Carcinoma arising in anorectal fistulas of Crohn's disease

Ky, Alex; Sohn, Norman; Weinstein, Michael A.; Korelitz, Burton I.

doi:10.1007/bf02237388

Cited by 187 publications

(100 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4 -5. In a 31-and a 38-yr-old woman, both with a 20-yr history of Crohn's disease, an unsuspected squamous cell carcinoma was found by biopsies of complex perirectal fistulas and then treated by chemotherapy and radiation therapy (14). 6.…”

Section: Henri Bismuth MD Facs (Hon)mentioning

confidence: 99%

See 1 more Smart Citation

Carcinoma Arising in Crohn's Disease Fistulae: Another Concern Warranting Another Type of Surveillance

Korelitz¹

1999

American Journal of Gastroenterology

View full text Add to dashboard Cite

tion prevalence of 1-2% of hepatitis C infection in Western countries. Some 10 -20% of hepatitis C patients develop cirrhosis, and of these, 1-4% per year will develop HCC. Early detection of small tumors as a result of screening programs in cirrhosis will increase the number of patients with a better prognosis and who may be candidates for transplantation.In this issue of the journal, Dr. Poon and the Hong Kong team (1) report their experience with surgical and nonsurgical management of HCC in the elderly. They deserve congratulations for an interesting study, carried out with rigor, and analyzing the many factors involved in the assessment of the risks of surgery and of chemoembolization in the elderly.They have shown that there is not an increased risk in hepatic resection for HCC in patients aged 70 yr or more, for tumors assessed as operable. When tumors are not resectable, patients in this age group can be treated by percutaneous approaches, such as transarterial chemoembolization or ethanol injection for smaller tumors. Cisplatin was chosen as the chemotherapeutic agent for chemoembolization, which in our own experience, seems to give better tumor necrosis than doxorubicin (2).Dr. Poon's team performed a preselection of elderly patients, with exclusion of those with comorbid risk factors. This may have contributed to the good results. Nonetheless, it is important to know that one can carry out a full screening of elderly patients with HCC to select those who will best benefit from resection, and that age by itself, is not a contraindication to surgery. As all of us know, some patients aged 70 or 75 yr are in better physiological condition than younger ones.A second topic that the article raises concerns critical review of institutional practice. Data were stratified into two periods because of a change in surgical technique. The experience of the surgical team is also a key factor. The self-evaluation process highlighted both surgical technique and postoperative management as important in the reduction of hospital mortality and morbidity in HCC. The approach is one that we all could apply to other procedures and pathologies in our quest for continuous improvement in surgical quality and outcomes. This paper is a contribution to surgical science that may reduce age-related treatment bias in the management of the increasing numbers of elderly patients with HCC that are expected in the near future.Henri Bismuth, M.D., F.A.C.S. (Hon.) Centre

show abstract

Section: Henri Bismuth MD Facs (Hon)mentioning

confidence: 99%

“…6. In one 30-yr-old woman with Crohn's disease for 8 yr, the tissue obtained at fistulotomy (perirectal) revealed a squamous cell carcinoma, which was then treated by chemotherapy and radiation therapy (14). 7-9.…”

Section: Henri Bismuth MD Facs (Hon)mentioning

confidence: 99%

Carcinoma Arising in Crohn's Disease Fistulae: Another Concern Warranting Another Type of Surveillance

Korelitz¹

1999

American Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Thorough physical examination of the rectum and perianal region is usually limited by pain, stricture, and/or induration of the perineal tissues (9). Even examination under anesthesia by experienced colorectal surgeons may miss an early malignant lesion.…”

Section: Discussionmentioning

confidence: 99%

“…Even examination under anesthesia by experienced colorectal surgeons may miss an early malignant lesion. Ky et al (9) have recommended that biopsy or curettage be performed at examination under anesthesia to avoid delaying the diagnosis of a low rectal malignancy.…”

Section: Discussionmentioning

confidence: 99%

MRI appearance of perianal carcinoma in Crohn's disease

Lad

Haider

Brown

et al. 2007

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Detection of carcinoma in perianal Crohn's disease can be difficult. The purpose of this study was to describe the MRI appearance of anorectal cancer in patients with perianal Crohn's disease. A total of six patients with anorectal carcinoma (four mucinous adenocarcinoma, two squamous) in Crohn's disease were retrospectively reviewed. Axial T2 and dynamic postcontrast fat‐suppressed T1‐weighted gradient echo sequences were performed, and findings were compared with 18 noncancer patients with perianal fistulae in Crohn's disease. MRI characteristics of carcinoma were irregular inner wall contours and delayed mild enhancement of internal tissue. The combined features of an irregular internal wall and delayed enhancing tissue were seen exclusively in cancer patients. The four cases of mucinous adenocarcinoma all displayed a pattern of lobulated fluid‐filled cavities with delayed internal tissue enhancement. This pattern was not seen in any of the control cases. The presence of a double‐layered enhancement pattern was seen in both cases of squamous carcinoma and in only one of four cases of mucinous adenocarcinoma and one of 18 noncancer cases. The pattern of contrast enhancement is valuable in the MRI diagnosis of carcinoma in perianal Crohn's disease. J. Magn. Reson. Imaging 2007. © 2007 Wiley‐Liss, Inc.

show abstract

“…The presence of perianal disease is associated with a more disabling natural history [11], with increased extraintestinal manifestations [12] and greater steroid resistance [13]. Large studies have also shown an increased risk for squamous cell carcinoma and adenocarcinoma of the anus in patients with anorectal involvement [14,15].…”

Section: Introductionmentioning

confidence: 99%

MRI of Crohn?s Anoperineal Disease

McDermott¹

2013

J Gastrointest Dig Syst

View full text Add to dashboard Cite

Anoperineal involvement is seen in up to 38% of patients with Crohn's disease. To adopt the best treatment strategy and avoid recurrences, it is important to obtain precise radiological information of the fistulous track. Magnetic resonance imaging provides precise information on the anatomy of the anal canal, the anal sphincteric complex, and the relationship of the fistula to the pelvic floor structures. In this article we review the anatomy of the anal canal, the pathogenesis of perianal fistula, different MRI sequences for the evaluation of fistula with emphasis on their imaging findings and an MR imaging based grading system for their classification.

show abstract

Carcinoma arising in anorectal fistulas of Crohn's disease

Cited by 187 publications

References 18 publications

Carcinoma Arising in Crohn's Disease Fistulae: Another Concern Warranting Another Type of Surveillance

Carcinoma Arising in Crohn's Disease Fistulae: Another Concern Warranting Another Type of Surveillance

MRI appearance of perianal carcinoma in Crohn's disease

MRI of Crohn?s Anoperineal Disease

Contact Info

Product

Resources

About