Anal Metastasis of Colorectal Carcinoma Origin: Implications for Diagnosis and Treatment Strategy

Takahashi, Hidekazu; Ikeda, Masataka; Takemasa, Ichiro; Mizushima, Tsunekazu; Yamamoto, Hirofumi; Sekimoto, Mitsugu; Doki, Yuichiro; Mori, Masaki

doi:10.1007/dcr.0b013e318205e116

Cited by 17 publications

(16 citation statements)

References 21 publications

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“…The pattern of metastases to the anus is implanted or lymphovascular metastases [12]. Implantation of rectal carcinoma cells has often been reported in the last half century.…”

Section: Discussionmentioning

confidence: 99%

“…Rectal cancer cells are able to metastasize to the anal fistula [13,14], biopsy wounds [15], suture lines [16-18], and obstructive colitis [19]. Lymphovascular metastasis in the literature is defined as anorectal metastatic cancer with an intact anorectal epithelium [12]. In this case, the histological findings showed that small white nodules, consisting of cancer cells, existed in the lymphatic vessels of the submucosa and muscularis mucosae, but not on the mucosa (Figure 4B).…”

Section: Discussionmentioning

confidence: 99%

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Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

et al. 2012

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This report describes a case of rectal cancer with endoscopically observable white nodules caused by distal intramural lymphatic spread. A 57-year-old female presented to our hospital with frequent diarrhea and hemorrhoids. Computed tomography showed bilateral ovarian masses and three hepatic tumors diagnosed as rectal cancer metastases, and also showed multiple lymph node involvement. The patient was preoperatively diagnosed with stage IV rectal cancer. Colonoscopy demonstrated that primary rectal cancer existed 15 cm from the anal verge and that there were multiple white small nodules on the anal side of the primary tumor extending to the dentate line. Biopsies of the white spots were performed, and they were identified as adenocarcinoma. The patient underwent Hartmann’s procedure because of the locally advanced primary tumor. The white nodules were ultimately diagnosed as being caused by intramural lymphatic spreading because lymphatic permeation was strongly positive at the surrounding area. Small white nodules near a primary rectal cancer should be suspected of being intramural spreading. Endoscopic detection of white nodules may be useful for the diagnosis of distal intramural spread.

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“…The pattern of metastases to the anus is implanted or lymphovascular metastases [12]. Implantation of rectal carcinoma cells has often been reported in the last half century.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

et al. 2012

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“…Moreover, rectal carcinoma with synchronous anal metastasis is extremely rare [3], is difficult to diagnose, and no standardized therapeutic strategy exists [4]. In the present case, we performed local resection of the anal tumor to determine whether it was a primary cancer or represented metastasis of the rectal carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all of the cases had a history of anal fistulas or fissures. The optimal surgical procedure for colorectal cancer with anal metastasis has been controversial [4, 6, 7]. For the purpose of radical resection, APR has been performed in some cases, particularly in Japan.…”

Section: Discussionmentioning

confidence: 99%

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Anal metastasis of rectal cancer—adenocarcinoma of squamous cells: a case report and literature review

et al. 2017

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Anal metastasis of colorectal cancer is very rare and is usually associated with a history of anal disease, including anal fistula, fissure, hemorrhoidectomy, and anastomotic injury. We report a case of rectal cancer with a synchronous anal metastasis consisting of adenocarcinoma of squamous cells without a history of anal disease. A 60-year-old woman had a chief complaint of melena. She had a 1.5-cm anal tumor on the perianal skin, and a Bollman type 2 rectal tumor on the Ra portion was found on colonoscopy. Biopsy of both tumors revealed a similar histology of well- to moderately differentiated adenocarcinoma. There was no sign of metastases in lymph nodes or other organs. For the purpose of diagnosis and treatment, transperineal local resection of the anal tumor was performed, and it was histologically identified as adenocarcinoma of squamous cells with no invasion to muscles, lymph ducts, or microvessels. The pathological margin was free. Then, to achieve radical cure, laparoscopic low anterior resection (LAR) with D3 lymphadenectomy was performed. The histological diagnosis of the anal tumor was adenocarcinoma of squamous cells without invasion to muscles, lymph ducts, or vessels. The surgical margin was completely free. Immunohistochemical analysis of both tumors revealed similar staining patterns, and the final diagnosis was rectal cancer with metastasis to the anal skin. The patient received no postoperative therapy, and no recurrences have been observed 12 months after surgery. We expect that our sphincter-preserving surgical strategy provided a good prognosis for the synchronous rectal cancer and anal metastasis. This is a rare report of a case with an anal metastasis of colorectal cancer on perianal squamous cells without a history of anal disease that was resected while preserving anal function.

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Anal metastasis of sigmoid colon cancer

Yamada¹

2022

Clinical Case Reports

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Anal Metastasis of Colorectal Carcinoma Origin: Implications for Diagnosis and Treatment Strategy

Cited by 17 publications

References 21 publications

Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

Anal metastasis of rectal cancer—adenocarcinoma of squamous cells: a case report and literature review

Anal metastasis of sigmoid colon cancer

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