Magnetic resonance imaging findings of carcinoma arising from anal fistula: A retrospective study in a single institution

Abstract

BACKGROUND Magnetic resonance imaging (MRI) is currently the standard investigation for suspected perianal diseases. Carcinoma arising from anal fistula is very rare, and early diagnosis is often difficult. AIM To describe and summarize the MRI findings of carcinoma arising from anal fistula. METHODS In this retrospective study, records of ten patients diagnosed with carcinoma arising from anal fistula and confirmed by surgery ( n = 7) or biopsy ( n = 3) between June 2006 and August 2018 were analyzed. All patients underwent preoperative pelvic MRI. Morphologic features, signal characteristics, fistula between the mass and the anus, contrast enhancement of mass, signal and enhancement of peritumoral areas, and regional lymphadenopathy were assessed. RESULTS All ten tumors were solitary (8 mucinous adenocarcinomas and 2 adenocarcinomas). The maximum diameter of the tumors ranged from 3.4 cm to 12.4 cm (median: 4.15 cm; mean: 5.68 cm). Eight patients had a fistula between the mass and the anus. Contrast enhancement of the peritumoral areas was noted in three (3/5) patients. Perirectal or inguinal lymphadenopathy was noted in seven patients. Most lesions of mucinous adenocarcinoma were multiloculated and cauliflower-like, with a thin capsule and focally unclear boundary. They were markedly hyperintense on fat-suppressed T2WI, slightly hyperintense with focal hyperintensity on diffusion-weighted imaging (DWI), and hyperintense with focal hypointensity on apparent diffusion coefficient (ADC) map, with progressive mesh-like contrast enhancement. Adenocarcinomas had an infiltrative margin without a capsule and appeared heterogeneously hyperintense or slightly hyperintense on fat-suppressed T2WI, hyperintense on DWI, and hypointense on ADC map, with persistent heterogeneous enhancement. CONCLUSION Our study highlighted several characteristic and potentially helpful MRI findings to diagnose carcinomas arising from anal fistula.

Cancer in Anal Fistulas

“…24 An additional study evaluating MRIs of CD patients with adenocarcinoma report that mucinous subtypes have typical “cauliflowerlike” appearance with internal septations. 25 Despite the identification of these characteristics seen on MRI, it appears that these findings are often not so helpful in practice. 15 21 Additionally, some studies report the use of fluorodeoxyglucose positron emission tomography (PET) with inability to differentiate between benign inflammation and malignancy.…”

Value of apparent diffusion coefficient on MRI for prediction of histopathological type in anal fistula cancer

“…[ 11 ] Such imaging findings may reflect the characteristic features of mucinous carcinoma as a cystic tumor with a protein component within multifocal septal walls. [ 12 ] However, no previous report examined in detail the differences in MRI findings between mucinous and tubular adenocarcinomas.…”