Annals of Coloproctology

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Case Report

Anal Adenocarcinoma Can Masquerade as Chronic Anal Fistula in Asians: Faith Qi-Hui Leong, Dedrick Kok Hong Chan, Ker-Kan Tan; Ann Coloproctol. 2019;35(1):47-49. Published online December 3, 2018; DOI: https://doi.org/10.3393/ac.2018.03.15

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Purpose
Perianal adenocarcinoma arising from a chronic anorectal fistula is a rare condition for which the natural history and optimal management are not well established. For that reason, we conducted a retrospective analysis of 5 consecutive patients with a perianal adenocarcinoma arising from a chronic anorectal fistula managed at our institution from January 2014 to December 2015.
Methods
The patients were identified from a prospectively collected colorectal cancer database that included all patients managed for colorectal cancer at our institution.
Results
The median age at diagnosis was 64 years (range, 55–72 years). Magnetic resonance imaging (MRI) was the initial investigation for all patients and showed a hyperintense T2-weighted image. One patient underwent an abdominoperineal resection following neoadjuvant chemoradiotherapy and remained disease free during the 12-month follow-up. Three patients received neoadjuvant therapy with intent for surgery, but did not undergo surgery due to either worsening health or metastatic spread. One patient declined intervention. The median overall survival was 10.5 months (range, 2–19 months).
Conclusion
A high index of suspicion is required to make a clinical diagnosis of an anal adenocarcinoma arising from a chronic fistula. Histologic diagnosis must be achieved to confirm the diagnosis. Multimodal therapy with neoadjuvant chemoradiotherapy followed by abdominoperineal resection is the treatment of choice.

Citations

Citations to this article as recorded by

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature
Nalini Kanta Ghosh, Ashok Kumar
Annals of Coloproctology.2024; 40(Suppl 1): S1. CrossRef
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Synchronous anal mucinous adenocarcinoma and anal tuberculosis presenting as chronic anal fistula: Challenging management
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Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature
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Journal of Cancer Research and Clinical Oncology.2022; 148(6): 1509. CrossRef
Management and Outcomes in Anal Canal Adenocarcinomas—A Systematic Review
Vasilis Taliadoros, Henna Rafique, Shahnawaz Rasheed, Paris Tekkis, Christos Kontovounisios
Cancers.2022; 14(15): 3738. CrossRef
Adjuvant chemoradiotherapy does not improve outcomes in patients with fistula-associated anal adenocarcinoma undergoing abdominoperineal resection
Min Wang, Yu Xiang, Yunshan Wang, Jiayi Zhang, Haoran Zhao, Can Wang, Lichao Qiao, Bolin Yang
Frontiers in Oncology.2022;[Epub] CrossRef

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