Abstract
IntroductionExtramucosal anal canal adenocarcinomas can arise in anorectal fistulas and the anal glands, the latter being rare. We present a rare case of anal gland adenocarcinoma treated with a combination of neoadjuvant therapy and radical surgical resection. Presentation of caseA 56-year-old man presented with rectal bleeding and irritation, and a nodule that had been enlarging for 10 months. Rectal examination revealed a bleeding ulceroproliferative growth at the left lateral edge of the anus without apparent invasion of the anal mucosa. Histopathology and immunohistochemistry confirmed the diagnosis of anal canal adenocarcinoma CK7+,CDX2−, and focalCK20+). Endoanal ultrasound showed a lesion involving the anal canal, extending into the transition zone with the lower rectum, invading the external anal sphincter, with no cleavage plane with the urethra, measuring 89 × 33 × 57 mm, associated with lymphadenopathy in the lower mesorectum (uT4N1). PET/CT confirmed a hypermetabolic lesion on the anal edge and bilateral hypermetabolic inguinal lymph nodes suggestive of secondary involvement. Colonoscopy was normal. The patient was started on neoadjuvant therapy with oral capecitabine and radiotherapy (57.6 Gy). Twelve weeks, the patient underwent extralevator abdominoperineal excision, cystoscopy (free urethral mucosa), skeletonization of the urethra with partial resection of the corpus cavernosum, and pelvic floor reconstruction with a vertical rectus abdominis myocutaneous flap. DiscussionTreatment of anal gland adenocarcinoma remains to be established. A combination of radical surgical resection and neoadjuvant/adjuvant chemoradiotherapy has been suggested, as performed here. ConclusionPatients with advanced anal gland adenocarcinoma may benefit from neoadjuvant therapy followed by rescue surgery.
Highlights
Extramucosal anal canal adenocarcinomas can arise in anorectal fistulas and the anal glands, the latter being rare
Adenocarcinomas may be of colorectal type arising in the anal mucosa above the dentate line or extramucosal adenocarcinoma arising in the epithelium of the anal canal, including the mucosal surface, the anal glands, and the lining of fistulous tracts [2]
We present a rare case of anal gland adenocarcinoma successfully treated with a combination of neoadjuvant therapy and radical surgical resection in the coloproctology service at a tertiary care center supported by federal government funds with a wide range of specialty services
Summary
Extramucosal anal canal adenocarcinomas can arise in anorectal fistulas and the anal glands, the latter being rare. We present a rare case of anal gland adenocarcinoma treated with a combination of neoadjuvant therapy and radical surgical resection. Endoanal ultrasound showed a lesion involving the anal canal, extending into the transition zone with the lower rectum, invading the external anal sphincter, with no cleavage plane with the urethra, measuring 89 × 33 × 57 mm, associated with lymphadenopathy in the lower mesorectum (uT4N1). PET/CT confirmed a hypermetabolic lesion on the anal edge and bilateral hypermetabolic inguinal lymph nodes suggestive of secondary involvement. A combination of radical surgical resection and neoadjuvant/adjuvant chemoradiotherapy has been suggested, as performed here. CONCLUSION: Patients with advanced anal gland adenocarcinoma may benefit from neoadjuvant therapy followed by rescue surgery
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