Endoscopic submucosal dissection for early squamous cell carcinoma in the anal canal and Lugol chromoendoscopy for assessment of the lateral margin

Abstract

A 66-year-old man underwent follow-up colonoscopy after colon polypectomy. The retroflexed view of the anal canal with white-light imaging revealed a whitish, slightly elevated lesion on the dentate line and an ill-defined flat lesion. A biopsy of the whitish elevation revealed squamous cell carcinoma (SCC), and endoscopic submucosal dissection (ESD) was planned. The lateral margin of the SCC was identified by spraying with Lugol’s iodine, and the tumor was resected en bloc with no complications. The pathological findings were SCC in situ with parakeratosis in the whitish elevation and high-grade intraepithelial neoplasia in the ill-defined flat lesion, which exhibited a wide iodine-unstained area by chromoendoscopy. Early SCC in the anal canal is a rare gastrointestinal cancer, and Lugol chromoendoscopy helped visualize the tumor margin for ESD.

Percutaneous- and EUS-guided gastroenterostomy for malignant afferent limb syndrome

“…Several case reports have demonstrated the efficacy of endoscopic self-expanding metal stent placement as a therapeutic strategy among these patients. 2 , 3 , 4 However, as demonstrated by our case, in patients with complete or even partial obstruction, enteral stent placement may not be optimal. In such patients, when surgery poses a significant risk of morbidity, construction of a gastroenterostomy using a lumen-apposing metal stent is an efficacious option.…”

Safety, feasibility, and short-term-outcome of anal endoscopic submucosal dissection for anal intraepithelial neoplasia: an option for focal lesions?

“…This is, to our knowledge, the biggest cohort of patients with anal neoplasms treated with ESD in a single institution. Case reports and series have shown the possibility of ESD in the anal canal, but larger cohorts or prospective studies are lacking [ 14 – 17 ].…”

Endoscopic diagnostics and treatment of “early” anal cancer

“…Для эндоскопической диагностики рака анального канала отдельные авторы рекомендуют использование хромоэндоскопии с раствором Люголя, который селективно абсорбируется клетками плоского эпителия и не накапливается в железистом и в клетках плоскоклеточного рака [22] (Рис. 6,7 ) .…”