Adenocarcinoma in the anal canal associated with a fistula: Report of a case

Abstract

Adenocarcinoma in the anal canal associated with an anal fistula is extremely rare, and in most cases its origin is difficult to ascertain because the primary sites have already been destroyed before any diagnosis of malignancy is able to be made. We report herein the case of a 62-year-old man found to have papillary adenocarcinoma with partial mucinous carcinoma associated with an anal fistula. The tumor was not exposed to the mucosal surface of the anal canal or rectum and an abdominoperineal resection was carried out. Macroscopic findings suggested that the tumor had developed from the anal fistula; however, the tumor showed a positive results when tested for O-acetylated sialic acids. This test also proved positive in the mucus of normal rectal mucosa, but not in the mucus of the anal glands. We speculated that the results of these tests may indicate that this tumor could have originated from the rectal mucosa, from where it migrated into the anal fistula.

Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from a single institution

“…Anthony et al reported survival of 2-48 months in their patients [2]. Taniguchi et al presented one patient who has survived for 6 years after abdominoperineal resection as the primary treatment without adjuvant therapy [3]. Klas et al reported survival and recurrence rates at 5 years of 63% and 21%, respectively; this high survival rate was attributed to a relatively small tumour (in 78% of cases, <5 cm) and the use of chemoradiotherapy either preoperatively or postoperatively for larger tumours (>5 cm) [17].…”

“…Shoji Taniguchi et al reported a case of an anal canal adenocarcinoma associated with a fistula in 1996 [3]. They histochemically demonstrated the presence of Oacetylated sialic acids in the mucus of the tumours cells, as well as in the cells of the normal colorectal mucosa.…”

“…Mucinous adenocarcinoma of the perianal region is a rare cancer, constituting 3%-19% of all anal carcinomas [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. It is even rarer still that a mucinous adenocarcinoma is found to be arising from a chronic anorectal fistula, with few reports in the literature.…”

Mucinous adenocarcinoma derived from chronic perianal fistulas: report of a case and review of the literature

“…However, wide surgical resection is the preferable treatment option, and is usually not associated with radiotherapy or chemotherapy [9][10][11], as in this case. Mucinous adenocarcinoma should be suspected in every patient presenting with chronic perianal fistulas.…”

“…A review of the literature revealed fewer than 120 cases of this disease (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14]. Early diagnoses is difficult, as the symptoms are nonspecific and appear late.…”