Mucinous adenocarcinoma arising in chronic perianal fistula: good results with neoadjuvant chemoradiotherapy followed by surgery.

Marisa D Santos,Carlos Lopes,Carlos Nogueira

doi:10.1155/2014/386150

Marisa D Santos, Carlos Lopes + Show 1 more

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https://doi.org/10.1155/2014/386150

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Abstract

Chronic perianal fistulas are a common clinical condition. However, their evolution to adenocarcinoma is rare. We report the case of a 48-year-old man with perianal chronic fistulas, who developed two perianal ulcerated lesions near the external orifices of the fistulas, which extended proximally as a pararectal tumor. No intestinal lesion was seen at endoscopic examination. Histopathological biopsy indicated mucinous adenocarcinoma. Staging was performed by pelvic magnetic resonance imaging (MRI) and thoracoabdominal CT scan. The patient underwent a laparoscopic colostomy followed by neoadjuvant chemoradiotherapy and then laparoscopic abdominoperineal resection followed by adjuvant therapy. We have seen a favorable outcome with no recurrence at 3 years of follow-up.

Highlights

Perianal mucinous adenocarcinoma is a rare disease often associated with a long-standing anal fistula, representing approximately 2-3% of large bowel cancers [1,2,3,4]
We report a rare case of large mucinous adenocarcinoma, arising from a perianal fistula, successfully resected after neoadjuvant chemoradiotherapy
The development of a perianal mucinous adenocarcinoma arising in long-standing perianal fistulas is rare, with few reports in the literature [1, 3, 4, 8, 9]

Summary

Introduction

Perianal mucinous adenocarcinoma is a rare disease often associated with a long-standing anal fistula, representing approximately 2-3% of large bowel cancers [1,2,3,4]. The occurrence of a carcinoma arising in a fistula is probably due to chronic inflammation [3]. The diagnosis is challenging and is based on a high index of clinical suspicion and specific histologic features [3, 7]. Due to the rarity of this tumor and the lack of sufficient patients for controlled trials, there is no consensus regarding diagnosis and treatment strategies. We report a rare case of large mucinous adenocarcinoma, arising from a perianal fistula, successfully resected after neoadjuvant chemoradiotherapy

Case Report

Operative Technique Details

Discussion