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Sayrafi F, Settmacher U, Ali Deeb A. [28/m-Anal pain and light red blood secretions during defecation lasting for several days : Preparation for the medical specialist examination: part 47]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:89-92. [PMID: 37486398 DOI: 10.1007/s00104-023-01921-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Affiliation(s)
- F Sayrafi
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - A Ali Deeb
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Chelmow D, Cejtin H, Conageski C, Farid H, Gecsi K, Kesterson J, Khan MJ, Long M, O'Hara JS, Burke W. Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference. Obstet Gynecol 2023; 142:708-724. [PMID: 37543740 PMCID: PMC10424818 DOI: 10.1097/aog.0000000000005283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 08/07/2023]
Abstract
The Centers for Disease Control and Prevention sponsored a project conducted by the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. For this final module, focusing on the cancers of the lower anogenital tract (vulva, vagina, and anus), a panel of experts in evidence assessment from the Society for Academic Specialists in General Obstetrics and Gynecology, ASCCP, and the Society of Gynecologic Oncology reviewed relevant literature and current guidelines. Panel members conducted structured literature reviews, which were then reviewed by other panel members. Representatives from stakeholder professional and patient advocacy organizations met virtually in September 2022 to review and provide comment. This article is the executive summary of the review. It covers prevention, early diagnosis, and special considerations of lower anogenital tract cancer. Knowledge gaps are summarized to provide guidance for future research.
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Affiliation(s)
- David Chelmow
- Departments of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, Feinberg School of Medicine Northwestern University, Stroger Hospital, Chicago, Illinois, University of Colorado School of Medicine, Aurora, Colorado, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, Medical College of Wisconsin, Milwaukee, Wisconsin, Stanford University School of Medicine, Palo Alto, California, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, and Stony Brook University Hospital, Stony Brook, New York; the Division of Gynecologic Oncology, UPMC-Central PA, Mechanicsburg, Pennsylvania; and the American College of Obstetricians and Gynecologists, Washington, DC
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Albuquerque A, Cappello C, Stirrup O, Selinger CP. Anal High-risk Human Papillomavirus Infection, Squamous Intraepithelial Lesions, and Anal Cancer in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2023; 17:1228-1234. [PMID: 36929761 DOI: 10.1093/ecco-jcc/jjad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Ulcerative colitis [UC] and Crohn's disease [CD] can be associated with severe comorbidities, namely opportunistic infections and malignancies. We present the first systematic review and meta-analysis evaluating the burden of anal human papillomavirus disease in patients with UC and CD. METHODS PubMed, Web of Science, and Scopus were searched until November 2022. Meta-analyses were performed using random effects models. The protocol was recorded at PROSPERO register with the number CRD42022356728. RESULTS Six studies, including 78 711 patients with UC with a total follow-up of 518 969 person-years, described the anal cancer incidence rate. For anal cancer incidence rate in CD, six studies were selected, including 56 845 patients with a total follow-up of 671 899 person-years. The incidence of anal cancer was 10.2 [95% CI 4.3 - 23.7] per 100 000 person-years in UC and 7.7 [3.5 - 17.1] per 100 000 person-years in CD. A subgroup analysis of anal cancer in perianal CD, including 7105 patients, was calculated with incidence of 19.6 [12.2 - 31.6] per 100 000 person-years [three studies included]. Few studies described prevalence of anal cytological abnormalities [four studies including 349 patients] or high-risk human papillomavirus [three studies including 210 patients], with high heterogeneity. Prevalence of cytological abnormalities or high-risk human papillomavirus was not associated with pharmacological immunosuppression in the studies included. CONCLUSION The incidence of anal cancer is higher in UC than in CD, with the exception of perianal CD. There are limited and heterogeneous data on anal high-risk human papillomavirus infection and squamous intraepithelial lesions prevalence in this population.
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Affiliation(s)
- Andreia Albuquerque
- Gastroenterology Department, Fernando Pessoa Teaching Hospital, Porto, Portugal
- Precancerous Lesions and Early Cancer Management Research Group RISE@CI-IPO [Health Research Network], Portuguese Oncology Institute of Porto [IPO-Porto], Porto, Portugal
| | - Carmelina Cappello
- Homerton Anogenital Neoplasia Service, Homerton University Hospital, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
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Klein Nulend R, Singla A, De Silva R, Renthawa J, Yuen L, Laurence JM, Lee T, Pleass H. A First Case Report of Cytomegalovirus Infection Presenting With Perianal Fistula and Abscess Formation in a Kidney Transplant Recipient. EXP CLIN TRANSPLANT 2022; 20:771-775. [DOI: 10.6002/ect.2022.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Risk of Anorectal Cancer Associated with Benign Anal Inflammatory Diseases: A Retrospective Matched Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127467. [PMID: 35742716 PMCID: PMC9223752 DOI: 10.3390/ijerph19127467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
Purpose: The purpose of our study was to evaluate the relationship between benign anal inflammatory diseases and anorectal cancer and assess its risk factors. Methods: A retrospective matched cohort study was conducted that included data from 2002 to 2013. The National Health Insurance Service National Sample Cohort data from 2002 to 2013 was used for the study. Of a total study population of 143,884 individuals, 28,110 individuals with anal fissures were assigned to the case group, while 115,774 individuals without anal fissures were assigned to the control group based on the 1:4 propensity score matching age, sex, and year (case: diagnosed year, control: health service received year). Results: The risk of anorectal cancer was higher in the case group (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.51–2.53) compared to the control group. After grouping anorectal cancers into anal cancer and rectal cancer, the risk remained higher in the case group (anal cancer HR: 2.79, 95% CI: 1.48–5.27; rectal cancer HR: 1.82, 95% CI; 1.37–2.42). The case group was further categorized into patients with fissures and patients with fistulas; patients with fissures showed a higher risk of developing anorectal cancer than patients with fistulas (HR: 2.05, 95% CI: 1.53–2.73 vs. HR: 1.73, 95% CI: 1.13–2.66). Study participants in their 30s and 40s had a 4.19- and 7.39-times higher risk of anorectal cancer compared to those in the higher age groups (0.64–1.84), while patients who did not have inflammatory bowel disease (IBD) had a higher risk of developing anorectal cancer (HR: 2.09, 95% CI: 1.56–2.80). Conclusions and Relevance: Patients with anal fistulas or fissures have an increased risk of being diagnosed with anorectal cancer, especially at a young age and even without IBD.
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Tekbaş A, Mothes H, Settmacher U, Schuele S. Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature. J Cancer Res Clin Oncol 2022; 148:1509-1522. [PMID: 34338860 PMCID: PMC9114013 DOI: 10.1007/s00432-021-03747-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Abscess or fistula of the anal region is an uncommon presentation of malignancy. Under the assumption of a benign condition, diagnostics is often delayed, resulting in advanced tumour stages at first diagnosis. Due to the case rarity, treatment guidelines for cancers of anorectal region masquerading as abscess or fistula are missing. METHODS We analysed all patients presenting with an abscess or fistula of the anal region in our department between January 2004 and August 2020. The malignancies were included to our study to acquire data on clinical presentation, treatment and outcome. Furthermore, a systematic review to present adenocarcinomas and squamous cell carcinomas associated to an abscess or fistula was performed. RESULTS 0.5% of the patients treated for an abscess or fistula of the anal region met the selection criteria. Mean time from the onset of symptoms to diagnosis of malignancy was 100 days. Histology revealed adenocarcinoma and squamous cell carcinoma each in two patients. All patients had locally advanced tumours without distant metastases, in two cases with regional lymph-node metastases. Neoadjuvant chemoradiation was applied in two patients. All patients underwent abdomino-perineal resection of the rectum. The overall outcome reveals a recurrence-free survival of 4.5 and 3 years for two patients. Further two patients died within 5 months after the primary resection. CONCLUSION Advanced carcinomas of the anorectal region may masquerade as abscess or fistula, cause diagnostic problems and delay oncologic treatment. However, even in these very advanced situations, surgical therapy with curative intent should be attempted.
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Affiliation(s)
- Aysun Tekbaş
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany.
- Research Programme "Clinician Scientist Programme", Interdisciplinary Center for Clinical Research, University of Jena, Jena, Germany.
| | - Henning Mothes
- Department of General, Visceral and Vascular Surgery, Sophien-und Hufeland-Klinikum gGmbH, Weimar, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany
| | - Silke Schuele
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany
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Sachdeva M, Mufti A, Zaaroura H, Abduelmula A, Lansang RP, Bagit A, Alhusayen R. Squamous cell carcinoma arising within hidradenitis suppurativa: a literature review. Int J Dermatol 2021; 60:e459-e465. [PMID: 34075588 DOI: 10.1111/ijd.15677] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/28/2021] [Accepted: 05/02/2021] [Indexed: 01/18/2023]
Abstract
Squamous cell carcinoma (SCC) can present as a rare complication of longstanding hidradenitis suppurativa (HS) lesions. Limited data exist on characteristics and outcomes of SCC development within HS lesions. The purpose of this review is to conduct a literature review of previously reported cases of SCC development in pre-existing HS lesions. EMBASE and MEDLINE searches were conducted in OVID on June 25, 2020, to yield 59 studies. Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95). The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122). The mean duration between HS onset and SCC development was 25.5 years. Of the patients that had outcomes reported, 54.0% (n = 34/63) experienced SCC metastasis, 43.1% (n = 28/65) experienced SCC recurrences, and 58.7% (n = 44/75) experienced a mortality outcome. The most common documented reasons for death included metastasis (34.1%, n = 15/44) and sepsis (13.6%, n = 6/44). Patients with longstanding HS lesions can develop SCCs with a high rate of metastasis and mortality. Thus, chronic HS lesions, especially in the gluteal, perianal, genital, and perineal regions, should be monitored regularly for timely SCC diagnosis and management.
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Affiliation(s)
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hiba Zaaroura
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Ahmed Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
ZusammenfassungDie Analfissur ist eine der häufigsten Pathologien, welche sich dem Proktologen präsentiert. Entsprechend ist es wichtig, verlässliche Leitlinien dazu zu entwickeln. Die aktuelle Leitlinie wurde anhand eines systematischen Literaturreview von einem interdisziplinären Expertengremium diskutiert und verabschiedet.Die akute Analfissur, soll auf Grund ihrer hohen Selbstheilungstendenz konservativ behandelt werden. Die Heilung wird am besten durch die Einnahme von Ballaststoff reicher Ernährung und einer medikamentösen Relaxation durch Kalziumkanal-Antagonisten (CCA) unterstützt. Zur Behandlung der chronischen Analfissur (CAF), soll den Patienten eine medikamentöse Behandlung zur „chemischen Sphinkterotomie“ mittels topischer CCA oder Nitraten angeboten werden. Bei Versagen dieser Therapie, kann zur Relaxation des inneren Analsphinkters Botulinumtoxin injiziert werden. Es ist belegt, dass die operativen Therapien effektiver sind. Deshalb kann eine Operation schon als primäre Therapie oder nach erfolgloser medikamentöser Therapie erfolgen. Die Fissurektomie, evtl. mit zusätzlicher Botulinumtoxin Injektion oder Lappendeckung, ist die Operation der Wahl. Obwohl die laterale Internus Sphinkterotomie die CAF effektiver heilt, bleibt diese wegen dem höheren Risiko für eine postoperative Stuhlinkontinenz eine Option für Einzelfälle.
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Faber MT, Frederiksen K, Palefsky JM, Kjaer SK. Risk of Anal Cancer Following Benign Anal Disease and Anal Cancer Precursor Lesions: A Danish Nationwide Cohort Study. Cancer Epidemiol Biomarkers Prev 2019; 29:185-192. [PMID: 31597665 DOI: 10.1158/1055-9965.epi-19-0601] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/16/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is associated with the majority of anal high-grade intraepithelial neoplasia (AIN) and anal cancers. Little is known about the risk of anal cancer following a diagnosis of benign anal disease and AIN. METHODS Using data from nationwide, population-based Danish registries, a cohort of 126,174 individuals with either non-neoplastic anal disease or AIN 1 to 3 during 1970 to 2016 was followed until first occasion of anal cancer. Information on HIV status was obtained from the Danish HIV Cohort Study. The absolute risk of anal cancer was estimated using the Aalen-Johansen estimator taking into account censoring at emigration and end of follow-up and competing risk at time of death. Standardized incidence ratios (SIR) for anal cancer among individuals with non-neoplastic anal disease, including inflammatory lesions, hemorrhoids, and polyps, were estimated in Poisson models. Sex-, age-, and calendar period-specific national population rates were estimated using the Danish National Pathology Registry. RESULTS Anal cancer risk increased with increasing severity of lesions, reaching 4% 5 years after diagnosis of AIN3. Even among those with non-neoplastic anal lesions, particularly inflammatory lesions, anal cancer risk was significantly higher than expected from Danish national anal cancer rates (SIR = 2.8; 95% confidence intervals, 2.3-3.2). The absolute 5-year risk of anal cancer following AIN3 was considerably higher among HIV-positive (14.1%) than HIV-negative (3.2%) individuals. CONCLUSIONS Anal cancer risk increases with increasing severity of lesions and is especially high among HIV-positive individuals. IMPACT Vaccination against HPV is important in the prevention of both high-grade AIN and anal cancer.
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Affiliation(s)
- Mette T Faber
- Danish Cancer Society Research Center, Virus, Lifestyle and Genes, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Danish Cancer Society Research Center, Statistics and Pharmacoepidemiology, Copenhagen, Denmark
| | - Joel M Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Susanne K Kjaer
- Danish Cancer Society Research Center, Virus, Lifestyle and Genes, Copenhagen, Denmark. .,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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“-Omas” presenting as “-itis”: acute inflammatory presentations of common gastrointestinal neoplasms. Emerg Radiol 2019; 26:433-448. [DOI: 10.1007/s10140-019-01678-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
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Wandhöfer C, Gelos M, Schnabel R, Niedergethmann M. Seltene Komplikation einer chronischen perianalen Fistel. Chirurg 2017; 88:799-801. [DOI: 10.1007/s00104-017-0409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Human Papillomavirus Genotyping of Incidental Malignant and Premalignant Lesions on Hemorrhoidectomy Specimens. Am J Surg Pathol 2017; 41:382-388. [DOI: 10.1097/pas.0000000000000809] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Li C, Luo X, Lin Y, Tang X, Ling L, Wang L, Jiang Y. A Higher Frequency of CD14+ CD169+ Monocytes/Macrophages in Patients with Colorectal Cancer. PLoS One 2015; 10:e0141817. [PMID: 26509874 PMCID: PMC4625021 DOI: 10.1371/journal.pone.0141817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022] Open
Abstract
Objective Monocytes and macrophages can infiltrate into tumor microenvironment and regulate the progression of tumors. This study aimed at determining the frequency of different subsets of circulating monocytes and tumor infiltrating macrophages (TIMs) in patients with colorectal cancer (CRC). Methods The frequency of different subsets of circulating monocytes was characterized in 46 CRC patients and 22 healthy controls (HC) by flow cytometry. The frequency of different subsets of macrophages was analyzed in TIMs from 30 tumor tissues and in lamina propria mononuclear cells (LPMCs) from 12 non-tumor tissues. The concentrations of plasma cytokines and carcinoembryonic antigen (CEA) were determined. The potential association of these measures with the values of clinical parameters was analyzed. Results In comparison with that in the HC, the percentages of circulating CD14+CD169+, CD14+CD169+CD163+ and CD14+CD169+CD206+ monocytes and TIMs CD14+CD169+ as well as IL-10+CD14+CD169+, but not IL-12+ CD14+CD169+ macrophages were significantly increased, accompanied by higher levels of plasma IL-10 in the CRC patients. The percentages of CD14+CD169+ circulating monocytes and TIM macrophages were associated with the stage of disease and correlated positively with the levels of plasma IL-10 and CEA in CRC patients. Conclusion Our data suggest that an increase in the frequency of CD14+CD169+ cells may be associated with the development and progression of CRC and is concomitant rise of both, pro-tumor (M2-like, IL-10 producing) and anti-tumor (M1-like, IL-12 producing) monocytes and infiltrating macrophages. The frequency of CD14+CD169+ circulating monocytes and infiltrating macrophages may serve as a biomarker for evaluating the pathogenic degrees of CRC.
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Affiliation(s)
- Chenguang Li
- Department of Colorectal & Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xiaofan Luo
- Department of Colorectal & Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yuyang Lin
- Department of Colorectal & Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xiuqi Tang
- Department of Colorectal & Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Limian Ling
- Department of Colorectal & Anal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Lei Wang
- Department of Colorectal & Anal Surgery, The First Hospital of Jilin University, Changchun, China
- * E-mail: (YJ); (LW)
| | - Yanfang Jiang
- Genetic Diagnosis Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of Zoonosis Research, Ministry of Education, The First Hospital of Jilin University, Changchun, China
- * E-mail: (YJ); (LW)
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Unexpected anal squamous cells carcinoma after open hemorrhoidectomy. Case Rep Surg 2015; 2015:616274. [PMID: 25922781 PMCID: PMC4398956 DOI: 10.1155/2015/616274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of unexpected anal squamous cells carcinoma found in hemorrhoidectomy specimen. The patient had a 3-year history of prolapsing hemorrhoids. A prolapsing hemorrhoid was present at eleven o'clock in lithotomy. Milligan-Morgan was performed and gross examination of the specimen was unremarkable. Histopathologic evaluation showed noninvasive squamous cells carcinoma. The present case report evidences the opportunity of routine histopathologic analysis of hemorrhoidal specimens particularly in case of long-standing prolapse. Questions arise in the option of those techniques where no specimens are collected or tissue is excised far from deceased area.
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Lee PC, Hu YW, Hung MH, Chen CC, Lin HC, Lee FY, Hung YP, Yi-Fong Su V, Yen SH, Tzeng CH, Chiou TJ, Liu CJ. The risk of cancer in patients with benign anal lesions: a nationwide population-based study. Am J Med 2013; 126:1143.e9-18. [PMID: 24135515 DOI: 10.1016/j.amjmed.2013.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/17/2013] [Accepted: 05/28/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the risk of cancer among patients diagnosed with hemorrhoids and benign anal inflammatory lesions. METHODS A population-based, retrospective cohort study was conducted that included patients diagnosed with hemorrhoids or benign inflammatory anal lesions (eg, anal fissure, fistula, and perianal abscesses) that were registered in the National Health Insurance Research Database in Taiwan between January 1, 2000 and December 31, 2010. Standardized incidence ratios (SIRs) were calculated to compare the cancer incidence of these patients to the general population. RESULTS During a median observation period of 6.23 years, 3080 cancers developed among 70,513 hemorrhoid patients, with a follow-up period of 438,425.6 person-years, entailing the SIR of 1.52 (95% confidence interval [CI], 1.47-1.58). Increased cancer risk (SIR 1.16; 95% CI, 1.11-1.21) was still noted even after excluding the first year of observation. Significant long-term risk for colorectal cancer (SIR 1.50; 95% CI, 1.35-1.66) and prostate cancer (SIR 1.40; 95% CI, 1.17-1.66) was observed after corrections were made for multiple comparisons. In contrast, there was no remarkable increase in cancer risk for patients with inflammatory anal lesions when cancers detected within the first year of diagnosis were excluded. CONCLUSION The presence of hemorrhoids is associated significantly with a long-term risk of developing colorectal cancer or prostate cancer. In contrast, benign inflammatory anal lesions do not appear to increase the risk of malignancy.
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Affiliation(s)
- Pei-Chang Lee
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
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Slesser AAP, Bhangu A, Bower M, Goldin R, Tekkis PP. A systematic review of anal squamous cell carcinoma in inflammatory bowel disease. Surg Oncol 2013; 22:230-7. [PMID: 24050823 DOI: 10.1016/j.suronc.2013.08.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/13/2022]
Abstract
AIM The aim of this systematic review was to determine the incidence, aetiology and clinical characteristics of anal squamous cell carcinomas (SCC) presenting in patients with inflammatory bowel disease. METHOD A systematic review of the literature was undertaken using Medline, Embase, Cochrane and Web of Science. RESULTS A total of 33 cases of anal SCC were described, 7 in ulcerative colitis (UC) and 26 in Crohn's disease (CD). The annual incidence of anal SCCs was 0.9/100,000 and 2.0/100,000 in patients with UC and CD respectively. The gender ratio in CD was 3M:17F with a median age of 42 years, the main presenting symptom was anal pain and 85% of CD cases had peri-anal disease. No studies described anal intra-epithelial neoplasia. The human papilloma virus was found to be positive in 2 out of 5 (40%) cases. The majority of patients (73%) with CD received radical surgery as their first line treatment. The cumulative overall and disease free survival in CD was 37 per cent at five years. CONCLUSION The findings of this review when contrasted with the data from cancer registries suggests that there is a higher incidence of anal SCC, an earlier age of presentation and poorer outcomes in patients with Crohn's disease compared to the general population implying a more aggressive neoplastic process. This review supports the hypothesis that peri-anal disease plays a contributing role in anal SCCs and as such targeted surveillance in patients with longstanding peri-anal disease should be considered.
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Affiliation(s)
- A A P Slesser
- Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
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Immunopathological characteristics of cryptoglandular and Crohn's anorectal fistulas. Folia Med (Plovdiv) 2011; 52:5-12. [PMID: 21462886 DOI: 10.2478/v10153-010-011-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Anorectal fistulas are quite common proctologic disorders. They can be either of cryptoglandular origin or can be associated with Crohn's disease and chronic ileocolitis. Mechanical obstruction and local infections are prime causes of this pathological condition. Genetic predisposition and inadequate immune response with overproduction of pro-inflammatory cytokines appear prominently in the course of Crohn's disease. Interferon-gamma, a Th1 type cytokine, reflecting the engagement of cellular immune mechanisms, is the first to be produced in the intestinal mucosa. The inflammatory process in the colon mucosa induced by the abundant microbial flora is sustained and turned chronic by the gradual elevation of the local TNF-a and regulatory cytokines levels (interleukin-10, transforming growth factor-beta). The number of activated local memory T cells CD4+CD45RBl0 increases significantly. The regulatory CD4+CD25+ T lymphocytes producing interleukin-10 increase also trying to counterbalance the cytokine reaction. The chronic inflammatory infiltrates of the colon mucosa are represented by lymphocytes, plasma cells, macrophages. The long-term activation of macrophages by the released interferon-gamma leads to tissue damage and potentiation of angiogenesis--a risk factor for carcinoma development. Management of anorectal abscesses and fistulas is complex aiming to alleviate the symptoms, prevent relapses, reduce the risk of sphincter damage and improve quality of life. The main approach (surgery) should be combined with antimicrobial infection control and immunomodulation by intravenous or local administration of anti-TNF-alpha antibodies.
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Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol 2011; 106:57-61. [PMID: 21212754 DOI: 10.1038/ajg.2010.449] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Achalasia is a motor disorder of the lower esophageal sphincter, which fails to relax on swallowing. Although a greater risk of esophageal squamous cell carcinoma among achalasia patients is fairly well established, no epidemiological study has evaluated the risk of esophageal adenocarcinoma in these patients. METHODS We compiled a cohort of 2,896 patients recorded with a discharge diagnosis of achalasia between 1965 and 2003 in the Swedish Inpatient Register. The cohort was followed through 2003 via record linkages with essentially complete registers of cancer, causes of death, and migration. Standardized incidence ratios (SIRs) were used to estimate the relative risk of esophageal cancer in achalasia patients compared to the age-, sex-, and calendar period-matched Swedish population. We further estimated SIRs for esophageal cancer among patients treated with esophagomyotomy. RESULTS After excluding the first year of follow-up, we observed excess risks for both squamous cell carcinoma (SIR 11.0, 95% confidence interval [CI] 6.0-18.4) and adenocarcinoma (SIR 10.4, 95% CI 3.8-22.6) of the esophagus. Notwithstanding similar numbers of men and women in our achalasia cohort, 20 of 22 esophageal cancers developed in men (SIRs for adenocarcinoma and squamous cell carcinoma were 8.4 and 13.1, respectively). Increased SIRs among operated patients pertained mainly to esophageal squamous cell carcinoma. We found no evidence that surgical esophagomyotomy increases the risk of esophageal adenocarcinoma. CONCLUSIONS Male achalasia patients have substantially greater risks for both squamous cell carcinoma and adenocarcinoma of the esophagus. Small numbers preclude a firm conclusion about the risk among women.
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Chandramohan K, Mathew AP, Muralee M, Anila KR, Ramachandran K, Ahamed I. Squamous cell carcinoma arising from long-standing perianal fistula. Int Wound J 2010; 7:515-8. [PMID: 20726921 DOI: 10.1111/j.1742-481x.2010.00724.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Perianal fistula is a very common problem in general population. Ninety percent of perianal fistulae arise from infected anal glands, and they often give rise to perianal abscesses. Very rarely perianal fistulae and abscesses undergo malignant transformation and give rise to carcinomas, mainly adenocarcinomas. We are reporting a case of squamous cell carcinoma arising from long-standing perianal fistula and how we managed it surgically.
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Affiliation(s)
- K Chandramohan
- Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India.
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Sunesen KG, Nørgaard M, Thorlacius-Ussing O, Laurberg S. Immunosuppressive disorders and risk of anal squamous cell carcinoma: a nationwide cohort study in Denmark, 1978-2005. Int J Cancer 2010; 127:675-84. [PMID: 19960431 DOI: 10.1002/ijc.25080] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Compromised immune function may increase the risk of anal squamous cell carcinoma (SCC). We examined the risk of anal SCC in patients with HIV infection and other chronic disorders associated with immunosuppression. A population-based cohort study was conducted using the Danish National Patient Registry and the Danish Cancer Registry (DCR). We identified all patients with a first-time hospital contact or procedure for HIV infection, solid organ transplantation or autoimmune disease or a first-time record of haematologic malignancy in the DCR, 1978-2005, and followed these for a subsequent anal SCC, starting follow-up 1 year after diagnosis of the index disease. Standardised incidence ratios (SIRs) were computed as the ratio of observed to expected numbers of anal SCCs, based on national age-, sex- and period-specific rates. Among 4,488 patients with HIV, we observed 21 anal SCCs with 0.3 expected (SIR: 81.1 (95% confidence interval (CI): 51.6-121.9)). Risk of anal SCC was markedly increased among 5,113 solid organ recipients (SIR: 14.4 (CI: 7.0-26.4)) and 30,165 patients with haematologic malignancies (SIR: 2.3 (CI: 1.1-4.2)) but only moderately increased among 242,114 patients with autoimmune diseases (SIR: 1.3 (CI: 1.0-1.6)). SIRs varied according to type of autoimmune disease and were high in patients with Crohn's disease (SIR: 3.1 (CI: 1.2-6.4)), psoriasis (SIR: 3.1 (CI: 1.8-5.1)), polyarteritis nodosa (SIR: 8.8 (CI: 1.5-29.0)) and Wegener's granulomatosis (SIR: 12.4 (CI: 2.1-40.8)). In conclusion, we found HIV infection, solid organ transplantation, haematologic malignancies and a range of specific autoimmune diseases strongly associated with increased risk of anal SCC.
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Affiliation(s)
- Kåre G Sunesen
- Department of Colorectal Surgery P, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark.
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Engels EA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS 2009; 23:875-85. [PMID: 19349851 PMCID: PMC2677638 DOI: 10.1097/qad.0b013e328329216a] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Non-AIDS-defining malignancies have come to represent a growing fraction of the overall cancer burden in HIV-infected people, as improvements in HIV therapy prolong survival and reduce the incidence of AIDS-associated cancers. This review focuses on five non-AIDS-defining malignancies for which HIV-infected persons have an elevated risk, for which risk is substantial or increasing over time, and for which HIV infection may play an etiologic role. Among HIV-infected persons, lung cancer risk is high, in part due to frequent tobacco use in this population. Risks of anal cancer and liver cancer are also elevated, related to the high prevalence of infections with human papillomavirus and hepatitis B and C viruses. In addition, risk is elevated for Hodgkin lymphoma and several rare skin cancers, including Merkel cell carcinoma and sebaceous carcinoma. For anal cancer and Hodgkin lymphoma, it is particularly concerning that incidence in HIV-infected persons has risen in recent years, when highly active antiretroviral therapy has been available. Accumulating evidence supports the possibility that the high prevalence of known carcinogenic exposures (e.g., tobacco) and infections with oncogenic viruses does not completely explain the occurrence of these cancers. Indeed, HIV may act to increase the risk for each of these five non-AIDS-defining malignancies, although the mechanisms may vary, including immunosuppression, immune reconstitution, and chronic inflammation. These non-AIDS-defining cancers also present important opportunities for prevention (e.g., smoking cessation), screening (e.g., periodic anal Pap smear screening), and early detection.
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Martínez-Ramos D, Nomdedéu-Guinot J, Artero-Sempere R, Escrig-Sos J, Gibert-Gerez J, Alcalde-Sánchez M, Salvador-Sanchis JL. [Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care]. Aten Primaria 2009; 41:207-12. [PMID: 19328596 DOI: 10.1016/j.aprim.2008.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 07/16/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases. DESIGN Cross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery. SETTING Department of General Surgery and Digestive Diseases. Castellon General Hospital. PARTICIPANTS Patients diagnosed with a benign anal disease in PC and referred to our department. MEASUREMENTS The sensitivity, specificity and kappa index was calculated for each disease. RESULTS A total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results. CONCLUSIONS The diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results.
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Affiliation(s)
- David Martínez-Ramos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General de Castellón, Castellón, Spain.
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Zendehdel K, Nyrén O, Edberg A, Ye W. Risk of Esophageal Adenocarcinoma in Achalasia Patients, a Retrospective Cohort Study in Sweden. Am J Gastroenterol 2007. [DOI: 10.1111/j.1572-0241.2007.01258.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
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