Abstract

IntroductionAnal canal tumors are uncommon amongst gastrointestinal tumors or anorectal tumors. While the majority of them seem to be squamous cell carcinoma in nature, adenocarcinoma may be equally as common amongst the Asian population. Recurrent nodal metastasis from a primary anal malignancy is not a rare occurrence in view of the anatomy of the anal canal. Case presentationA 70 year-old patient underwent surgery for synchronous sigmoid and anal adenocarcinoma in 2015. He then re-presented 2 years later with recurrence in the right inguinal lymph nodes. He subsequently underwent a right ilio-inguinal lymph node block dissection with a Sartorius flap creation. DiscussionAs most anal canal tumors are squamous cell carcinomas, the optimal treatment for recurrent ilioinguinal lymph node disease has been well-established. This usually involves groin dissection as surgical treatment, with consideration for adjuvant combined chemoradiotherapy. Such an approach is likely to be beneficial for ilioinguinal lymph node disease from primary anal canal adenocarcinomas as well. ConclusionPhysicians caring for patients with primary anal adenocarcinoma should be vigilant for possible ilioinguinal lymph node metastasis as this is not a rare occurrence. Surgical treatment appears to be a reasonable approach, with consideration for adjuvant therapy.

Highlights

  • Anal canal tumors are uncommon amongst gastrointestinal tumors or anorectal tumors

  • While literature from the West reports a majority being squamous cell carcinoma, recent Asian literature seems to show that adenocarcinoma as a pathological diagnosis could be as common, if not more common [3,4]

  • It has been reported that the presence of inguinal lymph node disease in anal adenocarcinomas at diagnosis could be a poor prognostic factor, with lower 5-year survival rates [7]

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Summary

INTRODUCTION

Anal canal tumors are uncommon amongst gastrointestinal tumors or anorectal tumors. While the majority of them seem to be squamous cell carcinoma in nature, adenocarcinoma may be as common amongst the Asian population. CASE PRESENTATION: A 70 year-old patient underwent surgery for synchronous sigmoid and anal adenocarcinoma in 2015. He re-presented 2 years later with recurrence in the right inguinal lymph nodes. DISCUSSION: As most anal canal tumors are squamous cell carcinomas, the optimal treatment for recurrent ilioinguinal lymph node disease has been well-established. This usually involves groin dissection as surgical treatment, with consideration for adjuvant combined chemoradiotherapy. Such an approach is likely to be beneficial for ilioinguinal lymph node disease from primary anal canal adenocarcinomas as well. Surgical treatment appears to be a reasonable approach, with consideration for adjuvant therapy

Introduction
Presentation of case
Discussion
Conclusion
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