Abstract
PurposeAbscess 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.MethodsWe 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.Results0.5% 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.ConclusionAdvanced 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.
Highlights
Infections of the anal, perianal, perineal, sacral or gluteal region, such as abscesses and fistulas, are a common occurrence in surgical practice
Sporadic fistulas occur in approximately one-third of the patients with perianal abscesses; they are observed in 5–40% of patients with Crohn’s disease (Gold et al 2018)
The aim of this paper is to report our experiences with patients who were treated for an abscess or fistula of the perianal skin and diagnosed with cancer
Summary
Infections of the anal, perianal, perineal, sacral or gluteal region, such as abscesses and fistulas, are a common occurrence in surgical practice. Malignant tumours of the anal region can masquerade as inflammatory changes of the skin or fistulas, often rendering timely diagnosis (DS) extremely difficult (Klas et al 1999; Leong et al 2019; Ohta et al 2013). These patients usually present with advanced tumour stages (Ohta et al 2013; Kapiteijn et al 2001). For these rare cases, there is no consensus regarding diagnostic and treatment strategies (Yang et al 2009). Previous reports mostly consist of case reports, in which multimodal treatment and extensive surgery are recommended, despite differences in the histological
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