Anal metastasis of rectal cancer—adenocarcinoma of squamous cells: a case report and literature review

Sasaki, Shun; Shimada, Masahiko; Nakaji, Yu; Nakanishi, Ryota; Nakashima, Yasuhiro; Saeki, Hiroshi; Oki, Eiji; Oda, Yoshinao; Maehara, Yoshihiko

doi:10.1186/s40792-017-0319-x

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…While colorectal cancer metastasis to the anus itself is a rare finding, its presentation without any antecedent trauma or perianal disease has only been described once in the literature. 24 The current case occurring in an irradiated and re-operative field following multiple local recurrences of a rectosigmoid cancer presents an added therapeutic challenge. Given the paucity of previous reports describing this issue, no guidelines exist to help direct management.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23] To our knowledge, isolated anal metastasis to intact perianal surface tissue in the absence of epithelial injury has only been described once before in the literature. 24 Herein, we present the case of a 69-year-old man with a colorectal cancer originally at the rectosigmoid junction, presenting with a recurrence at the anal verge 5 years later, with no history of prior anal disease or trauma.…”

Section: Introductionmentioning

confidence: 99%

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Rectal Cancer Metastasis to the Anal Verge: An Unusual Case Presentation and Review of the Literature

Yip¹,

Helewa²,

Shariff³

et al. 2022

IMCRJ

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Background: Anal metastasis of colorectal adenocarcinoma is very rare, represented by only a handful of case reports in the literature. Previously, reports of metastasis to this region had occurred following a history of anorectal disease, such as anal fistulae. Antecedent trauma to the area from hemorrhoidectomy, fissures, or perineal retractor injury have also been implicated. Case Presentation: Herein we report the case of 69-year-old man without any history of anal disease presenting with a metachronous metastasis of a colorectal-type adenocarcinoma to the anal verge. He was previously treated for T1N0 rectal adenocarcinoma at the rectosigmoid junction with a low anterior resection 5 years prior, then had a T3N0 local recurrence at the colorectal anastomosis treated with neoadjuvant chemoradiation, and eventually a Hartmann's procedure 4 years later. Subsequently, on surveillance flexible sigmoidoscopy, a new tumor was identified on the perianal skin extending from the anal verge. Histopathology demonstrated colorectal-type adenocarcinoma. Flexible endoscopy identified no other residual or recurrent disease in the colon or rectal stump. The patient was treated with wide local excision and advancement flap reconstruction. Conclusion: Isolated metastasis to the anus is an extremely rare occurrence for colorectal adenocarcinoma. There exists little evidence to inform management. One option is to treat like a locally recurrent rectal cancer with aggressive tri-modality management consisting of chemoradiation, abdominal perineal resection, and adjuvant chemotherapy. In the absence of metastatic disease, local resection and close surveillance remain an option. As always, patient factors should guide management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rectal Cancer Metastasis to the Anal Verge: An Unusual Case Presentation and Review of the Literature

Yip¹,

Helewa²,

Shariff³

et al. 2022

IMCRJ

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“…ChemoRT has been administered postoperatively or preoperatively in a few cases of synchronous anal fistula and colorectal cancer; none of those patients developed recurrences (3). Furthermore, there are no reports of treatment of such cases with RT alone (3,12). RT may have complications, including radiation proctitis and adhesive Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Relapse of Rectal Cancer in an Anal Fistula: A Rare Case

Katō

Miyamoto

Shinmoto

et al. 2021

In Vivo

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Background: Colorectal cancer is the second most common cause of cancer-related death worldwide. It is well-known that metasta sis to the liver and lung and local recurrences can occur. Additionally, colorectal cancer occasionally metastasizes to other sites. Only a few reports of such metastases have been published and no definitive therapeutic strategies have been proposed for them. Case Report: The case of a 77-year-old man who was diagnosed with rectal cancer is presented. Eighteen months after curative laparoscopic low anterior resection and D3 lymph node resection, an anal fistula metastasis was diagnosed by computed tomography and biopsy. After administering radiotherapy, percutaneous excision of the lesion. was performed. At 21 months from the surgery, the patient is healthy and no recurrence has been found. Conclusion: Metachronous metastasis of a colorectal cancer to an anal fistula is rare. Careful investigation and optimal treatment can result in a disease-free status.Anal fistulas are known to result in abscesses; additionally, primary cancer originates in 0.1% of anal fistulas (1, 2). Metastasis of a cancer to an anal fistula is very rare. There are some reports of synchronous colorectal cancer in an anal fistula; however, metachronous colorectal cancer developing in an anal fistula has rarely been reported (3). We present a case of a patient with rectal cancer who developed a recurrence in an anal fistula and was treated successfully with radiation therapy (RT) and surgery.

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“…Recently, several studies have highlighted that metastasis can occur synchronously [ 2 – 7 ] or metachronously [ 8 , 9 ]. Pre-existing anal diseases, such as anal fistula, fissure, or trauma, may be associated with the development of anal metastasis [ 2 , 3 , 6 , 8 ]; however, it can also arise in normal squamous mucosa [ 4 , 5 , 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

et al. 2022

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Background Anal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion. Case presentation A 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor’s partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery. Conclusions This is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.

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Anal metastasis of rectal cancer—adenocarcinoma of squamous cells: a case report and literature review

Cited by 9 publications

References 24 publications

Rectal Cancer Metastasis to the Anal Verge: An Unusual Case Presentation and Review of the Literature

Rectal Cancer Metastasis to the Anal Verge: An Unusual Case Presentation and Review of the Literature

Relapse of Rectal Cancer in an Anal Fistula: A Rare Case

Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report

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