1/21. pneumocystis carinii infection presents as common bile duct mass biopsied by fine-needle aspiration.This paper describes a case of pneumocystis carinii (PC) presenting as a common bile duct intraluminal mass in an hiv-infected 30-yr-old homosexual man. In fine-needle aspiration smears, exuberant vascular proliferation associated with multinucleated giant-cell reactions was found within the granular exudate of PC.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/21. Warty carcinoma of the anus: a variant of squamous cell carcinoma associated with anal intraepithelial neoplasia and human papillomavirus infection.Warty carcinoma (WC) is a rare variant of squamous cell carcinoma primarily described in the vulva in younger women and classically associated with human papillomavirus (HPV) infection. The gross findings are similar to those of verrucous carcinoma with large, exophytic tumors with a papillomatous surface. Microscopically, the tumor is papillated and contains fibrovascular cores covered by hyperkeratotic epithelium showing presence of koilocytes. We report a case of anal squamous cell carcinoma showing similar features, occurring in a young immunosuppressed male patient with a history of multifocal anal intraepithelial neoplasia (AIN). HPV-16 has been demonstrated both in the WC and in adjacent AIN, but the HPV status appears different in the two lesions: integrated in WC and episomal in AIN lesions. We also have demonstrated by immunohistochemistry that both WC and AIN are highly proliferative entities sharing the same MIB-1 pattern, and that WAF1/CIP1 protein expression is common in the two lesions irrespective of p53 protein expression.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/21. Successful palliation of stenosing anorectal melanoma by intratumoral injections with natural interferon-beta.Anorectal malignant melanoma is an uncommon tumour. Unlike for cutaneous melanoma, there are few guidelines for its optimal management. In particular, very few palliative treatment strategies have been described for patients with advanced disease. We report on an 80 year old patient with locally advanced anorectal melanoma nearly completely blocking the anal orifice and disseminated metastases. Complete regression of the primary tumour and partial remission of the metastases was achieved with intratumoral injections of natural interferon-beta and systemic administration of dacarbazine. The quality of life in this patient was improved markedly by providing relief from severe rectal pain and bleeding. We propose that conservative treatment strategies such as intratumoral injections with interferon-beta should be considered as a palliative treatment option for stenosing anorectal melanoma before an abdominoperineal resection is recommended.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/21. Merkel cell (neuroendocrine) carcinoma of the anal canal: report of a case.Merkel cell tumors are rare neuroendocrine tumors typically found on sun-exposed areas such as extremities. We describe the case of a 42-year-old female with a Merkel cell tumor arising in the anal canal. The tumor was initially thought to represent a hemorrhoid arising during pregnancy and was excised locally after confirmation of extensive metastatic disease. The patient died 13 months after diagnosis with extensive metastatic disease involving the liver. In our search of the world literature there are several reports of neuroendocrine tumors in the rectum; however, no cases of documented Merkel cell tumors arising in the anal canal have been reported. These tumors seem to behave in a very aggressive manner when found in other atypical areas. The presentation symptoms were perianal discomfort and bleeding. Local excision may be the only surgical treatment necessary to control symptoms, given the propensity to early metastases and short life expectancy.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/21. amifostine and curative intent chemoradiation for compromised cancer patients.Concurrent chemotherapy and radiation are usually indicated for locally advanced carcinomas such as head and neck and anal malignancies. Because of the toxicity of the treatment, patient selection plays an important role in recommendations to treat with a curative intent. Elderly patients (> 70 years), those with underlying medical conditions or acquired immunological disorders (AIDS) are commonly excluded from combined modality therapy because of their perceived inability to tolerate the aggressive treatment. They may thus be deprived of a potentially curative therapy. In an attempt to improve outcome, we conducted a pilot study using amifostine, a radioprotector, to increase the tolerance of such compromised individuals to treatment. amifostine (500 mg intravenously) was given during chemotherapy on days 1-5, and days 21-25 of radiation regimen. All patients were able to complete the chemoradiation. Despite the locally advanced stage of the disease, five out of our six patients achieved a complete response (CR). One patient with synchronous primaries had a complete response for the base of tongue cancer and regression of the esophageal cancer, which allowed him to resume oral feeding. All patients achieved improved quality of life. Successful chemoradiation appears to be feasible in patients with advanced stage, age and/or underlying medical conditions when amifostine is integrated in the treatment.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/21. Large ulcerated perianal hidradenoma papilliferum in a young female.BACKGROUND: Hidradenoma papilliferum is an uncommon benign tumor that is located almost exclusively in the vulvar and anal areas. It is usually very small and asymptomatic, and to make a correct diagnosis is clinically very difficult. Occasionally the tumor becomes elevated to form a reddish brown papillary mass, and the surface ulcerates, which may erroneously suggest malignancy. OBJECTIVE: We report a case of a large, perianal hidradenoma papilliferum with suspected malignancy in a young Japanese female. RESULTS: A 22-year-old female had been aware of a perianal nodule for approximately 1 year. Examination of the perianal area revealed a wide pedunculated, reddish nodule with several white maculae. It was ulcerated and bleeding, 2.0 x 1.2 x 0.8 cm in size, and located in the 3 o'clock position. The nodule was totally excised with a narrow margin. The histopathologic diagnosis was hidradenoma papilliferum. No recurrence was observed for 23 months. CONCLUSION: When dermatologists encounter tumors of the anogenital area of adult females, it is important to keep hidradenoma papilliferum in mind as the differential diagnosis. Dermatologists should recognize that the tumor is benign, eliminating the need for wide resection.- - - - - - - - - - ranking = 8keywords = life (Clic here for more details about this article) |
7/21. Anorectal melanoma. Problems of histopathologic diagnosis.The present study discusses, in the light of the comparatively restricted data in the speciality literature, two cases of anorectal melanoma emphasizing the histologic diagnostic difficulties linked to appraisal of the limits of the benign naevus formations, predominance of the achromatous zones, alternation of the benign and sarcomatous fascicular proliferations and those of the anaplastic carcinoma type. Stress is laid on the importance for the diagnosis of the histologic examination and of serial sections, in all pedunculate formations in the anorectal region as well as of the tests applied for detecting melanin.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/21. Fibroepithelioma-like changes associated with anogenital epidermotropic mucinous carcinoma. Fibroepitheliomatous Paget phenomenon.We describe two patients with crusted perineal plaques that were biopsied and diagnosed as Paget's disease. Resection specimens of each contained a dermal mucinous carcinoma with extensive epidermotropism and coexistent epidermal basaloid proliferations closely resembling fibroepithelioma (Pinkus). The presence of the Paget phenomenon was supported by histochemical, immunohistochemical, and ultrastructural evidence. No other primary neoplasms were found in either patient. Followup at 2 1/2 and 3 1/2 years, respectively, has been negative. We conclude that either the fibroepitheliomatous changes may be induced by or may represent a collison (unlikely) with the epidermotropic mucinous carcinoma. It is proposed that the concept fibroepitheliomatous Paget phenomenon be used to stand for the histologic changes common to our cases as well as those previously reported.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/21. Primary anorectal malignant melanoma.A case of primary anorectal malignant melanoma seen in a 46 year old woman is presented herein. Her most marked symptoms were bloody stools and anal pain. Endoscopic examination indicated a tumor with ulceration but without pigmentation in the anorectal region. Histologic examination of the biopsied specimens showed spindle-shaped cells with atypia proliferating in a bandlike arrangement, as in leiomyosarcoma. An abdominoperineal resection was done and detailed histological examination of the tumor confirmed the nature of the tumor to be malignant melanoma. The postoperative immunochemotherapy consisted of Dimetyl-Triazeno-Imidasole-Carboxamide (DTIC), Amino-Methyl-Pyrimidinyl-Methyl-Chlorethyl-Nitrosourea-Hydrochlori de (ACNU), vincristine (VCR) and OK-432. The patient has been well without recurrence for fifteen months following her operation through the continuous administration of these agents.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/21. anal canal neuroendocrine carcinoma with Pagetoid extension.A case of anal canal neuroendocrine carcinoma with Pagetoid intraepithelial extension is presented. An 80-year-old man was admitted to hospital with a complaint of pain in the anorectal region. Clinical examination revealed a hard and fixed mass in the anal canal, and subsequent biopsy of the lesion showed it to be a carcinoma. The surgically resected specimen showed a solid tumor measuring 3.4 x 3.2 cm within the area from the surgical anal canal to the anatomical anal canal. Tumor cells proliferated predominantly with compact nests. Many tumor cells had a high nuclear-to-cytoplasmic ratio, dispersed chromatin, and conspicuous nucleoli. Additionally, neoplastic cells focally formed a glandular structure. Some polygonal neoplastic cells were small with round nuclei. A rosette-like arrangement was also focally observed. In addition, tumor cells exhibited Pagetoid extension into the overlying epithelium of the histological anal canal. Both the underlying original neoplastic cells and the Pagetoid spreading tumor cells showed cytoplasmic granules positive for Grimelius staining and immunopositivity for carcinoembryonic antigen, synaptophysin and cytokeratins 7 and 20. These findings are highly suggestive of neuroendocrine differentiation of adenocarcinoma cells. To the best of our knowledge, this is the first case of anal canal neuroendocrine carcinoma with Pagetoid extension into the overlying epithelium of the histological anal canal.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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