Case report of an anal adenocarcinoma arising from a perineal lump

Abstract

Anal adenocarcinoma is a rare condition and can arise in chronic inflammatory states such as in Crohn's disease, or in a chronic fistula-in-ano. We report our diagnosis and management of a patient who presented with a large perineal lump with a long-standing history of perianal fistulous disease. This was initially evaluated with a Magnetic Resonance Imaging, and the diagnosis was confirmed with biopsy. Multimodality treatment with chemoradiotherapy and surgery should be offered to achieve the best outcomes.

What factors are associated with the poor prognosis of anal adenocarcinoma compared with low-lying rectal adenocarcinoma based on a population analysis: A propensity score matching study

“…It seems that radiotherapy and surgery provide the best 5-year disease-free survival rates, reaching 54%[15]. Primary CRT should be combined with APR; otherwise, it may be associated with high rates of local recurrence and distant metastases [1]. Contemporary studies of small sample sizes have suggested chemoradiotherapy mandated before abdominoperineal resection to achieve R0 resections and negative margins, with complete response rates as high as 85% (6/7)[16].…”

“…After neoadjuvant therapy, positive circumferential resection margins achieved during abdominoperineal resection were present in only 8% of patients[18]. The current literature suggests that when the disease is potentially curative, radical surgery with either pre- or postsurgery chemoradiotherapy should be attempted to achieve the best overall survival[1]. However, in a retrospective analysis of 22 patients, the conclusions demonstrated that local and regional control with radiation with or without chemotherapy resulted in high relapse rates in AA[3], and it is suggested that the use of radiation therapy among patients with AA did not appear to significantly influence survival rates[6].…”

“…Anal adenocarcinoma (AA), which is thought to originate from the columnar epithelium lining the anal glands, is a rare condition, accounting for approximately 1.5%-2.5% of all digestive system cancers[1, 2]. However, the worldwide incidence rate has steadily increased over the years[2].…”

A dualistic model of primary anal canal adenocarcinoma with distinct cellular origins, etiologies, inflammatory microenvironments and mutational signatures: implications for personalised medicine

“…According to a survey conducted by Abel et al, 12 most clinicians only occasionally encounter patients with anal adenocarcinoma. Therefore, the majority of recent descriptive studies are clinical case reports, 13–15 and there is a lack of sufficient information to generate guidelines for uniform treatment recommendations. 16,17 Moreover, molecular perturbations that might serve as targets for therapy are completely unknown.…”