Cases reported "Anus Neoplasms"

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1/44. A solitary fibrous tumor in the perianal region with a 13-year follow-up: report of a case.

    A case of a solitary fibrous tumor (SFT) of the perianal region in a 62-year-old man is reported herein. The patient had undergone an abdominoperineal excision of the rectum for an anorectal tumor 13 years previously, and had been referred to our hospital for a perineal mass. Computerized tomography and angiography revealed a markedly hypervascular tumor measuring 11 x 8 cm in size in the pelvic cavity. After preoperative radiotherapy (total 58 Gy) and the embolization of the feeding arteries, he underwent an en bloc excision of the tumor. Microscopically, the tumor was composed of spindle shaped cells with a "patternless" arrangement in a collagenous background. There was immunohistochemical evidence that these cells were strongly positive for CD34, thus suggesting the tumor to be SFT. The previously resected anorectal tumor showed similar histological and immunohistochemical findings. The patient's recovery was uneventful.
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2/44. adenocarcinoma arising from a recurrent fistula-in-ano.

    Anal fistulas are frequent events which often recur after an inadequate surgical treatment. Nevertheless their evolution into malignant diseases is infrequently observed. The authors report one case of mucinous adenocarcinoma arising out of a recurrent, long-lasting fistula-in-ano. As reported, abdomino-perineal resection combined with radiotherapy can be the choice treatment. The difficulty is to obtain a reliable differential diagnosis. No imaging technique nor histologic examination can establish a definitive reliable diagnosis; nevertheless, as the risk of adenocarcinoma developing from a long-lasting recurrent fistula-in-ano, although small, is real, authors believe that operative exploration and biopsy of recurrent abscesses and fistulas should be recommended.
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3/44. Mucinous adenocarcinoma in chronic anorectal fistula.

    adenocarcinoma in association with chronic anal fistula is a rare disease which gives rise to difficult problems of diagnosis and treatment. A case of mucinous adenocarcinoma arising on a long standing fistula in ano is described. A patient with a long history of mucinous discharge, pain and perianal induration underwent a biopsy of the external opening of the fistula that showed mucinous infiltrating adenocarcinoma. After a colonoscopy and a preoperative abdominal CT scan, she underwent a successful abdominoperineal resection with adjuvant chemoradiation therapy. diagnosis of this condition is often difficult; deep and multiple biopsies of the fistulous tracks or perianal mass are necessary to establish the diagnosis. An accurate staging of the neoplasm, using endorectal ultrasound, NMR or CT scans is needed to plan the appropriate treatment. Recent studies have shown that locally advanced anal adenocarcinomas could benefit from pre or postoperative chemoradiation therapy. However, an accurate and complete removal of the tumor, which usually entails abdominoperineal resection, is often necessary to achieve radicality. Despite new therapy protocols, the prognosis of mucinous adenocarcinoma is still poor, mostly due to its advanced nature at the time of diagnosis. This reinforces the importance of biopsy of all perianal abscesses and fistulas for early detection and treatment.
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4/44. Perianal mucinous carcinoma successfully treated with a combination of external beam radiotherapy and high dose rate interstitial brachytherapy.

    The case of an 84-year-old man with perianal mucinous carcinoma is presented. The tumour was 6 cm in diameter and extended into the surrounding tissues. Taking the patient's advanced age and disease into account, rectosigmoidectomy and colostomy were carried out without resection of most of the tumour. radiotherapy consisted of pre-operative external beam radiotherapy (EBRT) of 40 Gy in 20 fractions, post-operative EBRT of 24 Gy in 12 fractions, and high dose rate interstitial brachytherapy of 12 Gy in a single fraction. The patient tolerated the entire course of radiotherapy well. The patient is doing well without regrowth or complications 7 years after radiotherapy. To our knowledge, there have been no reports on the successful outcome of radiotherapy for perianal mucinous carcinoma. This case suggests that a combination of EBRT plus interstitial brachytherapy boost may play a role in the definitive treatment of perianal mucinous carcinoma.
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5/44. Complete remission of the liver metastases of anorectal malignant melanoma with regional chemotherapy: a case report.

    The prognosis of anorectal malignant melanoma is very poor. We present a 48-year-old male patient with anorectal malignant melanoma and multiple liver metastases who underwent abdominoperineal resection. A port system was implanted to the gastroduodenal artery for regional chemotherapy for liver metastases. Histopathological findings of tumor were 5 cm diameter and 2 cm depth, invading to the external sphincter. Both regional chemotherapy and immunotherapy were initiated 4 weeks postoperatively. The immunochemotherapy regimen included cisplatin (via port system) 50 mg/m2 once in 2 weeks, x 8 cycles, alpha-interferon 5 x 10(6) U subcutaneously on days 1-7 in 4 weeks, x 8 cycles, interleukin-2 9 x 10(6) U subcutaneously on days 5-9 in 4 weeks, x 8 cycles. Computed tomography scan was taken after the 2nd and 4th cycles of chemotherapy and the tumor had not responded to chemotherapy. dacarbazine 200 mg/m2 intravenously on days 1-5 in a month, x 4 cycles, was added to the previous immunochemotherapy regimen. Computed tomography and magnetic resonance imaging scans were taken on the 10th and 12th months after operation, respectively, no evidence of metastases in the liver was noted. No case of complete remission of liver metastases of anorectal malignant melanoma with regional intraarterial chemotherapy and systemic immunochemotherapy has been previously reported in the literature.
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6/44. amputation and the prevention of phantom pain.

    Although it has been proposed that preoperative analgesia with epidural administration of analgesics may prevent long-term phantom pain, published results to date have been contradictory and controversial. In this case report, we describe a 41-year-old man with local recurrence of squamous cell carcinoma of the anus who underwent a hemipelvectomy. Preoperatively he had a significant neuropathic pain syndrome requiring oxycodone 60 mg every 4 hours. An epidural infusion of morphine and bupivacaine was started 24 hours preoperatively and discontinued on the third postoperative day. Over the next 10 days the oxycodone was gradually decreased and eventually discontinued prior to discharge. A review of the literature reveals conflicting reports on the benefit of preoperative epidural pain management in the prevention of postoperative pain syndromes. Conflicting research and conclusions of commentators leaves unanswered questions for clinicians. Nevertheless, we do know that we need to provide the best pain relief for patients both before and after amputation. This may require a combination of the oral, subcutaneous or intravenous, and epidural routes.
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ranking = 6
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7/44. Use of hyperbaric oxygen chamber in the management of radiation-related complications of the anorectal region: report of two cases and review of the literature.

    PURPOSE: This article was undertaken to present two cases of nonhealing ulcers that occurred after primary radiation therapy and local excision of suspected residual or recurrent anal carcinomas. Both patients responded favorably to hyperbaric chamber treatment. review of the literature is discussed, including cause, clinical presentation, diagnosis, and options for management of radiation-related complications in the anorectal region and use of hyperbaric oxygen treatment in colorectal surgery. methods: The cases of two patients with recurrent or residual anal carcinomas were reviewed. Objective clinical, laboratory test, and intraoperative findings were implemented to define this pathologic entity precisely, results of its treatment, and management of radiation-related complications. RESULTS: The study shows clinical effectiveness of hyperbaric chamber treatment for nonhealing wounds in the previously radiated anorectal region. The refractory wounds of both our patients healed. The patients were rendered free of symptoms. CONCLUSIONS: Substantial pathologic changes in the irradiated tissues leading occasionally to nonhealing radiation proctitis are relatively infrequent consequences of radiation therapy for pelvic malignancies. Excisional and incisional biopsies of the radiation-injured tissues result in chronic ulcers accompanied by debilitating symptoms. Hyperbaric chamber treatment seemed to be a very effective means of therapy of radiation proctitis and nonhealing wounds in the involved anorectal region after conventional therapy had failed.
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keywords = operative
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8/44. Anal duct carcinoma: case report and review of the literature.

    This report details the clinical course of two patients with true anal duct carcinoma. The incidence of this malignancy is low. The tissues of origination are the glands of the anal duct. The features that differentiate this tumor from the usual rectal carcinoma are prominent ductal structures, abundant mucin production with organized mucinous pools, and infiltration into the perirectal soft tissue. The clinical management of anal duct carcinoma remains a surgical challenge. The extent of surgical resection must be radical because of the infiltrative nature of the tumor. This report describes treatment of two patients with anal duct carcinoma. The first patient was a black woman with no previous history of rectal disease. Her operative procedure was an abdominoperineal resection with posterior vaginectomy. Nine months after initial surgery a local recurrence was resected. The second patient was a white man with a previous history of hemorrhoidectomy and anal fissure. He underwent an abdominoperineal resection but had positive dermal skin margins on permanent sections despite wide perirectal soft tissue resection. A secondary resection with confirmed clear margins of the skin was performed 2 weeks postoperatively. One management aspect of anal duct carcinoma that needs emphasis is the need for wide local excision of the perirectal soft tissues.
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ranking = 2
keywords = operative
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9/44. Anorectal teratoma in an adult woman.

    We present the case of a 21-year-old woman referred to us with the diagnosis of a pelvic mass originating in the lower rectum. Following preoperative assessment she underwent surgery from a posterior approach. The pathology of the removed mass revealed an extremely rare rectal tumor--an anorectal teratoma of the mature type. We describe the successful surgical treatment, together with radiological, microscopic and perioperative appearance.
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ranking = 2
keywords = operative
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10/44. The sentinel node in anal carcinoma.

    AIMS AND BACKGROUND: Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. methods AND STUDY DESIGN: To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous and carcinoma. RESULTS: Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. CONCLUSIONS: We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.
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