|
|
慢性肛瘘继发肛周黏液腺癌1例并文献复习
|
Abstract:
为了探讨肛瘘继发肛周黏液腺癌的诊断、治疗及预后，提高临床医务工作者对该疾病的认识，早期诊断，避免漏诊、误诊，降低远期并发症及死亡率，对昆明医科大学第二附属医院中医科收治的1例肛瘘继发肛周黏液腺癌病例进行分析并回顾性总结文献报道的相关诊治经验，发现肛瘘癌变病程进展缓慢，在病变早期通常无排便习惯改变及直肠刺激症状，缺乏特征性的临床表现，致使该病误诊、漏诊率高，确诊需依靠瘘管及相关肿物的病理学活检。因此对于长期不愈的肛瘘应警惕恶变的可能，及时完善组织病理学检查有助于早期诊断和治疗，提高患者预后。
In order to explore the diagnosis, treatment and prognosis of perianal mucinous adenocarcinoma secondary to anal fistula, improve the understanding of clinical staff on this disease, make early diagnosis, avoid missed diagnosis and misdiagnosis, and reduce long-term complications and mortality, a case of perianal mucinous adenocarcinoma secondary to anal fistula admitted to Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Kunming Medical University, was analyzed and the relevant diagnosis and treatment experience reported in the literature was retrospectively summarized. It was found that the course of anal fistula cancer progressed slowly, there were usually no bowel habit changes and rectal irritation symptoms in the early stage of the disease, and the lack of characteristic clinical manifestations led to a high rate of misdiagnosis and missed diagnosis of the disease, and the diagnosis was determined by pathological biopsy of fistulas and related tumors. Therefore, the possibility of malignant transformation should be vigilant for the long-term unhealed anal fistula, and timely improvement of histopathological examination is conducive to early diagnosis and treatment, and improve the prognosis of patients.
| [1] | Rosser, C. (1934) The Relation of Fistula in Ano to Cancer of the Anal Canal. Trans Am Proc Soc, 35, 65-71. |
| [2] | Heriot, A.G. (2020) Whither Anal Cancer? British Journal of Cancer, 122, 733-734. https://doi.org/10.1038/s41416-019-0690-4 |
| [3] | Van der Zee, R.P., Richel, O., De Vries, H.J., et al. (2013) The Increasing Incidence of Anal Cancer: Can It Be Explained by Trends in Risk Groups? The Netherlands Journal of Medicine, 71, 401-411. |
| [4] | Laohawetwanit, T., Hareerak, T., Thamwongskul, C. and Boon‐Ing, N. (2021) Extramucosal Anal Canal Adenocarcinoma, Non‐Anal Gland Type, and Non‐Fistula‐Associated with Mucinous Appearance: A Recently Described Diagnostic Entity. Pathology International, 71, 715-718. https://doi.org/10.1111/pin.13146 |
| [5] | Deruyter, L., Venken, R. and Maetens, M. (2014) Perianal Mucinous Adenocarcinoma Arising from a Chronic Fistula-in-Ano. Acta Chirurgica Belgica, 114, 410-413. https://doi.org/10.1080/00015458.2014.11681053 |
| [6] | Alvarez-Laso, C.J., Moral, S., Rodríguez, D., Carrocera, A., Azcano, E., Cabrera, A., et al. (2017) Mucinous Adenocarcinoma on Perianal Fistula. A Rising Entity? Clinical and Translational Oncology, 20, 666-669. https://doi.org/10.1007/s12094-017-1750-y |
| [7] | Kotsafti, A., Scarpa, M., Angriman, I., Castagliuolo, I. and Caruso, A. (2021) Fistula-Related Cancer in Crohn’s Disease: A Systematic Review. Cancers (Basel), 13, Article No. 1445. https://doi.org/10.3390/cancers13061445 |
| [8] | Panés, J. and Rimola, J. (2017) Perianal Fistulizing Crohn’s Disease: Pathogenesis, Diagnosis and Therapy. Nature Reviews Gastroenterology & Hepatology, 14, 652-664. https://doi.org/10.1038/nrgastro.2017.104 |
| [9] | Ilbawi, A.M., Simianu, V.V., Millie, M. and Soriano, P. (2015) Wide Local Excision of Perianal Mucinous Adenocarcinoma. Journal of Clinical Oncology, 33, e16-e18. https://doi.org/10.1200/jco.2012.48.5722 |
| [10] | Jee, S.L., Amin-Tai, H., Fathi, N.Q. and Jabar, M.F. (2018) Perianal Mucinous Adenocarcinoma Diagnosed by Histological Study of Anorectal Abscess with Fistula. ACG Case Reports Journal, 5, e21. https://doi.org/10.14309/crj.2018.21 |
| [11] | Koizumi, M., Matsuda, A., Yamada, T., Morimoto, K., Kubota, I., Kubota, Y., et al. (2023) A Case Report of Anal Fistula-Associated Mucinous Adenocarcinoma Developing 3 Years after Treatment of Perianal Abscess. Surgical Case Reports, 9, Article No. 159. https://doi.org/10.1186/s40792-023-01743-3 |
| [12] | Ong, J., Jit-Fong, L., Ming-Hian, K., Boon-Swee, O., Kok-Sun, H. and Eu, K.W. (2007) Perianal Mucinous Adenocarcinoma Arising from Chronic Anorectal Fistulae: A Review from a Single Institution. Techniques in Coloproctology, 11, 34-38. https://doi.org/10.1007/s10151-007-0322-5 |
| [13] | 陈志康, 陈子华, 伍韶斌, 等. 慢性肛瘘癌变: 附6例临床分析[J]. 中国普通外科杂志, 2006(10): 769-771. |
| [14] | Baars, J.E., Kuipers, E.J., Dijkstra, G., Hommes, D.W., de Jong, D.J., Stokkers, P.C.F., et al. (2011) Malignant Transformation of Perianal and Enterocutaneous Fistulas Is Rare: Results of 17 Years of Follow-Up from the Netherlands. Scandinavian Journal of Gastroenterology, 46, 319-325. https://doi.org/10.3109/00365521.2010.536251 |
| [15] | Khalafi, S., Riddle, M., Harper, B. and Fikfak, V. (2023) Perianal Mucinous Adenocarcinoma Found Incidentally from Perianal Mass. Cureus, 15, e48314. https://doi.org/10.7759/cureus.48314 |
| [16] | Cenac, L.A., Xiao, P. and Asarian, A. (2020) Incidental Discovery of Mucinous Adenocarcinoma from a Suspected Inflammatory Perianal Mass. Journal of Surgical Case Reports, 2020, rjz413. https://doi.org/10.1093/jscr/rjz413 |
| [17] | Luo, C., Cen, S., Ding, G. and Wu, W. (2019) Mucinous Colorectal Adenocarcinoma: Clinical Pathology and Treatment Options. Cancer Communications (London), 39, 1-13. https://doi.org/10.1186/s40880-019-0361-0 |
| [18] | Hama, Y., Makita, K., Yamana, T. and Dodanuki, K. (2006) Mucinous Adenocarcinoma Arising from Fistula in Ano: MRI Findings. American Journal of Roentgenology, 187, 517-521. https://doi.org/10.2214/ajr.05.0011 |
| [19] | Prasad, S.N., Razik, A., Siddiqui, F. and Lal, H. (2018) Mucinous Adenocarcinoma Arising from Chronic Perianal Fistula Mimicking Horseshoe Abscess. BMJ Case Reports, 2018, bcr-2017-223063. https://doi.org/10.1136/bcr-2017-223063 |
| [20] | Ho, C.M., Tan, C.H. and Ho, B.C. (2012) Clinics in Diagnostic Imaging (143). Perianal Mucinous Adenocarcinoma Arising from Chronic Fistula-in-Ano. Singapore Medical Journal, 53, 843-849. |
| [21] | Gkegkes, I.D., Milionis, V., Goutas, N., Mantzoros, I., Bourtzinakou, A.A. and Stamatiadis, A.P. (2024) Perianal Mucinous Adenocarcinoma: A Case Report and a Systematic Review of the Literature. Journal of Gastrointestinal Cancer, 56, Article No. 6. https://doi.org/10.1007/s12029-024-01116-5 |
| [22] | Sunami, E., et al. (2022) Diagnosis and Surgical Treatment for Carcinoma Associated with Anal Fistula. Journal of Clinical Surgery, 77, 962-966. |
| [23] | Santos, M.D., Nogueira, C. and Lopes, C. (2014) Mucinous Adenocarcinoma Arising in Chronic Perianal Fistula: Good Results with Neoadjuvant Chemoradiotherapy Followed by Surgery. Case Reports in Surgery, 2014, Article ID: 386150. https://doi.org/10.1155/2014/386150 |
| [24] | Anwar, S., Welbourn, H., Hill, J. and Sebag‐Montefiore, D. (2013) Adenocarcinoma of the Anal Canal—A Systematic Review. Colorectal Disease, 15, 1481-1488. https://doi.org/10.1111/codi.12325 |
| [25] | Yang, B., Shao, W., Sun, G., Chen, Y. and Huang, J. (2009) Perianal Mucinous Adenocarcinoma Arising from Chronic Anorectal Fistulae: A Review from Single Institution. International Journal of Colorectal Disease, 24, 1001-1006. https://doi.org/10.1007/s00384-009-0657-7 |
| [26] | Oberholzer, K., Menig, M., Kreft, A., Schneider, A., Junginger, T., Heintz, A., et al. (2012) Rectal Cancer: Mucinous Carcinoma on Magnetic Resonance Imaging Indicates Poor Response to Neoadjuvant Chemoradiation. International Journal of Radiation Oncology Biology Physics, 82, 842-848. https://doi.org/10.1016/j.ijrobp.2010.08.057 |
| [27] | Causey, M.W., Steele, S.R., Maykel, J., Champagne, B. and Johnson, E.K. (2012) Surgical Therapy for Epidermoid Carcinoma of the Anal Canal: An NSQIP Assessment of Short-Term Outcomes. Journal of Surgical Research, 177, 235-240. https://doi.org/10.1016/j.jss.2012.05.005 |
| [28] | Pai, V.D., Jatal, S., Engineer, R., Ostwal, V. and Saklani, A.P. (2015) Multidisciplinary Management of Colorectal Adenocarcinoma Associated with Anal Fistula: An Indian Series. Colorectal Disease, 17, O240-O246. https://doi.org/10.1111/codi.13100 |
| [29] | Nushijima, Y., Nakano, K., Sugimoto, K., et al. (2014) A Case of Primary Carcinoma Associated with Anal Fistula. Gan to Kagaku Ryoho, 41, 1872-1874. |
| [30] | Flam, M., John, M., Pajak, T.F., Petrelli, N., Myerson, R., Doggett, S., et al. (1996) Role of Mitomycin in Combination with Fluorouracil and Radiotherapy, and of Salvage Chemoradiation in the Definitive Nonsurgical Treatment of Epidermoid Carcinoma of the Anal Canal: Results of a Phase III Randomized Intergroup Study. Journal of Clinical Oncology, 14, 2527-2539. https://doi.org/10.1200/jco.1996.14.9.2527 |
| [31] | Hongo, K., Kazama, S., Sunami, E., et al. (2013) Perianal Adenocarcinoma Associated with Anal Fistula: A Report of 11 Cases in a Single Institution Focusing on Treatment and Literature Review. Hepatogastroenterology, 60, 720-726. |
| [32] | Inoue, T., Sekido, Y., Ogino, T., Hata, T., Miyoshi, N., Takahashi, H., et al. (2023) Resection of Anorectal Fistula Cancer Associated with Crohn’s Disease after Preoperative Chemoradiotherapy: A Case Report. Surgical Case Reports, 9, Article No. 197. https://doi.org/10.1186/s40792-023-01778-6 |
| [33] | Chrysikos, D., Mariolis-Sapsakos, T., Triantafyllou, T., Karampelias, V., Mitrousias, A. and Theodoropoulos, G. (2018) Laparoscopic Abdominoperineal Resection for the Treatment of a Mucinous Adenocarcinoma Associated with an Anal Fistula. Journal of Surgical Case Reports, 2018, rjy036. https://doi.org/10.1093/jscr/rjy036 |
