Abstract
Background
Mucinous adenocarcinoma arising from a chronic anorectal fistula is rare, with few reports in the literature. Such lesions can be misdiagnosed for the more common benign perianal abscess or fistula.
Methods
From our retrospective chart review, we identified three patients with chronic perianal fistula-in-ano who were subsequently found to have developed perianal mucinous adenocarcinoma on biopsy. We recorded the symptomatology, subsequent management and further follow-up of each patient.
Results
Two of three patients who received irradiation and chemotherapy were still alive during 28 and 24 months of follow-up, respectively without any evidence of distant metastasis. One patient with inguinal lymph node metastases died due to distant metastasis 6 months after diagnosis.
Conclusions
Fistula-associated perianal mucinous adenocarcinoma is an uncommon malignant transformation of chronic fistula-in-ano. MRI can provide important diagnostic information on patient with this suspicious inflammatory condition. Although radical resection of the tumour with abdominoperineal resection remains the surgical treatment of choice. Combined chemoradiotherapy may be appropriate for these patients with promising results.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Salat A (2006) Anal cancer. Eurg Surg 38(2):135–138
Schaffzin DM, Stahl TJ, Smith LE et al (2003) Perianal mucinous adenocracinoma: unusual case presentations and review of the literature. Am Surgeon 69:166–169
Ong J, Jit-Fong L, Ming-Hian K, Boon-Swee O, Kok-Sun H, Eu KW (2007) Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from a single institution. Tech Coloproctol 11(1):34–38
Sato H, Maeda K, Maruta M, Kuroda M, Nogaki M, Nogaki M (2006) Mucinous adenocarcinoma associated with chronic anal fistula reconstructed by gracilis myocutaneous flaps. Tech Coloproctol 10(3):249–252
Gaertner WB, Hagerman GF, Finne CO et al (2008) Fistula-associated anal adenocarcinoma good results with aggressive therapy. Dis Colon Rectum 51:1061–1067
Okada K, Shatari T, Sasaki T, Tamada T, Suwa T, Futuuchi T et al (2008) Is histopathological evidence really essential for making a surgical decision about mucinous carcinoma arising in a perianal fistula: report of a case. Surg Today 38:555–558
Sierra EM, Saenz V, Martínez PH, Rocha JR (2006) Mucinous adenocarcinoma associated with fistula in ano: report of a case. Tech Coloproctol 10:51–53
Ibáñez Aguirre FJ, Erro Azcárate JM, Aranda Lozano F, Almendral López ML, Valentí Ponsa C, Echenique Elizondo M (2006) Mucinous adenocarcinoma on chronic perianal fistula treated by neoadjuvant QT-RT neoadyuvante and laparoscopic abdomino-perineal resection. Rev Esp Enferm Dig 98(4):310–312
Papapolychroniadis C, Kaimakis D, Giannoulis K, Berovalis P, Karamanlis E, Haritanti A et al (2004) A case of mucinous adenocarcinoma arising in long-standing multiple perianal and presacral fistulas. Tech Coloproctol 8(Suppl 1):s138–s140
Erhan Y, Sakarya A, Aydede H, Demir A, Seyhan A, Atici E (2003) A case of large mucinous adenocarcinoma arising in a long-standing fistula-in-ano. Dig Surg 20(1):69–71
Kuclaylat M, Doerr R, Karamanoukian H, Barrios G (1996) Basal cell carcinoma arising in a fistula-in-ano. Am Surgeon 62:1000–1002
Taniguchi S, Yamanari H, Inada K et al (1996) Adenocarcinoma in the anal canal associated with a fistula: report of a case. Surg Today 26:707–710
Pyan DP, Compton CC, Mayer RJ (2000) Carcinoma of the anal canal. N Engl J Med 342:729–800
Terra MP, Deutekom M, Beets-Tan R et al (2006) Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Dis Colon Rectum 49:668–678
Halligan FS, Stoker J (2006) Imaging of fistula in Ano. Radiology 239:18–33
Teixeira CR, Tanaka S, Haruma K et al (1993) The clinical significance of the histologic subclassification of colorectal carcinoma. Oncology 50:495–499
Fujimoto H, Ikeda M, Shimofusa R, Terauchi M, Eguchi M (2003) Mucinous adenocarcinoma arising from fistula-in-ano: findings on MRI. Eur Radiol 13:2053–2054
Hama Y, Makita K, Yanmana T, Dodanuk K (2006) Mucinous adenocarcinoma arising from fistula in ano: MRI findings. AJR 187:517–521
Muffy MJ, Dalen AV, Haglund A et al (2007) Tumour markers in colorectal cancer: European group on tumour markers (EGTM) guidelines for clinical use. Eur J Cancer 43:1348–1360
Belkacemi Y, Berger C, Poortmans P, Piel G, Zouhair A, Meric J-B et al (2003) Management of primary anal canal adenocarcinoma: a large retrospective study from the Rare Cancer Network. Int J Radiat Oncol Biol Phys 56:1274–1283
Church JM, Weakley FL, Fazio VW, Sebek BA, Achkar E, Carwell M (1985) The relationship between fistulas in Crohn’s disease and associated carcinoma: report of four cases and review of the literature. Dis Colon Rectum 28:361–366
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yang, BL., Shao, WJ., Sun, GD. et al. Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from single institution. Int J Colorectal Dis 24, 1001–1006 (2009). https://doi.org/10.1007/s00384-009-0657-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-009-0657-7