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Rescue surgery for advanced anal gland adenocarcinoma: A case report()

INTRODUCTION: 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. PRESENTATION OF CASE: A 56-year-old...

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Autores principales: Bernardes, Sonaira Francisca Alves da Silva, Rezende Junior, Dirceu de Castro, Rissin, Natasha Sa Gille, da Mota, Tânia Rosa Pereira, Pimentel, Alexandre de Brito Borges
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514360/
https://www.ncbi.nlm.nih.gov/pubmed/31078011
http://dx.doi.org/10.1016/j.ijscr.2019.03.019
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author Bernardes, Sonaira Francisca Alves da Silva
Rezende Junior, Dirceu de Castro
Rissin, Natasha Sa Gille
da Mota, Tânia Rosa Pereira
Pimentel, Alexandre de Brito Borges
author_facet Bernardes, Sonaira Francisca Alves da Silva
Rezende Junior, Dirceu de Castro
Rissin, Natasha Sa Gille
da Mota, Tânia Rosa Pereira
Pimentel, Alexandre de Brito Borges
author_sort Bernardes, Sonaira Francisca Alves da Silva
collection PubMed
description INTRODUCTION: 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. PRESENTATION OF CASE: A 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. DISCUSSION: Treatment of anal gland adenocarcinoma remains to be established. 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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spelling pubmed-65143602019-05-20 Rescue surgery for advanced anal gland adenocarcinoma: A case report() Bernardes, Sonaira Francisca Alves da Silva Rezende Junior, Dirceu de Castro Rissin, Natasha Sa Gille da Mota, Tânia Rosa Pereira Pimentel, Alexandre de Brito Borges Int J Surg Case Rep Article INTRODUCTION: 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. PRESENTATION OF CASE: A 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. DISCUSSION: Treatment of anal gland adenocarcinoma remains to be established. 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. Elsevier 2019-03-28 /pmc/articles/PMC6514360/ /pubmed/31078011 http://dx.doi.org/10.1016/j.ijscr.2019.03.019 Text en © 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bernardes, Sonaira Francisca Alves da Silva
Rezende Junior, Dirceu de Castro
Rissin, Natasha Sa Gille
da Mota, Tânia Rosa Pereira
Pimentel, Alexandre de Brito Borges
Rescue surgery for advanced anal gland adenocarcinoma: A case report()
title Rescue surgery for advanced anal gland adenocarcinoma: A case report()
title_full Rescue surgery for advanced anal gland adenocarcinoma: A case report()
title_fullStr Rescue surgery for advanced anal gland adenocarcinoma: A case report()
title_full_unstemmed Rescue surgery for advanced anal gland adenocarcinoma: A case report()
title_short Rescue surgery for advanced anal gland adenocarcinoma: A case report()
title_sort rescue surgery for advanced anal gland adenocarcinoma: a case report()
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514360/
https://www.ncbi.nlm.nih.gov/pubmed/31078011
http://dx.doi.org/10.1016/j.ijscr.2019.03.019
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