Cases reported "Rectal Diseases"

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1/20. adenocarcinoma arising within a tailgut cyst: clinicopathological description and follow up of an unusual case.

    Full clinicopathological details and clinical follow up of a case of malignant transformation within a tailgut cyst are presented. A 43 year old woman presented with signs and symptoms of an imminent threatened abortion. Routine examination identified a coincidental, asymptomatic retrorectal/presacral mass. Following imaging studies, surgical resection was carried out and an adenocarcinoma arising within a pre-existent tailgut cyst was identified by microscopy. Four years later the patient presented with neurological symptoms consistent with local recurrence of the tumour. Surgical biopsies confirmed this diagnosis and she was subsequently started on chemotherapy. She died soon after from a cause unrelated to the disease, after declining further active intervention. Differential diagnosis of such cases includes (cystic) teratoma, epidermal cyst, rectal duplication cyst, anal gland cyst and carcinoma, extension of local carcinoma, and metastatic disease. It is recommended that these lesions be completely excised when detected incidentally.
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2/20. The gonadotropin-releasing hormone agonist leuprolide acetate induces apoptosis and suppresses cell proliferative activity in rectovaginal endometriosis.

    A gonadotropin-releasing hormone agonist, leuprolide acetate, was administered every 4 weeks for treatment of rectovaginal endometriosis. Degrees of apoptosis (percentage of in situ deoxyribonucleic acid 3'-end-labeled cells) and cell proliferative activity (percentage of cells with immunostaining for proliferating cell protein Ki-67) were examined in endometriotic glands of biopsy specimens taken before and during gonadotropin-releasing hormone agonist therapy. gonadotropin-releasing hormone agonist induced apoptosis and suppressed cell proliferative activity in endometriotic glands.
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3/20. Solitary rectal ulcer syndrome (colitis cystica profunda) in spinal cord injury patients: 3 case reports.

    Clinically indicated endoscopic examinations of 56 patients with spinal cord injury (SCI) (31 for bleeding) were performed over a 3-year period, of which 3 (6%) showed solitary rectal ulcer syndrome (SRUS). The presentation was rectal bleeding or mucoid discharge. The endoscopic appearance was multiple pseudopolyps and occasional mucosal ulcers extending proximally 8 to 40cm from the anus. Mucosal biopsy specimens showed distorted mucosal glands and displaced smooth muscle fibers wrapping around the glands, the hallmark of SRUS. The affected patients had routinely used suppositories and digital stimulation for bowel care and had been paralyzed 7 to 50 years. None had rectal prolapse. These cases show that SRUS (colitis cystica profunda) can be found among patients with SCI.
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keywords = gland
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4/20. Salivary gland heterotopia in the rectum.

    Heterotopic tissues in the submucosal region of the gastrointestinal tract are a well-described occurrence. In the rectal region, these most commonly involve gastric-type mucosa. Only rare reports of salivary gland-type tissue presenting as a submucosal rectal heterotopia have been previously reported. This case report reviews the literature and details an occurrence of heterotopic salivary gland-type tissue in the rectal submucosa of a 31-year-old man who presented with intermittent bleeding and a rectal polypoid mass.
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keywords = gland
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5/20. Inflammatory myoglandular polyp--a rare but distinct type of colorectal polyps.

    The aim of this paper was to report another example of a rare type of colorectal polyps, the inflammatory myoglandular polyp, and to reaffirm this type of polyp as a distinct entity. This solitary pedunculated polyp was detected after a single episode of rectal bleeding. It was situated in the sigmoid colon, measured 2.5 cm in greatest diameter, and was composed almost exclusively of smooth muscles and hyperplastic glands. The patient had neither chronic colitis nor diverticula. Clinical presentation, localization, and histology give this type of polyp a unique appearance and justify its designation as a separate entity.
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keywords = gland
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6/20. Tailgut cyst associated with a carcinoid tumor: case report and review of the literature.

    We report the case of a 49-year-old woman who presented a tailgut cyst lined by a variety of epithelium including squamous, columnar and transitional. Fortuitously a microscopic carcinoid tumor expressing immunohistochemically neuroendocrine markers was identified in the cystic wall. Tailgut cysts are congenital abnormalities located in the presacrococcygeal area occurring usually in adult patients. Clinical diagnosis is difficult because they are often asymptomatic. patients may present symptoms resulting from local mass effects or complications. The differential diagnoses include rectal duplication cysts, cystic sacrococcygeal teratomas, epidermal cysts, epidermoid cysts, anal duct or gland cysts. magnetic resonance imaging has recently become the modality of choice to image the cyst. Malignant transformation is rare; 23 cases including 10 carcinoid tumors have been reported in the literature. To our knowledge, this is the eleventh case of carcinoid tumor arising in a tailgut cyst.
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7/20. Anterior rectal wall hematoma: complication of transrectal ultrasound-guided biopsy of prostate.

    Transrectal biopsy of the prostate, because of its directness and simplicity, is utilized by many practicing urologists to obtain prostatic tissue for histologic evaluation. Complications arising from this procedure are primarily of an infectious origin and less commonly of a vascular etiology. We report on the first known patient in whom a large hematoma of the anterior rectal wall with nearly total occlusion of the rectal lumen developed following a transrectal ultrasound-guided biopsy of the prostate. Guidelines to reduce the likelihood of vascular complications following biopsy of the prostate gland for patients consuming medications that may alter normal platelet function or interfere with the various clotting factors are described.
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keywords = gland
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8/20. Mucinous adenocarcinoma in anorectal fistulae.

    Mucinous adenocarcinoma arising in an anorectal fistula is an uncommon condition which gives rise to difficult problems of diagnosis and pathogenesis. The clinical history and pathology of seven patients are described and compared with six patients in whom anal fistulae were lined by normal rectal mucosa or 'misplaced glands'. In five of the cases granulomas were present which were a further cause of diagnostic difficulty. The evidence from this study suggests that the fistulous tracks are congenital duplications of the lower end of the hind gut lined by rectal mucosa which is prone to malignant change to mucinous adenocarcinoma. The prognosis after excision of the rectum is good.
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9/20. Iatrogenic supralevator fistula.

    This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.
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10/20. anticoagulants and abdominal pain. The role of computed tomography.

    The development of abdominal pain in the patient receiving anticoagulants, especially with a documented drop in hematocrit levels, almost certainly indicates a major hemorrhage. If loss of blood from the GI tract is not documented, some form of internal bleeding must have occurred. Unfortunately, the site of the bleeding is frequently unclear. Even small hemorrhages in critical locations (eg, the adrenal gland) can have serious consequences. In the obese patient, a rectus sheath hematoma may remain hidden at the time of repeated physical examinations. Generally, the cause of a mass palpated or perhaps demonstrated by conventional radiological studies cannot be diagnosed accurately. Computed tomography can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. By careful evaluation of the attenuation coefficient, it is possible to establish the definitive diagnosis of hemorrhage. Should the attenuation value of a mass be insufficiently high to diagnose hemorrhage conclusively on the initial scan, serial scans demonstrating a decrease in size and/or attenuation of the mass confirm the diagnosis of hemorrhage. In our opinion a negative CT examination is a reliable indicator that such a bleeding complication has not occurred.
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