Use of Ultrasonography in Clarifying the Etiology of Anal Pain

Youssef, Ashraf Talaat

doi:10.1016/j.jmu.2017.03.014

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…It has unique advantages in distinguishing solid, cystic or lacunar masses, providing high speci city and sensitivity of the diagnosis of perianal abscess. Endoanal ultrasound can clarify tumor involvement of the anal canal, and thus provide clues for accurate diagnosis and following treatment [33]. 5 cases of PRMS treated in our center showed solid masses with uneven echo and rich intratumoral blood ow signal with or withoud clear boundary, which was consistent with the relevant reports [34][35][36].…”

Section: Discussionsupporting

confidence: 90%

Perianal and Perineal Rhabdomyosarcomas - A Retrospective Multicenter Study of 35 Cases

Guo

Huang

et al. 2020

Preprint

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BackgroundPerianal/perineal rhabdomyosarcoma (PRMS) is rare, easy to be misdiagnosed and has poor prognosis. This study was designed to analyze the clinical, diagnostic, pathological and prognostic features of PRMS, and to explore its therapeutic modality.MethodsClinical data of PRMS patients in the Sixth Affiliated Hospital and the Cancer Center of Sun Yat-sen University and related Chinese literatures published between 1987 and 2018 were described and analyzed. Chi-square test was used to test the differences between groups. The Kaplan-Meier methods were used to estimate and compare survival rates.Results35 patients, 20 identified in the Chinese literatures and 15 of our center from 1997 to 2019, were included in this study. 34 cases presented as perianal mass and one presented as inguinal mass. 20 patients complained about pain and 16 cases were misdiagnosed as perianal abscess, in which pain was found related to misdiagnosis (p＜0.05). The average time from symptoms to pathological diagnosis was 3.1 months. 13 cases were categorized into IRS group III/IV and 20 cases into stages 3/4. 14 Cases were diagnosed as embryonal rhabdomyosarcoma pathologically and 9 as alveolar rhabdomyosarcoma. Five patients survived for more than two years, three of them survived for more than five years. The overall survival rates of two years and five years were 32% and 24% respectively, in which misdiagnosis contributes to poor prognosis (p＜0.05). MRI showed that PRMS was closely related to external anal sphincter in 10 cases. ConclusionPRMS is easy to be misdiagnosed, which could lead to worse outcome. Patients with painful perianal mass should be evaluated to exclude PRMS. MRI shows PRMS is closely related to external anal sphincter. Comprehensive therapy including radical operation and chemotherapy is recommended.

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Section: Discussionsupporting

confidence: 90%

Perianal and Perineal Rhabdomyosarcomas - A Retrospective Multicenter Study of 35 Cases

Guo

Huang

et al. 2020

Preprint

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“…Lesions which lower margin start at the first curve of the rectum (about 3-4 cm from the anal verge) are extremely rare DE nodules. Anorectal abscesses [29,30] and Gartner duct cysts [31] in the vaginal wall belong here. Both may present as cystic structure in grayscale and increased vascularity with color Doppler.…”

Section: Endometriotic Lesionmentioning

confidence: 81%

Diagnostic accuracy of the IDEA protocol for non invasive diagnosis of rectosigmoid DE – a prospective cohort study

et al. 2023

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Objectives: To test the accuracy of TVS applying the IDEA approach for suspected rectosigmoid DE and to determine the frequency of other pelvic diseases mimicking DE in patients undergoing surgery. Materials und Methods: Prospective single center observational study including consecutive women undergoing TVS for clinically suspected rectosigmoid DE followed by conservative or surgical therapy. TVS findings were compared with those obtained by laparoscopy and confirmed histologically. Results: Of the 671 included patients, 128 women opted for medical therapy, and 6 patients decided for surgery but did not give consent to participate in the study. 537 women were enrolled in the final analysis. 279 (52%) exhibited surgically confirmed rectosigmoid DE. The sensitivity and specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio (LR+/-) and accuracy of TVS for diagnosing DE in the rectosigmoid were 93.5%, 94.6%, 94.9%, 93.1%, 17.24, 0.07, 94.04%. 12 women who were clinically suspected for DE and mimicked sonographic signs fulfilling the IDEA criteria did exhibit other pathologies. Diagnoses were as follows: vaginal Gartner duct cyst (3/291;1.0%), anorectal abscess (3/291;1.0%), rectal cancer (2/291;0.7%), hydrosalpinx (2/291;0.7%), metastatic endometrial cancer (1/291;0.35%) and Crohn’s disease (1/291;0.35%). Conclusion: TVS for diagnosing colorectal DE applying the IDEA criteria is highly accurate for presurgical diagnosis. However, additional pelvic pathologies are encountered in 4-5% of women attending for suspected rectosigmoid DE. These need to be taken into account when investigating patients for suspected DE. Ziel: Die Prüfung der diagnostischen Aussagekraft der TVS nach dem IDEA-Protokoll bei Verdacht auf rektosigmoidale TIE und Bestimmung der Häufigkeit möglicher anderwertiger pathologischer Veränderungen. Material und Methode: Prospektive TVS-basierte Beobachtungsstudie mit konsekutivem Einschluss von Patientinnen mit klinischem Verdacht auf rektosigmoidale TIE. Die Ergebnisse der TVS wurden mit den Ergebnissen der chirurgischen Therapie verglichen. Ergebnisse: Von den 671 Patientinnen, die sich einer TVS unterzogen, 128 Frauen entschieden sich für eine medikamentöse Therapie. 6 Patientinnen entschieden sich für einen chirurgischen Eingriff, gaben aber keine Zustimmung zur Teilnahme an der Studie. 537 Patientinnen wurden in die Studie aufgenommen. 279 (52%) Patientinnen wiesen histologisch verifizierte rektosigmoidale TIE auf. Die Sensitivität und Spezifität, der PPV der NPV, die LR+ und die LR- sowie die Genauigkeit der TVS zur Diagnose von rektosigmoidealen TIE lagen bei 93,5 %, 91,8 %, 94,9 % 89,7 %, 11,54, 0,07, 92,9 %. 12 Frauen, bei denen ein klinischer und sonografischer Verdacht auf rektosigmoidale TIE bestand wiesen andere Pathologien auf: Gartner-Gang Zyste der Vaginalwand (3/291;1,0 %), anorektaler Abszess (3/291;1,0 %), Rektumkarzinom (2/291;0,7 %), Hydrosalpinx (2/291;0,7 %), metastasierendes Endometriumkarzinom (1/291;0,35 %) und Morbus Crohn (1/291;0,35 %). Schlussfolgerungen: Die TVS zur prächirurgischen Diagnose der rektosigmoidalen TIE unter Anwendung des IDEA-Protokolls ist aussagekräftig. Bei etwa 4-5 % der Patientinnen mit sonografischen, IDEA-basierten Zeichen einer rektosigmoidalen TIE, müssen anderwertige Krankheiten in Betracht gezogen werden.

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“…It has unique advantages in distinguishing solid, cystic or lacunar masses, providing high specificity and sensitivity for the diagnosis of perianal abscess. Endoanal ultrasound can clarify tumor involvement of the anal canal, and thus provide clues for accurate diagnosis and adequate treatment [ 33 ]. Five cases of PRMS treated at our center revealed solid masses with uneven echo and rich intratumural blood flow signals with or without clear boundaries, which was consistent with the relevant reports [ 34 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

Perianal and perineal rhabdomyosarcomas: a retrospective multicenter study of 35 cases

Guo

Huang

et al. 2021

BMC Surg

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Background Perianal/perineal rhabdomyosarcomas (PRMS) are easily misdiagnosed soft tissue tumours with a poor prognosis. This study was designed to analyze the clinical, diagnostic, pathological and prognostic features of PRMS, and to explore currently available therapeutic modalities. Methods Clinical data of PRMS patients admitted to the Sixth Affiliated Hospital and the Cancer Center of Sun Yat-sen University and from related Chinese literature published from 1987 to 2018 were collected and analyzed. The Chi-square test was used to evaluate the differences between each group. The Kaplan–Meier methods were applied to estimate and compare survival rates. Results A total of 35 patients were included in this study; 20 identified within related Chinese literatures and 15 from our center admitted during the period of 1997–2019. Out of these cases, 34 presented with perianal masses and the remaining one manifested as an inguinal mass. Moreover, 20 patients complained of pain and 16 of them were misdiagnosed as perianal abscesses, in which the presence of pain contributed to the misdiagnosis (p < 0.05). The average time interval between symptom onset and pathological diagnosis was 3.1 months. Next, 13 cases were classified into IRS group III/IV and 20 cases into stages 3/4. Additionally, 14 and 9 cases received the pathological diagnoses of embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma, respectively. Regarding the patients’ survival rates, five patients survived for more than 2 years, and three of them survived for more than 5 years. The overall 2 years and 5 years survival rates were 32% and 24%, respectively. The symptom of pain and misdiagnosis both contributed to the poor prognosis in these patients (p < 0.05). MRI showed that the PRMS were closely related to external anal sphincter in 10 cases. Conclusion PRMS are easily misdiagnosed lesions, which often leads to an unfavourable outcome in affected patients. Patients with painful perianal masses should be evaluated to exclude PRMS. MRI revealed that PRMS are closely related to the external anal sphincter. Multidisciplinary management is recommended in the treatment of PRMS.

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Use of Ultrasonography in Clarifying the Etiology of Anal Pain

Cited by 11 publications

References 11 publications

Perianal and Perineal Rhabdomyosarcomas - A Retrospective Multicenter Study of 35 Cases

Perianal and Perineal Rhabdomyosarcomas - A Retrospective Multicenter Study of 35 Cases

Diagnostic accuracy of the IDEA protocol for non invasive diagnosis of rectosigmoid DE – a prospective cohort study

Perianal and perineal rhabdomyosarcomas: a retrospective multicenter study of 35 cases

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