Annals of Coloproctology

Case Report

Anorectal benign disease

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature: Nalini Kanta Ghosh, Ashok Kumar; Ann Coloproctol. 2024;40(Suppl 1):S1-S5. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.00752.0107

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Abstract PDF: The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

Original Article

Colorectal cancer

Are the width, length, depth, and area of submucosal invasion predictive of lymph node metastasis in pT1 colorectal cancer?: Olga Maynovskaia, Evgeny Rybakov, Stanislav Chernyshov, Evgeniy Khomyakov, Sergey Achkasov; Ann Coloproctol. 2023;39(6):484-492. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00087.0012

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Abstract PDF

Purpose
Submucosa-limited (pathological T1, pT1) colorectal cancers (CRCs) pose a continuing challenge in the choice of treatment options, which range from local excision to radical surgery. The aim of this study was to evaluate the morphometric and morphologic risk factors associated with regional lymph node metastasis (LNM) in pT1 CRC.
Methods
We performed a histological review of patients who underwent oncological resection between 2016 and 2022. Tumor grade, budding, poorly differentiated clusters (PDCs), cancer gland rupture, lymphovascular invasion (LVI), and presence of deep submucosal invasion (DSI), as well as width, length, total area, and area of DSI, were evaluated as potential risk factors for LNM.
Results
A total of 264 cases of colon and rectal carcinomas with invasion into the submucosal layer (pT1) were identified. LNM was found in 46 of the 264 cases (17.4%). All morphometric parameters, as well as DSI (P=0.330), showed no significant association with LNM. High grade adenocarcinoma (P=0.050), budding (P=0.056), and PDCs (P<0.001) were associated with LNM. In the multivariate analysis, LVI presence remained the only significant independent risk factor (odds ratio, 15.7; 95% confidence interval, 8.5–94.9; P<0.001).
Conclusion
The DSI of T1 CRC, as well as other morphometric parameters of submucosal tumor spread, held no predictive value in terms of LNM. LVI was the only independent risk factor of LNM.

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IMMUNOREACT 8: Immune markers of local tumor spread in patients undergoing transanal excision for clinically N0 rectal cancer
Giulia Becherucci, Cesare Ruffolo, Melania Scarpa, Federico Scognamiglio, Astghik Stepanyan, Isacco Maretto, Andromachi Kotsafti, Ottavia De Simoni, Pierluigi Pilati, Boris Franzato, Antonio Scapinello, Francesca Bergamo, Marco Massani, Tommaso Stecca, An
Surgery.2025; 178: 108902. CrossRef
Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Scientific Reports.2025;[Epub] CrossRef

Case Report

Metastasis

Peritoneal metastatic mixed adenoneuroendocrine carcinoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a case report: Sungchul Lee, Euitae Kim, Dong-Guk Park; Ann Coloproctol. 2024;40(Suppl 1):S18-S22. Published online November 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00339.0048

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Abstract PDF

A 61-year-old man presented with abdominal distension without any symptoms. On colonoscopy and computed tomography findings, it was clinically diagnosed as peritoneal metastasis of sigmoid colon cancer, and diagnostic laparoscopy was performed. Only the peritoneum was partially resected, and the pathology was signet ring cell carcinoma with predominantly local mucinous carcinoma component. However, the patient complained of persistent symptoms and, despite the progress of chemotherapy, the peritoneal dissemination worsened, and additional cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. Mixed adenoneuroendocrine carcinomas (MANECs) were reported in the appendix with perforated visceral peritoneum. After additional chemotherapy, the patient was discharged. Patients with advanced MANEC with peritoneal spreading may benefit from aggressive treatment by cytoreduction surgery with HIPEC, followed by intravenous chemotherapy.

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Mixed neuroendocrine non-neuroendocrine neoplasms in gastroenteropancreatic tract
Sebastián Díaz-López, Jerónimo Jiménez-Castro, Carlos Enrique Robles-Barraza, Carlos Ayala-de Miguel, Manuel Chaves-Conde
World Journal of Gastrointestinal Oncology.2024; 16(4): 1166. CrossRef

Original Article

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy,Minimally invasive surgery

Should transanal total mesorectal excision be implemented in medium-sized colorectal unit? technical and oncological outcome: Man-fung Ho, Dennis Chung-Kei Ng, Janet Fung-yee Lee, Simon Siu-man Ng; Ann Coloproctol. 2022;38(3):207-215. Published online July 28, 2021; DOI: https://doi.org/10.3393/ac.2020.00941.0134

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Abstract PDF

Purpose
This study was performed to evaluate the outcome of implementation of transanal total mesorectal excision (TaTME) for low rectal cancer in a regional hospital and in comparison to laparoscopic (Lap) TME.
Methods
Consecutive patients with low rectal cancer of which the lowest border of the tumour was located beween 1 and 5 cm from the puborectalis who underwent TME at North District Hospital between January 2013 and December 2019 were included. Clinical, operative, and pathologic outcomes were compared between Lap TME and TaTME. The primary end point was complication profile.
Results
Thirty-five patients underwent Lap TME and 45 patients underwent TaTME for low rectal cancer. The conversion rate of the TaTME group was significantly lower than that of the Lap TME group (4.4% vs. 20%, P=0.029), but the operating time was longer (259 minutes vs. 219 minutes, P=0.009). The tumour location was significantly lower in the TaTME group, but the distal resection margins were adequate and not different between both groups. The TaTME group had higher incidence rates of prolonged ileus and urinary tract infection, but the other complications were similar between the two groups. The resection margin positivity rates of the TaTME and Lap TME groups were 2.2% and 5.7%, respectively (P=0.670). At a median follow up of 39 months, no abnormal early recurrence was detected.
Conclusion
It is technically feasible and oncologically safe to perform TaTME in a medium-volume colorectal unit. Patients with difficult pelvic anatomy can benefit by reducing the risk of conversion and margin positivity rate.

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Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
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Ji-Hyun Seo, In-Ja Park
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Case Report

Metachronous carcinoma at the colostomy site after abdominoperineal resection of rectal cancer: a case report: Young Sun Choi, Kil-young Lee, Youn Young Park, Hyung Jin Kim, Jaeim Lee; Ann Coloproctol. 2023;39(2):175-177. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2020.00185.0026

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Abstract PDF

Metachronous carcinoma at the colostomy site is very rare after abdominoperineal resection. A 53-year-old male patient underwent an abdominoperineal resection 6 years earlier for rectal cancer developed metachronous carcinoma at the site of stoma. A portion of the colon, including the stoma and the surrounding skin, was resected and a new stoma was created in the transverse colon. Although the occurrence of carcinoma at the stoma site is a rare condition, careful observation for the stoma and colonoscopy for surveillance are necessary.

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Colostomy‐site carcinoma with primitive phenotype in a rectal cancer patient after achieving pathological complete response with neoadjuvant chemoradiotherapy
Takayuki Kodama, Maki Kanzawa, Hiroshi Hasegawa, Shuichi Tsukamoto, Mari Nishio, Manabu Shigeoka, Yu‐ichiro Koma, Tomoo Itoh, Hiroshi Yokozaki
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Muhammed Huzaifa, Ankita Singh, Vaibhav Aggarwal, Anita Dhar
Clinical Cancer Investigation Journal.2023; 12(2): 1. CrossRef
Peristomal adenocarcinoma 16 years after colorectal adenocarcinoma resection with curative intent
Kayleigh A M van Dam, Thaís T T Tweed, Bart de Vries, Henricus J Belgers
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Original Articles

Malignant disease,Prognosis and adjuvant therapy

Analysis of the Incidence and Clinical Features of Colorectal Nonadenocarcinoma in Korea: A National Cancer Registry-Based Study: Soomin Nam, Dongwook Kim, Kyuwon Jung, Yoon Jung Choi, Jung Gu Kang; Ann Coloproctol. 2020;36(6):390-397. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.05.03.2

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11 Citations

Abstract PDF

Purpose
Although most colorectal malignancies are adenocarcinomas from mucosa, various types of malignant and benign tumors can develop. Due to extremely low incidence, little research has been conducted. The purpose was to assess incidence and compare it according to demographic factors.
Methods
Data from the Korea National Cancer Registry from 2007 to 2016 were used. The crude incidence, age-standard incidence rate (ASR) of colorectal nonadenocarcinomas were calculated.
Results
Over 11 years, there were 267,142 patients with colorectal malignancies. The patients of 14,495 (5.43%) were diagnosed with nonadenocarcinoma. The ASR was 2.52 per 100,000 in men and 1.56 in women. Lesions were classified according to histologic categories; neuroendocrine tumor (NET) was the most common malignancy (10,919 [75.33%]). Nonadenocarcinoma was the most common in 40s and 50s (40 to 49 years, 3,530 [24.35%]; 50 to 59 years, 3,991 [27.53%]). Lymphoma was high (54.46%) in patients in teenagers. Proportion of NET decreased with age and that of carcinoma increased with age. Carcinoma, sarcoma, and lymphoma were more common among men and melanoma was more common among women. The most common site was the rectum (11,066 [76.34%]). Lymphoma occurred more frequently in proximal colon. Melanoma, gastrointestinal stromal tumor, and NET occurred mostly in rectum. A total of 10,155 patients (70.06%) were classified as having localized disease.
Conclusion
This study is meaningful as it is the first study to examine incidence of colorectal nonadenocarcinoma. Differences in incidence of different lesions based on demographic factors were identified. This study will play a role in cancer prevention and diagnosis projects.

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Kenji Baba, Masumi Wada, Naoki Kuroshima, Yuto Hozaka, Daisaku Kamiimabeppu, Masataka Shimonosono, Yota Kawasaki, Ken Sasaki, Michiyo Higashi, Hiroaki Kobayashi, Takaaki Arigami, Takao Ohtsuka
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Jin Sun Choi, Min Jung Kim, Rumi Shin, Ji Won Park, Seung Chul Heo, Seung-Yong Jeong, Kyu Joo Park, Seung-Bum Ryoo
Annals of Surgical Oncology.2024; 31(4): 2414. CrossRef
Assessing risk stratification in long-term outcomes of rectal neuroendocrine tumors following endoscopic resection: a multicenter retrospective study
Hyun Jin Lee, Yun Seo, Chang Kyo Oh, Ji Min Lee, Hyun Ho Choi, Tae-Geun Gweon, Sung-Hak Lee, Dae Young Cheung, Jin Il Kim, Soo-Heon Park, Han Hee Lee
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Surgical Endoscopy.2022; 36(4): 2445. CrossRef
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Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Korean Medical Association.2022; 65(9): 549. CrossRef
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In Ja Park
Journal of the Korean Medical Association.2022; 65(9): 540. CrossRef
Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 231. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Trends in the Incidence and Survival Rates of Colorectal Signet-Ring Cell Carcinoma in the South Korean Population: Analysis of the Korea Central Cancer Registry Database
Ji-Hoon Kim, Hyunil Kim, Jin Woo Kim, Hee Man Kim
Journal of Clinical Medicine.2021; 10(18): 4258. CrossRef
Primary tumor location (right versus left side of the colon) and resection affect the survival of patients with liver metastases from colonic neuroendocrine carcinoma: a population-based study
Wen Cai, Weiting Ge, Jiawei Zhang, Siyuan Xie, Dehao Wu, Hanguang Hu, Jianshan Mao
Therapeutic Advances in Gastroenterology.2021;[Epub] CrossRef
Colorectal Nonadenocarcinoma in South Korea
Jung Wook Huh
Annals of Coloproctology.2020; 36(6): 359. CrossRef

Malignant disease, Rectal cancer, Functional outcomes

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma: Osama Eldamshety, Sherif Kotb, Ashraf Khater, Sameh Roshdy, Mohamed Elashry, Mohamed S. Zahi, Hend M. Hamdey Rashed Elkalla, Waleed Elnahas, Omar Farouk, Adel Fathi, Ahmed Senbel, Emad-Eldeen Hamed, Khaled Abdelwahab, Islam Abdou Elzahby, Ahmed abdallah, Mahmoud Abdelaziz, Emanuele Lezoche; Ann Coloproctol. 2020;36(3):148-154. Published online April 20, 2020; DOI: https://doi.org/10.3393/ac.2018.07.19

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Abstract PDF

Background
The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma.
Methods
In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year.
Results
Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%).
Conclusion
Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function

Citations

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Transanal Minimally Invasive TME (TaTME) Versus Non-Endoscopic Transanal Intersphincteric Resection of Post-Neoadjuvant Ultralow Rectal Adenocarcinoma: A Multicentric, Matched Case–Control Study
Osama Eldamshety, Mohamed Abdekhalek, Amir M. Zaid, Essam Attia, Mohamed Zuhdy, Emanuel Lezoche, Giovanni Lezoche, Enjy Mosaad, Marwa Abogabal, Islam Elzahby
Indian Journal of Surgery.2025;[Epub] CrossRef
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Hyun Gu Lee, Chan Wook Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
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Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
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Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
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The Ewha Medical Journal.2022;[Epub] CrossRef
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Sung Uk Bae
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Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
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Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
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Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Simplification or Accuracy: In Assessing Functional Outcomes After Intersphincteric Resection for Low Rectal Cancer
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Malignant disease

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis: Seung Jae Roh, Sung Chan Park, Jaehee Choi, Joon Sang Lee, Dong Woon Lee, Chang Won Hong, Kyung Su Han, Hyoung Chul Park, Dae Kyung Sohn, Jae Hwan Oh; Ann Coloproctol. 2020;36(1):22-29. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.04.30

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Abstract PDF

Purpose
This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer.
Methods
A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC.
Results
Median disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality.
Conclusion
Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

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Case Reports

Malignant disease,Rare disease & stoma

Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano: Jordan Au, Francis M. Hulme-Moir, Andrew Herd, Mathew A. Kozman; Ann Coloproctol. 2021;37(Suppl 1):S7-S10. Published online November 26, 2019; DOI: https://doi.org/10.3393/ac.2019.11.19

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Abstract PDF

We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

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Seyed Khalafi, Malini Riddle, Brittany Harper, Vid Fikfak
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Advances in the Treatment of Colorectal Cancer with Peritoneal Metastases: A Focus on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Youngbae Jeon, Eun Jung Park
The Ewha Medical Journal.2023;[Epub] CrossRef

Malignant disease

Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report: Sungjin Kim, Sung Il Kang, Sohyun Kim, Min Hye Jang, Jae Hwang Kim; Ann Coloproctol. 2020;36(6):417-420. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.11.07

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2 Citations

Abstract PDF

Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.

Citations

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Carcinomatosis peritoneal, como medirla
A. Mesa Álvarez, M. da Silva Torres, A. Fernández del Valle, A. Cernuda García, E. Turienzo Santos, L. Sanz Álvarez
Radiología.2024;[Epub] CrossRef
Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease
Alin Mihai Vasilescu, Eugen Târcoveanu, Cristian Lupascu, Mihaela Blaj, Corina Lupascu Ursulescu, Costel Bradea
Life.2022; 12(3): 447. CrossRef

Original Article

Chemotherapeutic Response and Survival for Patients With an Anal Squamous Cell Carcinoma and Low Hemoglobin Levels: Ali Zain Naqvi, Esther Platt, Maki Jitsumura, Martyn Evans, Mark Coleman, Sebastian Smolarek; Ann Coloproctol. 2018;34(6):312-316. Published online December 31, 2018; DOI: https://doi.org/10.3393/ac.2017.10.12

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1 Web of Science
1 Citations

Abstract PDF

Purpose
Anemia is associated with poor treatment results for a variety of cancers. The effect of low hemoglobin levels on long-term outcomes after the treatment of patients with an anal squamous cell carcinoma (SCC) remains unclear. For that reason, this study aimed to investigate the effect of anemia on treatment outcomes following chemoradiation for an anal SCC.
Methods
This was a retrospective study of all patients who underwent curative treatment for an anal SCC between 2009 and 2015 at 2 trusts in the United Kingdom. Data were collated from prospectively collected cancer databases and were cross-checked with operating-room records and records in the hospitals’ patient management systems.
Results
We identified 103 patients with a median age of 63 years (range, 36–84 years). The median overall survival was 39 months (range, 9–90 months), and the disease-free survival was 36 months (range, 2–90 months). During the follow-up period, 16.5% patients died and 13.6% patients developed recurrence. Twenty-two people were anemic prior to treatment, with a female preponderance (20 of 22). No differences in disease-free survival (P = 0.74) and overall survival (P = 0.12) were noted between patients with anemia and those with normal hemoglobin levels. On regression the analysis, the combination of anemia, the presence of a defunctioning colostomy, lymph-node involvement and higher tumor stage correlated with poor overall survival.
Conclusion
In this study, anemia did not influence disease-free survival or overall survival. We suggest that the interaction between anemia and survival is more complex than previously demonstrated and potentially reliant on other coexisting factors.

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Prognostic and Predictive Clinical and Biological Factors in HPV Malignancies
Shivani Sud, Ashley A. Weiner, Andrew Z. Wang, Gaorav P. Gupta, Colette J. Shen
Seminars in Radiation Oncology.2021; 31(4): 309. CrossRef

Case Reports

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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6 Citations

Abstract PDF

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

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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
Value of apparent diffusion coefficient on MRI for prediction of histopathological type in anal fistula cancer
Shinji Yamamoto, Keiji Yonezawa, Naoki Fukata, Koji Takeshita, Makoto Kodama, Tetsuro Yamana, Shigeru Kiryu, Yukinori Okada
Medicine.2023; 102(14): e33281. CrossRef
Synchronous anal mucinous adenocarcinoma and anal tuberculosis presenting as chronic anal fistula: Challenging management
Sarah Benammi, Youness Bakali, Mouna Alaoui
Archive of Clinical Cases.2023; 10(2): 74. CrossRef
Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature
Aysun Tekbaş, Henning Mothes, Utz Settmacher, Silke Schuele
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

Large Cell Neuroendocrine Carcinoma of the Colon With Carcinomatosis Peritonei: Jang Jin Kim, Sung Su Park, Taek-Gu Lee, Ho-Chang Lee, Sang-Jeon Lee; Ann Coloproctol. 2018;34(4):222-225. Published online July 26, 2018; DOI: https://doi.org/10.3393/ac.2018.02.27

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8 Citations

Abstract PDF

Colorectal large-cell neuroendocrine carcinomas (NECs) are extremely rare and have very poor prognosis compared to adenocarcinomas. A 74-year-old man presented with abdominal pain, diarrhea and hematochezia. The histopathologic report of colonoscopic biopsy performed at a local clinic was a poorly differentiated carcinoma. An abdominopelvic computed scan revealed irregularly enhanced wall thickening at the sigmoid colon with regional fat stranding and lymphnode enlargement. He underwent a laparoscopic high anterior resection with selective peritonectomy for peritoneal carcinomatosis, intraoperative peritoneal irrigation chemotherapy, and early postoperative intraperitoneal chemotherapy for 5 days. The tumor had a high proliferation rate (mitotic count > 50/10 HPFs and 90% of the Ki-67 index) and lymph-node metastases had occurred. On immunohistochemistry, the tumor cells expressed CD56 and synaptophysin. Large-cell NEC was confirmed. Systemic chemotherapy with cisplatin/etoposide was done. The patient is still alive after 3 years with no evidence of recurrence.

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Large Cell Neuroendocrine Carcinoma Presenting as Adult Intussusception
John O Agboola, Hagar Attia, Li Zhonghua, Meredith Pittman
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Large cell neuroendocrine carcinoma of the colon: An unexpected diagnosis: A case report
Maissa Ben Thayer, Imen Helal, Fatma Khanchel, Nizar Khdhiri, Ehsen Ben Brahim, Raja Jouini, Aschraf Chadli-Debbiche
International Journal of Surgery Case Reports.2024; 121: 109929. CrossRef
Resection of primary lesion with chemotherapy improves the survival of patients with metastatic colorectal neuroendocrine carcinoma
Qinghua WANG, Ruihua YIN, Wanfen TANG, Chenghui LI, Hongjuan ZHENG, Xia ZHANG, Xiayun JIN, Mingliang YING, Jianfei FU
Journal of Zhejiang University (Medical Sciences).2022; 51(5): 594. CrossRef
The Expression of Chromogranin A, Syanptophysin and Ki67 in Detecting Neuroendocrine Neoplasma at High Grade Colorectal Adenocarcinoma
W. A. Gusti Deasy, M. Husni Cangara, Andi Alfian Zainuddin, Djumadi Achmad, Syarifuddin Wahid, Upik A. Miskad
Open Access Macedonian Journal of Medical Sciences.2021; 9(A): 1142. CrossRef
Isolation and Characterization of Two Novel Colorectal Cancer Cell Lines, Containing a Subpopulation with Potential Stem-Like Properties: Treatment Options by MYC/NMYC Inhibition
Jan Schulte am Esch, Beatrice Ariane Windmöller, Johannes Hanewinkel, Jonathan Storm, Christine Förster, Ludwig Wilkens, Martin Krüger, Barbara Kaltschmidt, Christian Kaltschmidt
Cancers.2020; 12(9): 2582. CrossRef
Large cell neuroendocrine carcinoma of the colon with brain metastasis: A case report
Ali Allouch, Mohamad K. Moussa, Ali Dirany, Zahraa Barek, Mohammad Makke, Nizar Bitar
International Journal of Surgery Case Reports.2020; 76: 421. CrossRef
A case of colorectal large cell neuroendocrine carcinoma accompanied by disseminated peritoneal leiomyomatosis
Kunihiko Suga, Hiroomi Ogawa, Makoto Sohda, Chika Katayama, Naoya Ozawa, Katsuya Osone, Takuhisa Okada, Takuya Shiraishi, Ryuji Katoh, Akihiko Sano, Makoto Sakai, Takehiko Yokobori, Ken Shirabe, Hiroshi Saeki
Surgical Case Reports.2020;[Epub] CrossRef
Colorectal neuroendocrine carcinoma: A case report and review of the literature
Tomoaki Yoshida, Kenya Kamimura, Kazunori Hosaka, Koji Doumori, Hiromitsu Oka, Akito Sato, Yasuo Fukuhara, Shoji Watanabe, Tomomi Sato, Akira Yoshikawa, Takashi Tomidokoro, Shuji Terai
World Journal of Clinical Cases.2019; 7(14): 1865. CrossRef

Abdominal Sarcoidosis Mimicking Peritoneal Carcinomatosis: Won Seok Roh, Seungho Lee, Ji Hyun Park, Jeonghyun Kang; Ann Coloproctol. 2018;34(2):101-105. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2018.01.29

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6 Citations

Abstract PDF

We present a patient diagnosed with skin sarcoidosis, breast cancer, pulmonary tuberculosis, and peritoneal sarcoidosis with a past history of colorectal cancer. During stage work up for breast cancer, suspicious lesions on peritoneum were observed in imaging studies. Considering our patient’s history and imaging findings, we initially suspected peritoneal carcinomatosis. However, the peritoneal lesion was diagnosed as sarcoidosis in laparoscopic biopsy. This case demonstrates that abdominal sarcoidosis might be considered as a differential diagnosis when there is a lesion suspected of being peritoneal carcinomatosis with nontypical clinical presentations.

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Eva van Boven, Robert R J Coebergh van den Braak, Jan van Laar, Michiel G H Betjes
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Hypercalcemia and Acute Renal Failure Indicating Peritoneal Sarcoidosis
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Original Article

Clinical Significance of Signet-Ring-Cell Colorectal Cancer as a Prognostic Factor: Sang-Oh Yun, Yong Beom Cho, Woo Yong Lee, Hee Cheol Kim, Seong Hyeon Yun, Yoon Ah Park, Jung Wook Huh; Ann Coloproctol. 2017;33(6):232-238. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.232

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Abstract PDF

Purpose

The aim of this study is to evaluate the prognosis for patients with a signet-ring-cell carcinoma (SRCC) who undergo curative surgery by comparing them to patients with an adenocarcinoma (ADC), excluding a mucinous ADC.

Methods

Between September 1994 and December 2013, 14,110 patients with colorectal cancer underwent surgery and among them, 12,631 patients were enrolled in this study. 71 patients with a SRCC and 12,570 patients with a ADC were identified. We analyzed the disease-free survival and the overall survival rates before and after a 1:2 propensity score matching and evaluated those rates after stage stratification.

Results

The median follow-up durations were 48.5 months for the SRC group and 48.6 months for the ADC group. The disease-free survival rates and the overall survival rates were significantly lower in the SRC group before and after propensity score matching (P < 0.001). After stratification by stage, no differences were observed between the SRC and the ADC groups for the disease-free survival (DFS) and the overall survival (OS) rates for patients with cancer in its early stages (P = 0.913 and P = 0.380 for the DFS and the OS, respectively, in stages 0 and I, and P = 0.223 and P = 0.991 for the DFS and the OS, respectively, in stage II), but those rates were significantly lower in the SRC group for cancer in its later stages (P < 0.001, respectively in stages III and IV).

Conclusion

For cancer in advanced stages, patients with a resectable colorectal SRCC had a poorer prognosis after propensity score matching than those with an ADC did. Therefore, more intensive surveillance and closer observation should be offered to such patients.

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