Mucinous adenocarcinoma in anorectal fistulae

Abstract

Mucinous adenocarcinoma arising in an anorectal fistula is an uncommon condition which gives rise to difficult problems of diagnosis and pathogenesis. The clinical history and pathology of seven patients are described and compared with six patients in whom anal fistulae were lined by normal rectal mucosa or 'misplaced glands'. In five of the cases granulomas were present which were a further cause of diagnostic difficulty. The evidence from this study suggests that the fistulous tracks are congenital duplications of the lower end of the hind gut lined by rectal mucosa which is prone to malignant change to mucinous adenocarcinoma. The prognosis after excision of the rectum is good.

Fistula-Associated Anal Adenocarcinoma: Good Results with Aggressive Therapy

“…Adenocarcinomas and squamous-cell carcinomas have both arisen in nonhealing fistula tracts (Table 4). 7,8,[18][19][20][21][22][23][24][25][26][27] Long-standing fistulas of the gastrointestinal and bronchopulmonary systems have been the most widely affected by malignant transformation. [28][29][30] Chronic infection and inflammation (i.e., Crohn's disease and radiation) are the most frequently associated risk factors.…”

Is histopathological evidence really essential for making a surgical decision about mucinous carcinoma arising in a perianal fistula? Report of a case

“…The prognosis after APR is generally good, probably because of the propensity of this tumor to be well differentiated and slow growing, and the rarity of metastasis to lymph nodes. 6 In conclusion, biopsy of any anal tumor is undoubtedly essential for diagnosis, although it often fails to provide diagnostic evidence of mucinous carcinoma. Thus, surgical decisions about mucinous carcinoma should be based on clinical manifestations, imaging fi ndings, and cytology of mucin obtained by drainage even when it is diffi cult to obtain malignant cells in multiple biopsies.…”

“…Unfortunately, the diagnosis of mucinous adenocarcinoma is often delayed because of failure to obtain biopsy evidence. [5][6][7] As the cancer cells are usually present in clusters fl oating in a mucous lake, deep and multiple biopsies of fi stulous tracts or perianal masses are often necessary to establish the diagnosis. We report a case of mucinous adenocarcinoma associated with an anal fi stula, in which histological analysis of the resected specimen provided important insight into the distribution of the mucin and cancer cells.…”

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

“…Jones et al in 1984 studied the histology of patients in whom they found normal rectal mucosa, or 'misplaced' glands lining anal fistula [4]. He postulated that these fistulous tracts are congenital duplications of the lower third of the hind gut lined by rectal 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.…”