PSARP in the presence of a perineal hemangioma may lead to complications and adversely affect outcome. This study confirms the benefits of beta blocker treatment before surgical reconstruction. LEVEL OF EVIDENCE Treatment study, level III.
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Affiliation(s)
- Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Petach Tikva, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Carlos Gine
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron Barcelona, Spain
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Pernilla Stenstrom
- Department of Pediatric Surgery, Skåne University Hospital Lund and the Institution of Clinical Research, Lund University, Sweden
| | - Stefano Giuliani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England
| | - Gabriele Lisi
- Pediatric Surgery Department, G. d'Annunzio University of Chieti-Pescara, and Santo Spirito Hospital of Pescara, Italy
| | - Paola Midrio
- Pediatric Surgery Department, Cà Foncello Hospital, Treviso, Italy
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Egal A, London J, Lidove O, Atienza P, Etienney I. [Anorectal manifestations in systemic diseases]. Rev Med Interne 2019; 40:729-732. [PMID: 31400822 DOI: 10.1016/j.revmed.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
Numerous systemic diseases (vasculitis, connective tissue disease or sarcoidosis) can display an involvement of the perianal skin, the rectum and/or the anus. Such knowledge is important in order to treat these complications specifically when possible. Lesions of the anorectum arising from systemic diseases can sometimes cause perforations in the peritoneal cavity (if concerning the higher portion of the rectum) and/or fistulization to the anal margin. Differential diagnosis, mostly infectious or inflammatory (Crohn's disease) must be ruled out in every case. Other systemic diseases can display specific manifestations as this is the case in scleroderma which can lead to anal incontinence. Despite the relative rarity of these manifestations, their ignorance would forbid global management of these complex diseases. It should thus be detected in each consultation and a regular follow-up must be provided with a proctologist and/or a gastroenterologist when needed.
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Affiliation(s)
- A Egal
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France.
| | - J London
- Service de médecine interne, hôpital Croix Saint-Simon, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, hôpital Croix Saint-Simon, 75020 Paris, France
| | - P Atienza
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France
| | - I Etienney
- Service de proctologie chirurgicale, hôpital Croix Saint-Simon, 75020 Paris, France
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Spindler L, Pommaret E, Moyal Barracco M, Fathallah N, Plantier F, Duchatelle V, de Parades V. [Anal and vulvar hidradenoma papilliferum are similar: A study of 14 cases]. Ann Dermatol Venereol 2019; 146:537-541. [PMID: 31196616 DOI: 10.1016/j.annder.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/26/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hidradenoma papilliferum (HP) is an adenomatous proliferation of mammary-like glands. These glands are located preferentially on the vaginal labia, the perineum and the anal skin. About ninety percent of HP occur on the vulva, with anal localization being much less common. AIM OF THE STUDY To analyze the clinical and histological characteristics of anal HP and compare them to those seen on the vulva based on the literature. METHOD A monocentric retrospective analysis (in the medical and surgical proctology department of the Saint-Joseph Hospital Group, Paris) of patients for whom a diagnosis of anal HP was made based on pathological analysis of a resected sample. RESULTS A total of 14 female patients were included between 2012 and 2018. The mean age was 48.2 years (22-70). The tumor, single in all cases, was asymptomatic with very slow progression. It was located on the anal skin in all patients. It generally consisted of a round nodule measuring under 1cm that was barely prominent, translucent, depressible and mobile. In 15% of patients the tumor was ulcerated. Histologically, the tumor displayed the usual characteristics of HP. Only one relapse was seen, six years after resection. CONCLUSION The clinical and histological aspects of anal HP are the same as those of the vulva, which are better documented, namely a small, rounded, pink, translucent or bluish, and mobile tumor, with a smooth surface, and more rarely ulceration or budding, and in most cases asymptomatic. All HP were diagnosed in women and were located at the anal margin. Histopathological examination of an excised sample confirms the diagnosis and rules out a malignant tumor. The frequency of anal HP may be underestimated.
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Affiliation(s)
- L Spindler
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - E Pommaret
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - M Moyal Barracco
- Service de dermatologie, université Paris Descartes, hôpital Cochin, Assistance publique-hôpitaux de Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - N Fathallah
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - F Plantier
- Service d'anatomo-pathologie, université Paris Descartes, hôpital Cochin, Assistance publique-hôpitaux de Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - V Duchatelle
- Service d'anatomo-pathologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - V de Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
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Ortiz-Mendoza CM, Nieves-Valerdi AA. Esophageal Metallic-Stent Migration: a Rare Cause of Anal Pain in a Patient with Gastric Cancer. Indian J Surg Oncol 2018; 9:576-577. [PMID: 30538391 DOI: 10.1007/s13193-018-0780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022] Open
Abstract
Stents are a great development for esophageal fistula treatment; however, stent migration is a frequent complication. A stent migration that caused anal pain is presented. A 79-year-old man with poorly differentiated gastric carcinoma was submitted to a total gastrectomy with a Roux-en-Y esophagojejunostomy. The patient developed an anastomosis leakage 3 months after surgery; a fixed metallic stent was used as treatment with good evolution. Five months after the stent (and 8 months after gastrectomy), the patient returned to the emergency department with acute incapacitating anal pain; the pain was caused by the migrated stent. Esophageal stent migration is frequent; however, rarely, metallic stent migration may cause anal pain.
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Affiliation(s)
- Carlos Manuel Ortiz-Mendoza
- 1Department of Surgery, Hospital General Tacuba, ISSSTE, Lago Ontario #119, Col. Tacuba, Del. Miguel Hidalgo, 11410 Mexico City, Mexico
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26
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Badoual C, Pavie J, Ménard M, Pernot S, Cochand-Priollet B, Hurel S, Péré H, Bats AS. [Multidisciplinary consultation for patients with HPV-related invasive carcinoma or precancerous lesions]. Cancer Radiother 2018; 22:487-491. [PMID: 30197024 DOI: 10.1016/j.canrad.2018.07.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
Given the recent increase in the number of human papillomavirus (HPV)-induced cancers in other locations than gynaecological, the number of patients with two cancers at distinct sites, and because of the lack of exhaustive data, we decided to create a multidisciplinary network around an HPV consultation at the Georges-Pompidou European Hospital (HEGP). This network aims to set up the best tools for detecting HPV-associated "multisite" precancerous lesions in order to determine the possible impact of dedicated care for this at-risk population. This monthly consultation was created at the HEGP in June 2014. It is currently organized around five consultations: gynaecological, ENT, urological, digestive and immunological. Every patient who has been diagnosed with HPV-related cancer and whose care is provided at the HEGP is offered this particular follow-up: systematically, once the initial lesion has been treated, the patient is convened annually for a day during which it benefits from the consultations mentioned above. A consultation with a psychologist is systematically proposed. Local samples are taken at each site: a cytological examination, the analysis of known predictive and prognostic virological markers are carried out. This study fits more broadly in a theme of clinical and fundamental research around cancers related to HPV.
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Affiliation(s)
- C Badoual
- Service d'anatomie pathologique, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France; Inserm U 970, équipe 10, PARCC, France.
| | - J Pavie
- Service d'immunologie clinique, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Service d'ORL et chirurgie cervico-faciale, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - S Pernot
- Service de hépato-gastro-entérologie et oncologie digestive, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - B Cochand-Priollet
- Service d'anatomie pathologique, faculté Paris-Descartes, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Hurel
- Service d'urologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - H Péré
- Laboratoire de virologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - A-S Bats
- Service de gynécologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
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Donders GGG, Grinceviciene S, Bellen G, Ruban K. Is multiple-site colonization with Candida spp. related to inadequate response to individualized fluconazole maintenance therapy in women with recurrent Candida vulvovaginitis? Diagn Microbiol Infect Dis 2018; 92:226-9. [PMID: 30293562 DOI: 10.1016/j.diagmicrobio.2018.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/20/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although most women on fluconazole maintenance therapy for recurrent vulvovaginal candidosis experience a substantial improvement in quality of life, some do not respond to therapy. Is candidal colonization of extragenital sites related to suboptimal response to maintenance therapy? PATIENTS AND METHODS Women included in a multicenter follow-up study (ReCiDiF) were evaluated for clinical signs and presence of yeasts in nose, mouth, anus, perineum, and urine. Candida was diagnosed by positive microscopy, confirmed by positive culture or polymerase chain reaction. After treatment, women were divided into groups according to their response to a fluconazole maintenance regimen (optimal, suboptimal, and nonresponders). RESULTS The most frequent extravaginal Candida spp. were detected in urine (79.5%), perineum (78.6%), and anus (56.4%). Carriers of Candida in the mouth were more likely to have it in the anus (OR 3.2; 95% CI 1.4-7.7). Colonization in anus (OR 3.3; 95% CI 1.3-8.1) or in multiple extravaginal sites (OR 3.0; CI95% 1.2-7.4) was related to nonresponse to therapy. Candidal carriage in the anus did not increase anal and perianal symptoms. CONCLUSION Women with anal carriage and multiple-site candidal colonization are less likely to respond to individualized decreasing dose fluconazole therapy.
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Abstract
The aim of this paper is to report a case of ventriculoperitoneal (VP) shunt tube coming out through the anus in a 6-year-old boy, who had undergone shunt revision surgery for the malfunctioning of the peritoneal end 6 months back. Among the complications of VP shunt surgery, such unusual migration of peritoneal end of the VP shunt is very rare. The possible factors responsible for this complication, in our case, were abdominal adhesions and thin bowel wall in the children. Although this complication has been previously reported, it remains an exceedingly rare case. Risk factors and possible mechanisms of migration are discussed.
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Affiliation(s)
- Sachin Parshuram Guthe
- Department of Neurosurgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Survashe Pravin
- Department of Neurosurgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Poonam Darade
- Department of Radiology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Vernon Velho
- Department of Neurosurgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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29
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Shin S, Park HC, Kim MS, Han MR, Lee SH, Jung SH, Lee SH, Chung YJ. Whole-exome sequencing identified mutational profiles of squamous cell carcinomas of anus. Hum Pathol 2018; 80:1-10. [PMID: 29555573 DOI: 10.1016/j.humpath.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/13/2022]
Abstract
Anal squamous cell carcinoma (ASCC), either with human papillomavirus (+) or (-), is a neoplastic disease with frequent recurrence and metastasis. To characterize ASCC genomes, we attempted to disclose novel alterations of ASCC genomes and other genetic features including mutation signatures. We performed whole-exome sequencing and copy number alteration (CNA) profiling for 8 ASCC samples from 6 patients (2 cases with primary and recurrent/metastatic tumors). We found known ASCC mutations (TP53, CDKN2A, and PIK3CA) and CNAs (gains on 3q and 19q and losses on 11q and 13q). In addition, we discovered novel mutations in HRAS and ARID1A and CNAs (gain on 8q and losses 5q, 9p, 10q, and 19p) that had not been reported in ASCCs. We identified 4 signature patterns of the mutations (signatures 1 and 2 with deamination of 5-methyl-cytosin, signature 3 with APOBEC, and signature 4 with mismatch repair) in the ASCCs. Although signatures 1 to 3 have been detected in other SCCs, signature 4 was first identified in ASCCs. In addition, we first found that ASCCs harbored chromothripsis, copy-neutral losses of heterozygosity, and focal amplification of KLF5 super-enhancer. Analyses of primary and recurrent/metastatic pair genomes revealed that driver events in development and progression of ASCC might not be uniform. Our data indicate that ASCCs may have similar mutation and CNA profiles to other SCCs, but that there are unique genomic features of ASCCs as well. Our data may provide useful information for ASCC pathogenesis and for developing clinical strategies for ASCC.
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Affiliation(s)
- Sun Shin
- Department of Microbiology, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Integrated Research Center for Genome Polymorphism, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Precision Medicine Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyeon-Chun Park
- Integrated Research Center for Genome Polymorphism, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Precision Medicine Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Min Sung Kim
- Department of Pathology, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Cancer Evolution Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Mi-Ryung Han
- Integrated Research Center for Genome Polymorphism, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Precision Medicine Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Seung Hyun Jung
- Integrated Research Center for Genome Polymorphism, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Precision Medicine Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Cancer Evolution Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sug Hyung Lee
- Precision Medicine Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Department of Pathology, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Cancer Evolution Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Yeun-Jun Chung
- Department of Microbiology, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Integrated Research Center for Genome Polymorphism, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Cancer Evolution Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea; Precision Medicine Research Center, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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30
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Ranjith S, Muralee M, Sajeed A, Arun PM, Cherian K, Nair CK, Augustine P, Ahamed I. Anorectal melanoma: experience from a tertiary cancer care centre in South India. Ann R Coll Surg Engl 2018; 100:185-189. [PMID: 29046101 PMCID: PMC5930086 DOI: 10.1308/rcsann.2017.0184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Methods This study describes a retrospective analysis of 31 cases of anorectal melanoma presented to our centre between January 2001 and December 2013. Results Twenty-two patients (71%) presented with metastasis and had a median overall survival of nine months. None of the 22 patients survived for two years. Nine patients (29%) had curative surgery, in the form of abdominoperineal resection (six patients), abdominoperineal resection with bilateral inguinal node dissection (one patient), abdominoperineal resection with liver resection (one patient) and posterior exenteration (one patient). In patients who underwent curative surgery, the median overall survival was 15 months and disease-free survival was nine months, with a two-year overall survival of 22%. Conclusions Anorectal melanoma is an aggressive disease with a poor prognosis. The majority of patients present with distant metastases. Prognosis depends on stage at presentation. Early diagnosis and surgical resection may improve the overall outcome. Newer modalities such as immunotherapy and targeted therapies such as anti-CTLA4 monoclonal antibody and anti-programmed cell death protein 1 monoclonal antibodies have radically changed the management of mucosal melanoma and may, in the future, improve the overall prognosis of anorectal melanoma.
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Affiliation(s)
- S Ranjith
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - M Muralee
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - A Sajeed
- Division of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - PM Arun
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - K Cherian
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - CK Nair
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - P Augustine
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
| | - I Ahamed
- Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala
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31
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Durot C, Dohan A, Boudiaf M, Servois V, Soyer P, Hoeffel C. Cancer of the Anal Canal: Diagnosis, Staging and Follow-Up with MRI. Korean J Radiol 2017; 18:946-956. [PMID: 29089827 PMCID: PMC5639160 DOI: 10.3348/kjr.2017.18.6.946] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/26/2017] [Indexed: 12/20/2022] Open
Abstract
Although a rare disease, anal cancer is increasingly being diagnosed in patients with risk factors, mainly anal infection with the human papilloma virus. Magnetic resonance imaging (MRI) with external phased-array coils is recommended as the imaging modality of choice to grade anal cancers and to evaluate the response assessment after chemoradiotherapy, with a high contrast and good anatomic resolution of the anal canal. MRI provides a performant evaluation of size, extent and signal characteristics of the anal tumor before and after treatment, as well as lymph node involvement and extension to the adjacent organs. MRI is also particularly helpful in the assessment of complications after treatment, and in the diagnosis for relapse of the diseases.
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Affiliation(s)
- Carole Durot
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France
| | - Anthony Dohan
- Department of Abdominal Imaging, Hôpital Lariboisière-APHP, Paris 75010, France
| | - Mourad Boudiaf
- Department of Abdominal Imaging, Hôpital Lariboisière-APHP, Paris 75010, France
| | - Vincent Servois
- Department of Radiology and Nuclear Medicine, Institut Curie, Paris 75005, France
| | - Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière-APHP, Paris 75010, France
| | - Christine Hoeffel
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France.,CRESTIC, Reims Champagne-Ardenne University, Reims 51867, France
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32
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Seo KI, Moon W, Kim SE, Park MI, Park SJ. Malignant Melanoma of the Anus Found during Routine Colonoscopy in Ulcerative Colitis. Korean J Gastroenterol 2017; 69:368-371. [PMID: 28637107 DOI: 10.4166/kjg.2017.69.6.368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
Inflammatory bowel disease (IBD) is characterized by recurrent or chronic inflammation of the gastrointestinal tract, which results in increased risk of developing cancer. Anorectal malignant melanoma is often misdiagnosed as either hemorrhoids or benign anorectal conditions in inflammatory bowel disease. Therefore, the overall prognosis and survival of IBD are poor. To date, the best treatment strategy remains controversial. Only early diagnosis and complete excision yield survival benefit. Here, we report a 64-year-old woman with ulcerative colitis, who was found to have anal malignant melanoma on routine colonoscopy. The lesion was confined to the mucosa with no distant metastasis. She underwent complete trans-anal excision. There was no recurrence at the four-year follow-up. Physicians should be aware of increased risk of cancer development in IBD patients and remember the importance of meticulous inspection of the anal canal.
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Affiliation(s)
- Kwang Il Seo
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Abstract
Neuroendocrine tumors in gastrointestinal (GI) tract are a rare source of GI malignancy with an estimated incidence of 2.5 - 5 per 100,000 people per year and the prevalence of 35 per 100,000. In the GI tract, they are located in decreasing order of frequency in appendix, ileum, rectum, stomach, and colon. Those found in the anal region represent just 1% of all malignancies of the anal canal. Their clinical presentation can be widely varying, sometimes being found incidentally with metastatic disease and an unknown primary source. We report a case of a 60-year-old male who presented with a 2-week history of intermittent bright red blood per rectum and anal pain. He was found to have a lesion in the perianal area which was subsequently diagnosed has a poorly differentiated large cell type neuroendocrine carcinoma (NEC) with hepatic metastasis.
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Affiliation(s)
- Muhammad Khan
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Ahmed Dirweesh
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Chikezie Alvarez
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Herbert Conaway
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Robert Moser
- Department of Pathology, Saint Francis Medical Center, Trenton, NJ, USA
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34
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Chumbalkar V, Jennings TA, Ainechi S, Lee EC, Lee H. Extramammary Paget's Disease of Anal Canal Associated With Rectal Adenoma Without Invasive Carcinoma. Gastroenterology Res 2016; 9:99-102. [PMID: 28058078 PMCID: PMC5191897 DOI: 10.14740/gr727e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 01/27/2023] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare disease which is found in apocrine-rich locations such as anogenital region, axilla and rarely in other sites. Perianal EMPD is often reported as the involvement of perianal skin, but involvement of anal mucosa is very rare. Based on pathogenesis and association with either synchronous or metachronous malignancy, EMPD can be divided into primary and secondary types. Treatment approach for these two types of Paget's disease and their prognosis is different, thus it is important to make the distinction. Secondary type of Paget's disease is almost always described in association with invasive malignancy. While secondary Paget's disease arising in association with ductal carcinoma in situ of the breast is common, secondary EMPD associated with precursor lesion of the rectum without invasion is exceedingly rare. We report a very rare case of secondary Paget's disease of the anal canal in association with rectal tubular adenoma (precursor lesion) without malignancy.
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Affiliation(s)
- Vaibhav Chumbalkar
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Timothy A Jennings
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Sanaz Ainechi
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Edward C Lee
- General Surgery, Albany Medical College, Albany, NY, USA
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
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35
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Fanget F, Pasquer A, Djeudji F, Chabanon J, Barth X. Should the Surgical Management of Buschke-Lowenstein Tumors Be Aggressive? About 10 Cases. Dig Surg 2016; 34:247-252. [PMID: 27941342 DOI: 10.1159/000452496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/13/2016] [Indexed: 12/10/2022]
Abstract
AIMS Buschke-Lowenstein tumor (BLT) of the anal margin is a histologically benign tumor whose degeneration can lead to a deadly local evolution because of difficult and late diagnosis. The objective of this study was to report our experience and propose a therapeutic strategy for these rare tumors. METHODS From 1996 to 2014, 10 men with a median age of 45 years (25-64) were treated for a BLT of the anal margin with a first local excision possibly followed by rectal amputation. RESULTS Local perianal excision was curative in 6 cases without recurrence. The median follow-up time was 94.5 months (5-175). In 4 patients, local excision was followed by an early recurrence, justifying a complementary abdominoperineal excision (APE) of the rectum. Two patients who benefited from complementary resection are currently free from recurrence. Even if the postoperative course was uneventful, 2 died from recurrence and disease progression within 5 and 11 postoperative months each. CONCLUSION Macroscopic surgical evaluation of local tumoral invasion and extensive radical resection appears to be associated with long-term survival without recurrence. When recurrence occurs, APE of the rectum seems to be the only curative alternative. Based on low level of evidence, surgical excision is currently the only standard treatment for these lesions.
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Affiliation(s)
- Florian Fanget
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, Lyon, France
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Cho I, Kim KJ, Lim SC. Synchronous Primary Anorectal Melanoma and Sigmoid Adenocarcinoma. Ann Coloproctol 2016. [PMID: 27847790 DOI: 10.3393/ac.2016.32.5.190.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
A primary anorectal malignant melanoma is a rare tumor. Moreover, cases involving a synchronous anorectal melanoma and colon adenocarcinoma are extremely rare. The authors report a case of a synchronous anorectal melanoma and sigmoid adenocarcinoma in an 84-year-old man. The regions of the anorectal melanoma showed melanocytic nevi in the adjacent mucosa of the anal canal and rectum. A dysplastic nevus was also identified in the anal mucosa. This case demonstrates that an anorectal melanoma can arise from pre-existing anorectal melanocytic lesions.
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Affiliation(s)
- Inju Cho
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| | - Kyung Jong Kim
- Department of Surgery, Chosun University School of Medicine, Gwangju, Korea
| | - Sung-Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
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Abstract
A primary anorectal malignant melanoma is a rare tumor. Moreover, cases involving a synchronous anorectal melanoma and colon adenocarcinoma are extremely rare. The authors report a case of a synchronous anorectal melanoma and sigmoid adenocarcinoma in an 84-year-old man. The regions of the anorectal melanoma showed melanocytic nevi in the adjacent mucosa of the anal canal and rectum. A dysplastic nevus was also identified in the anal mucosa. This case demonstrates that an anorectal melanoma can arise from pre-existing anorectal melanocytic lesions.
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Affiliation(s)
- Inju Cho
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| | - Kyung Jong Kim
- Department of Surgery, Chosun University School of Medicine, Gwangju, Korea
| | - Sung-Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
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Abstract
The digital rectal examination (DRE) is performed in children less often than is indicated. Indications for the pediatric DRE include diarrhea, constipation, fecal incontinence, abdominal pain, gastrointestinal bleeding, and anemia. Less well-recognized indications may include abdominal mass, urinary symptoms, neurologic symptoms, urogenital or gynecologic symptoms, and anemia. Indeed, we believe that it should be considered part of a complete physical examination in children presenting with many different complaints. Physicians avoid this part of the physical examination in both children and adults for a number of reasons: discomfort on the part of the health care provider; belief that no useful information will be provided; lack of adequate training and experience in the performance of the DRE; conviction that planned "orders" or testing can obviate the need for the DRE; worry about "assaulting" a patient, particularly one who is small, young, and subordinate; anticipation that the exam will be refused by patient or parent; and concern regarding the time involved in the exam. The rationale and clinical utility of the DRE will be summarized in this article. In addition, the components of a complete pediatric DRE, along with suggestions for efficiently obtaining the child's consent and cooperation, will be presented.
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Affiliation(s)
- Susan R Orenstein
- University of Pittsburgh School of Medicine, 303 Church Ln, Pittsburgh, PA, 15238-1063, USA.
| | - Arnold Wald
- Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine & Public Health, Centennial Building, 1685 Highland Ave, Madison, WI, 53705-2281, USA.
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39
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Leon ME, Shamekh R, Coppola D. Human papillomavirus-related squamous cell carcinoma of the anal canal with papillary features. World J Gastroenterol 2015; 21:2210-2213. [PMID: 25717259 PMCID: PMC4326161 DOI: 10.3748/wjg.v21.i7.2210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/05/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV) related squamous cell carcinoma (SCC) involving the anal canal is a well-known carcinoma associated with high-risk types of HPV. HPV-related SCC with papillary morphology (papillary SCC) has been described in the oropharynx. We describe, for the first time, a case of anal HPV-related squamous carcinoma with papillary morphology. The tumor arose from the anal mucosa. The biopsies revealed a superficially invasive SCC with prominent papillary features and associated in situ carcinoma. The tumor cells were positive for p16 and were also positive for high-risk types of HPV using chromogenic in situ hybridization. The findings are consistent with a HPV-related SCC of the anal canal with papillary features. This tumor shows histologic features similar to a papillary HPV-related SCC of the oropharynx. Additional studies are needed to characterize these lesions.
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MESH Headings
- Aged, 80 and over
- Anus Neoplasms/chemistry
- Anus Neoplasms/pathology
- Anus Neoplasms/therapy
- Anus Neoplasms/virology
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Papillary/chemistry
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Carcinoma, Papillary/virology
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Squamous Cell/virology
- Chemoradiotherapy
- DNA, Viral/genetics
- Female
- Human Papillomavirus DNA Tests
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Neoplasm Invasiveness
- Papillomaviridae/genetics
- Papillomaviridae/isolation & purification
- Papillomavirus Infections/complications
- Papillomavirus Infections/virology
- Treatment Outcome
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40
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Badoual C, Tartour E, Roussel H, Bats AS, Pavie J, Pernot S, Weiss L, Mohamed AS, Thariat J, Hoffmann C, Péré H. [HPV (Human Papilloma Virus) implication in other cancers than gynaecological]. Rev Med Interne 2015; 36:540-7. [PMID: 25661671 DOI: 10.1016/j.revmed.2015.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/26/2023]
Abstract
Worldwide, approximately 5 to 10% of the population is infected by a Human Papilloma Virus (HPV). Some of these viruses, with a high oncogenic risk (HPV HR), are responsible for about 5% of cancer. It is now accepted that almost all carcinomas of the cervix and the vulva are due to an HPV HR (HPV16 and 18) infection. However, these viruses are known to be involved in the carcinogenesis of many other cancers (head and neck [SCCHN], penis, anus). For head and neck cancer, HPV infection is considered as a good prognostic factor. The role of HPV HR in anal cancer is also extensively studied in high-risk patient's population. The role of HPV infection in the carcinogenesis of esophageal, bladder, lung, breast or skin cancers is still debated. Given the multiple possible locations of HPV HR infection, the question of optimizing the management of patients with a HPV+ cancer arises in the implementation of a comprehensive clinical and biological monitoring. It is the same in therapeutics with the existence of a preventive vaccination, for example.
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Abstract
Radical and definitive surgical treatment is indicated in approximately one out of ten patients with hemorrhoidal disease. The Milligan and Morgan hemorrhoidectomy technique is the most widely performed in France: the technique is well-codified and results are satisfactory and durable if the indications and the post-operative follow-up are appropriately respected. Post-operative pain can be adequately controlled.
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Affiliation(s)
- H Pillant-Le Moult
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - M Aubert
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - V De Parades
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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Jung SP, Lee Y, Han KM, Lee SK, Kim S, Bae SY, Kim J, Kim M, Kim S, Kil WH, Koo HH, Nam SJ, Bae JW, Lee JE. Breast metastasis from rhabdomyosarcoma of the anus in an adolescent female. J Breast Cancer 2013; 16:345-8. [PMID: 24155766 PMCID: PMC3800733 DOI: 10.4048/jbc.2013.16.3.345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 07/25/2013] [Indexed: 11/30/2022] Open
Abstract
Rhabdomyosarcoma (RMS) of the breast is rare and there is scant information about the clinical behavior and treatment strategies. We report an adolescent female patient with metastatic RMS of the breast from the anus. An 18-year-old female patient was referred to our clinic due to palpable mass in the left breast. At age seven, she was diagnosed with acute lymphoblastic leukemia and treated with chemoradiation therapy. After 10 years of complete remission state, she presented with anal mass which was diagnosed as RMS and she received chemoradiation therapy. After 1 year of complete remission state, she noticed a palpable mass in her left breast. The breast mass was diagnosed as metastatic RMS based on core needle biopsy specimen. The RMS in breast was excised for the decreasing tumor burden despite of another metastatic lesion. Although rarely reported, metastasis of RMS should be considered as a cause of breast mass. Tissue biopsy is recommended when clinically suspected lesion is detected.
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Affiliation(s)
- Seung Pil Jung
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Abstract
Magnetic resonance imaging plays a pivotal role in the imaging and staging of rectal and anal carcinomas. Rectal adenocarcinomas and anal squamous cell carcinomas behave differently, and are staged and treated differently. This article attempts to explain these 2 entities, which share the same regions of interest, in a comprehensive manner.
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Affiliation(s)
- Michael R Torkzad
- Section of Radiology, Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala 75185, Sweden.
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Abstract
AIM: To report a case of rectal adenocarcinoma and a case of anal squamous cell carcinoma in situ after renal transplantation, and review the relevant literature.
METHODS: A case of squamous cell carcinoma in situ arising in a patient 2 years after renal transplantation and a case of rectal adenocarcinoma arising in a patient 14 years after renal transplantation were collected. The resected specimens were fixed in buffered formalin, paraffin-embedded, 4 μm-sectioned, and reviewed by two pathologists. Human papillary virus (HPV) and Epstein-Barr virus (EBV) were detected both in the adenocarcinoma and squamous carcinoma. K-ras and BRAF genes were sequenced in rectal adenocarcinoma to identify mutations.
RESULTS: The patient suffering from squamous cell carcinoma in situ was a 54-year-old female, with a history of mixed hemorrhoid for 30 years without obvious bleeding. The regimen of mycophenolate mofetil (MMF), prednisone (Pred) and tacrolimus was used to control rejection reactions. Six months after transplantation, the patients complained of intermittent painless hemorrhage. The diagnosis of mixed hemorrhoid was made by colonoscopy and conservative treatment was performed consequently for the next year. Since the hemorrhage became worse in the last month, hemorrhoid resection was performed. Squamous carcinoma in situ was diagnosed. There was no HPV or EBV infection. No adverse events occurred in the next 36-mo follow-up period. The patient suffering from rectal adenocarcinoma was a 39-year old male who complained of bloody stools for one year and aggravation for 1 mo. Colonoscopy revealed a space-occupying lesion localized in the rectum. He was diagnosed with renal failure 15 years ago and accepted renal allograft 14 years ago. MMF and Pred were used as the immunosuppressant for 12 years and stopped as the allograft lost its function 2 years ago. Anterior resection was performed and pathologic examination revealed poorly differentiated adenocarcinoma mixed with mucinous adenocarcinoma accompanied with numerous cancerous emboli and lymph node metastasis (pT3N2aM0). After 18 mo of follow-up, he suffered from abdominal relapse and hepatic metastasis. The lymphocytes infiltrating into the carcinoma were negative for EBER. Wild-type K-ras and BRAF were detected.
CONCLUSION: Bloody stools can be the fist sign of anal or rectal carcinoma. Immunosuppressive drugs may act as a pivotal enhancer during the pathogenesis of carcinoma. The patients sensitive to immunosuppression therapy and/or undergoing long-term immunosuppression therapy should be cautious of carcinoma.
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AbdullGaffar B, Abdulrahim M, Ghazi E. Benign fibrous histiocytoma presenting as anal canal polyp: first case report. Ann Diagn Pathol 2012; 17:464-5. [PMID: 22999485 DOI: 10.1016/j.anndiagpath.2012.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 07/17/2012] [Accepted: 07/24/2012] [Indexed: 11/25/2022]
Abstract
Nonepithelial and nonmelanocytic anal neoplasms are uncommon. The majority are mesenchymal tumors, most of which are malignant sarcomas, particularly leiomyosarcomas and gastrointestinal stromal tumors. Benign mesenchymal anal neoplasms are even rarer. The most common reported cases were anal leiomyomas, granular cell tumors, fibroadenomas, and xanthogranulomas. Benign fibrous histiocytomas (BFHs) or dermatofibromas are common mesenchymal cutaneous tumors that occur in different sites and at any age. Review of the literature did not show previous reports of BFH arising in the anal canal region. We report the first case of a solitary BFH, an unexpected occurrence of a common tumor type presenting as a polyp in an unusual site such as the anus. This rare occurrence can present diagnostic challenges for the surgeons and pathologists. Clinically, it can be confused with the usual anal tags, fibroepithelial polyps, or hemorrhoids. Benign fibrous histiocytoma is a neoplasm with a potential of local recurrence and, therefore, carries certain clinical implications for the patients' management and follow-up when compared with the common nonneoplastic causes of anal polyps such as the anal tags of anal fissures, hemorrhoids, or fibroepithelial papilla. Histologically, it should be differentiated from other histiocytic lesions. This can be resolved by the application of certain histologic features with the appropriate immunohistochemical markers taken within the correct clinical context.
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Kang TY, Huh MR, Kim SJ. Anal myolipoma: a new benign entity in patients with an anal tumor? J Korean Soc Coloproctol 2012; 28:219-21. [PMID: 22993709 PMCID: PMC3440492 DOI: 10.3393/jksc.2012.28.4.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/05/2011] [Indexed: 12/28/2022]
Abstract
A myolipoma is an extremely rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum. We experienced a case of an anal myolipoma occurring in a 30-year-old woman, and it was surgically resected. To our knowledge, this is the first reported case of a myolipoma arising from the anus, so such a possibility needs to be considered in the differential diagnosis.
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Li HS, Chen Q. Recent progress in surgical management of perianal abscess. Shijie Huaren Xiaohua Zazhi 2012; 20:580-584. [DOI: 10.11569/wcjd.v20.i7.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Perianal abscess is one of the common rectal diseases. Surgical management is still the most effective way. Surgical methods have roughly experienced three phases of landmark development: initially simple incision/drainage combined with surgery for the second time when fistula-in-ano is formed, followed by primary curative incision, and finally sphincter-preserving surgery, which reinforces the importance of protecting the function of the anus. The use of these surgical methods not only reduces the recurrence of abscess and the incidence of anal fistula, but also protects the fine function and integrity of the anus, greatly reducing the pain in patients and raising their quality of lives.
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Galanis I, Dragoumis D, Tsolakis M, Zarampoukas K, Zarampoukas T, Atmatzidis K. Obstructive ileus due to a giant fibroepithelial polyp of the anus. World J Gastroenterol 2009; 15:3687-90. [PMID: 19653351 PMCID: PMC2721247 DOI: 10.3748/wjg.15.3687] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fibroepithelial polyps or hypertrophied anal papillae are essentially skin tags that project up from the dentate line and the junction between the skin and the epithelial lining of the anus. They are usually small in size, but sometimes they become enlarged, causing unexpected medical conditions. An extremely rare case of a giant hypertrophied anal papilla complicated by obstructive ileus is reported. Fibroepithelial anal polyp, despite its size, should be included in the differential diagnosis of a smooth mass located near the anal verge, especially in a patient with a history of chronic anal irritation or infection.
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Choi YH, Kim IO, Cheon JE, Kim WS, Yeon KM. Imperforate anus: determination of type using transperineal ultrasonography. Korean J Radiol 2009; 10:355-60. [PMID: 19568463 PMCID: PMC2702044 DOI: 10.3348/kjr.2009.10.4.355] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 02/12/2009] [Indexed: 11/30/2022] Open
Abstract
Objective This study was designed to assess the usefulness of transperineal ultrasonography (US) for the determination of imperforate anus (IA) type. Materials and Methods From January 2000 to December 2004, 46 of 193 patients with an IA underwent transperineal US prior to corrective surgery. Sonographic findings were reviewed to identify the presence of internal fistulas and to determine "distal rectal pouch to perineum (P-P)" distances. IA types were determined based on the sonographic findings, and the diagnostic accuracy of transperineal US was evaluated based on surgical findings. Results Of the 46 patients, 17 patients were surgically confirmed as having a high-type IA, three patients were confirmed as having an intermediate-type IA and 26 patients were confirmed as having a low-type IA. The IA type was correctly diagnosed by the use of transperineal US in 39 of the 46 patients (85%). In 14 of the 17 patients with a high-type IA, internal fistulas were correctly identified. All cases with a P-P distance > 16 mm were high-type IAs and all cases with a P-P distance < 5 mm were low-type IAs. Conclusion Transperineal US is a good diagnostic modality for the identification of internal fistulas in cases of high-type IA and for defining the IA level.
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Affiliation(s)
- Young-Hun Choi
- Department of Radiology, Seoul National University Children's Hospital, Seoul, Korea
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Das S, Kar C, Giri PP. Mucosal patch on anus: a rare sequel of sodomy. Indian J Dermatol 2008; 53:195. [PMID: 19882034 PMCID: PMC2763769 DOI: 10.4103/0019-5154.44796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case of mucosal patch on the perianal area of a 15-year-old boy with history of frequent sodomy is presented here.
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Affiliation(s)
- Sudip Das
- Department of Dermatology and Venereology, AIIMS, New Delhi and Nilratan Sarkar Medical College and Hospital, Kolkata-700 014, India.
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