1/5. Mucinous adenocarcinoma in chronic anorectal fistula.adenocarcinoma in association with chronic anal fistula is a rare disease which gives rise to difficult problems of diagnosis and treatment. A case of mucinous adenocarcinoma arising on a long standing fistula in ano is described. A patient with a long history of mucinous discharge, pain and perianal induration underwent a biopsy of the external opening of the fistula that showed mucinous infiltrating adenocarcinoma. After a colonoscopy and a preoperative abdominal CT scan, she underwent a successful abdominoperineal resection with adjuvant chemoradiation therapy. Diagnosis of this condition is often difficult; deep and multiple biopsies of the fistulous tracks or perianal mass are necessary to establish the diagnosis. An accurate staging of the neoplasm, using endorectal ultrasound, NMR or CT scans is needed to plan the appropriate treatment. Recent studies have shown that locally advanced anal adenocarcinomas could benefit from pre or postoperative chemoradiation therapy. However, an accurate and complete removal of the tumor, which usually entails abdominoperineal resection, is often necessary to achieve radicality. Despite new therapy protocols, the prognosis of mucinous adenocarcinoma is still poor, mostly due to its advanced nature at the time of diagnosis. This reinforces the importance of biopsy of all perianal abscesses and fistulas for early detection and treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/5. Perianal mucinous adenocarcinoma: unusual case presentations and review of the literature.Perianal mucinous adenocarcinoma is a rare cancer constituting 3 to 11 per cent of all anal carcinomas. It may arise de novo or from a fistula or abscess cavity. We present two cases of this disease process. Case One is a 52-year-old man with a chronic history of perianal abscesses who presented to the emergency room with a large bowel obstruction. He required diversion and wide local excision with lateral internal sphincterotomy for relief of the obstruction. pathology from the excised material revealed the unexpected diagnosis of invasive mucinous adenocarcinoma of the anus. Case Two is a 59-year-old man with a chronic history of complex fistulas and abscesses who presented to our office with a horseshoe fistula and deep postanal space abscess. Because of the nonhealing nature of the wound, biopsies from the abscess crater, fistulous tract, and the perianal skin opening were taken. The pathology department identified the specimens as invasive mucinous adenocarcinoma of the anal canal. This is an aggressive cancer often misdiagnosed clinically as benign pathology. A high index of suspicion and biopsy of fistulous tracts and abscesses are the keys to early diagnosis and treatment. With combination chemotherapy and radiation therapy in conjunction with aggressive surgical resection long-term survival might be obtained.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/5. Chronic utero-rectal fistula with menochezia and amenorrhea.Utero-intestinal fistulas are commonly acute in nature and usually follow malignancies of the intestines. Here we report a chronic uterorectal fistula with uncommon symptom of cyclical rectal bleeding (menochezia) and amenorrhea.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/5. Rectovulvar fistula in a child secondary to an unusual foreign body.foreign bodies in the female genital tract are well recognized as a cause of pain, discharge, secretions, and infection. In the small child, the presence of a vaginal discharge is usually associated with either a common object which has been inserted or sexual abuse complicated by a sexually transmitted disease. A 3-year-old child presented with a recurrent labial secretion and drainage due to an unusual foreign body. It was only during a second operation that the possibility of a foreign body was entertained, and diagnostic testing was begun. A third operation permitted removal of the foreign body, a large bone probably of animal origin. The fistula tract was closed after a colostomy was performed. This represents the first reported case of a rectovulvar fistula not of a congenital nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/5. Carcinoma in anorectal fistula of rectal mucosal origin.A case report of mucinous adenocarcinoma in anorectal fistula of rectal mucosal origin, though many cases reported were thought to be of anal duct origin. The patient, a 51-year-old male, was operated for anal fistula twelve years previously. He presented to us for anal pain, anorectal stricture, and perianal induration. Abdominoperineal resection was performed for proper management. On gross no visible mucosal lesion of anal canal and rectosigmoid colon was revealed. On cross section a gelatinous tumor was found mostly outside the rectal muscle layer, and an internal opening of the lesion was detected in the rectal mucosa. Histologically, the rectal mucosa extended into the edge of the internal opening and the carcinoma appeared just adjacent to this rectal mucosa. Periodate-borohydride/saponification/PAS stain also indicated that the mucin produced by the carcinoma had the nature of rectal mucosal origin. We considered that the carcinoma of this case originated at the internal opening and developed into the antecedent fistulous track.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |