A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae
Mucinous adenocarcinoma of the perianal region is an oncologic rarity posing a diagnostic and therapeutic dilemma for treating oncologists. This is due to the low number of reported cases, compounded by the lack of definitive therapeutic guidelines. It accounts for 2% to 3% of all gastrointestinal m...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2020/1798543 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832566097039065088 |
|---|---|
| author | Fahmi Pramaditto Azmi Nur Afdzillah Abdul Rahman Luqman Mazlan Normala Basiron Farrah-Hani Imran |
| author_facet | Fahmi Pramaditto Azmi Nur Afdzillah Abdul Rahman Luqman Mazlan Normala Basiron Farrah-Hani Imran |
| author_sort | Fahmi Pramaditto Azmi |
| collection | DOAJ |
| description | Mucinous adenocarcinoma of the perianal region is an oncologic rarity posing a diagnostic and therapeutic dilemma for treating oncologists. This is due to the low number of reported cases, compounded by the lack of definitive therapeutic guidelines. It accounts for 2% to 3% of all gastrointestinal malignancies and is historically known to arise from chronic anal fistulas and ischiorectal or perianal abscesses. We hereby report an interesting case of perianal mucinous adenocarcinoma in a 66-year-old male initially treated for a horseshoe abscess with complex fistulae. He presented with a 6-month history of a discharging growth in perianal region and painful defecation associated with occasional blood mixed stools. An incisional biopsy from the ulcer revealed mucinous adenocarcinoma. Contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI) scan showed a localized perianal growth which involves the internal and external sphincter as well as suspicious involvement in the posterior aspect of the levator ani/puborectalis sling, which was further confirmed with colonoscopy (see figures). With no preset treatment protocol for this rare entity, he was managed with an abdominoperineal resection (APR) and vertical rectus abdominis myocutaneous flap (VRAM) tissue reconstruction. He had a turbulent postoperative period including intestinal obstruction secondary to internal herniation of bowel resulting in flap failure. The subsequent perineal wound was managed conservatively with advanced wound care and has since completely healed. |
| format | Article |
| id | doaj-art-c6a386d607c64e36b52d94cdc25e1e32 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-c6a386d607c64e36b52d94cdc25e1e322025-02-03T01:05:15ZengWileyCase Reports in Surgery2090-69002090-69192020-01-01202010.1155/2020/17985431798543A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex FistulaeFahmi Pramaditto Azmi0Nur Afdzillah Abdul Rahman1Luqman Mazlan2Normala Basiron3Farrah-Hani Imran4Colorectal Surgery Unit, Department of Surgery, UKM Medical Centre, Kuala Lumpur, MalaysiaColorectal Surgery Unit, Department of Surgery, UKM Medical Centre, Kuala Lumpur, MalaysiaColorectal Surgery Unit, Department of Surgery, UKM Medical Centre, Kuala Lumpur, MalaysiaDepartment of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, MalaysiaPlastic and Reconstructive Surgery Unit, Department of Surgery, UKM Medical Centre, Kuala Lumpur, MalaysiaMucinous adenocarcinoma of the perianal region is an oncologic rarity posing a diagnostic and therapeutic dilemma for treating oncologists. This is due to the low number of reported cases, compounded by the lack of definitive therapeutic guidelines. It accounts for 2% to 3% of all gastrointestinal malignancies and is historically known to arise from chronic anal fistulas and ischiorectal or perianal abscesses. We hereby report an interesting case of perianal mucinous adenocarcinoma in a 66-year-old male initially treated for a horseshoe abscess with complex fistulae. He presented with a 6-month history of a discharging growth in perianal region and painful defecation associated with occasional blood mixed stools. An incisional biopsy from the ulcer revealed mucinous adenocarcinoma. Contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI) scan showed a localized perianal growth which involves the internal and external sphincter as well as suspicious involvement in the posterior aspect of the levator ani/puborectalis sling, which was further confirmed with colonoscopy (see figures). With no preset treatment protocol for this rare entity, he was managed with an abdominoperineal resection (APR) and vertical rectus abdominis myocutaneous flap (VRAM) tissue reconstruction. He had a turbulent postoperative period including intestinal obstruction secondary to internal herniation of bowel resulting in flap failure. The subsequent perineal wound was managed conservatively with advanced wound care and has since completely healed.http://dx.doi.org/10.1155/2020/1798543 |
| spellingShingle | Fahmi Pramaditto Azmi Nur Afdzillah Abdul Rahman Luqman Mazlan Normala Basiron Farrah-Hani Imran A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae Case Reports in Surgery |
| title | A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae |
| title_full | A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae |
| title_fullStr | A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae |
| title_full_unstemmed | A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae |
| title_short | A Case of Large Perianal Mucinous Adenocarcinoma Arising from Recurrent Abscess and Complex Fistulae |
| title_sort | case of large perianal mucinous adenocarcinoma arising from recurrent abscess and complex fistulae |
| url | http://dx.doi.org/10.1155/2020/1798543 |
| work_keys_str_mv | AT fahmipramadittoazmi acaseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT nurafdzillahabdulrahman acaseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT luqmanmazlan acaseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT normalabasiron acaseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT farrahhaniimran acaseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT fahmipramadittoazmi caseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT nurafdzillahabdulrahman caseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT luqmanmazlan caseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT normalabasiron caseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae AT farrahhaniimran caseoflargeperianalmucinousadenocarcinomaarisingfromrecurrentabscessandcomplexfistulae |