Multidisciplinary management of colorectal adenocarcinoma associated with anal fistula: an Indian series

Pai, Vishwas D.; Jatal, Sudhir; Ostwal, Vikas; Saklani, Avanish

doi:10.1111/codi.13100

Cited by 16 publications

(20 citation statements)

References 17 publications

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“…showed 85% (6/7) complete response rates after neoadjuvant therapy [5] . These findings were further supported in another study whereby positive circumferential resection margins during abdominoperineal resection was present in only 8% (1/13) of patients following neoadjuvant therapy [15] .…”

Section: Discussionsupporting

confidence: 57%

Case report of an anal adenocarcinoma arising from a perineal lump

Chan

Chong

Tan

2016

Annals of Medicine &Amp; Surgery

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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.

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Section: Discussionsupporting

confidence: 57%

Case report of an anal adenocarcinoma arising from a perineal lump

Chan

Chong

Tan

2016

Annals of Medicine &Amp; Surgery

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“…A promising median disease-free survival and median overall survival can be achieved in cases of clear surgical margins[17]. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Chen

et al. 2019

PLoS ONE

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Purpose Anal adenocarcinoma (AA) represents a rare condition, and little is known about the predictive factors of the outcomes or the optimal TNM staging system for curable AA. Using population-based data, we preliminarily sought to determine the prognostic factors and evaluate the existing T and N staging criteria of AA. Methods We analyzed the Surveillance, Epidemiology, and End Results 18 database to identify patients 20–80 years old who were diagnosed with AA or rectal adenocarcinoma (RA) and underwent abdominal perineal resection between 2004 and 2012. The difference between Kaplan-Meier survival curves was estimated by a log-rank test. A Cox proportional hazard regression model was used to adjust the effects of other covariates on survival in the propensity score-matched cohort, including age, gender, race, marital status, histology, grade of differentiation, tumor size, number of positive lymph nodes, radiotherapy, and chemotherapy. Results Compared to patients with RA, patients with AA had a worse CSS after controlling for other covariates (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.25–3.07; P<0.01). For AA, the increasing tumor size (2–5 cm: HR, 0.62; 95% CI, 0.29–1.32; P>0.05; >5 cm: HR, 1.01; 95% CI, 0.49–2.07; P>0.05) had no significant influence on survival. The number of positive lymph nodes (1–3: HR, 2.93; 95% CI, 1.55–5.53; P<0.01; ≥4: HR, 4.24; 95% CI, 2.08–8.62; P<0.01) significantly influenced survival. Conclusions AA confers a worse prognosis than RA does. The T staging criteria of anal carcinoma, dominated by tumor size, seem to be invalid for AA, while the number of positive lymph nodes is a prognostic factor.

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“…Its diagnostic criteria were as follows: (1) The fistula should predate the carcinoma; (2) There should be no synchronous colorectal carcinoma; and (3) The internal opening of the fistula should be into the anal canal and not the malignancy[ 6 ]. However, it is often difficult to identify the disease origin since these criteria do not appear in all cases[ 3 , 7 ]. Here, we report a case of mucinous adenocarcinoma of the buttock with an atypical diagnostic course.…”

Section: Introductionmentioning

confidence: 99%

Mucinous adenocarcinoma of the buttock associated with hidradenitis: A case report

Kim

et al. 2020

WJCC

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BACKGROUND Mucinous adenocarcinomas of the buttock are rare and have an uncertain etiology and natural course. They are usually related to chronic anal fistulas, hidradenitis suppurativa, or Crohn's disease. Here, we report a case of mucinous adenocarcinoma associated with hidradenitis and contradictory immunochemistry results. CASE SUMMARY A 62-year-old man complained of recurrent abscesses of the buttock for 3 years. He had several scars and nodules in bilateral buttocks, with purulent discharge. The skin lesions did not appear to originate from the anus. The patient was diagnosed with recurrent abscesses due to hidradenitis suppurativa at the first visit. He showed purulent and subsequent mucin discharge in the first operation and was diagnosed with mucinous adenocarcinoma. Several examinations were performed to determine disease origin and staging. There were no significant findings or evidence of anal fistulas. Hence, he underwent wide local excision and V-Y advancement flap in the second operation. The final diagnosis was mucinous adenocarcinoma without any evidence of anal fistulas. Additional immunochemistry test results were negative for cytokeratin (CK) 7 and positive for CK20 and CDX2 , with a colorectal origin. A pathologist suggested that the disease originated from a chronic anal fistula. The patient has remained free of recurrence for 24 mo. CONCLUSION Although the patient with mucinous adenocarcinoma showed an atypical course, immunochemistry helped detect the disease origin.

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Multidisciplinary management of colorectal adenocarcinoma associated with anal fistula: an Indian series

Abstract: Colorectal adenocarcinomas associated with fistula are locally aggressive malignancies with a low incidence of lymph node involvement and distant metastasis. NACRT, wider resection in the form of extralevator APE, and liberal use of plastic reconstruction may result in favourable outcomes.

Cited by 16 publications

References 17 publications

Case report of an anal adenocarcinoma arising from a perineal lump

Case report of an anal adenocarcinoma arising from a perineal lump

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

Mucinous adenocarcinoma of the buttock associated with hidradenitis: A case report

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