講演情報
[JKS1-3]How to Deal with Unusual Anal Disease
*Woo Jung Nam1 (1. Seoul Songdo Hospital, Korea)
Background: Unusual perianal diseases are often mistaken for common benign conditions. This presentation reviews rare perianal diseases and highlights practical clues for earlier diagnosis.
Case Review: The cases included diffuse large B-cell lymphoma involving an anal fistula, fistula-associated squamous cell carcinoma, mucinous adenocarcinoma arising in a chronic fistula, and aggressive angiomyxoma of the anorectal and ischioanal region. Clinical findings were compared with operative, MR imaging, and histopathologic findings.
Key Findings: Several diagnostic pitfalls were identified. In the lymphoma case, the fistula tract was mainly composed of granulation tissue and inflammatory cells, and the tumor could have been missed without examination of multiple tissue sections. Immunohistochemistry confirmed diffuse large B-cell lymphoma. In squamous cell carcinoma, a persistent ulcer, mass, or non-healing fistula wound was an important warning sign. In mucinous adenocarcinoma, new pain, induration, or mucinous discharge from a long-standing fistula suggested malignant transformation; CK7(+) and CK20(-) staining supported primary anal gland origin in one case. Aggressive angiomyxoma presented as a slow-growing perineal mass and showed a myxoid tumor with desmin, estrogen receptor, and progesterone receptor positivity. MRI helped define the extent of disease, but tissue diagnosis remained essential.
Conclusion: Atypical, recurrent, rapidly enlarging, or treatment-resistant anal lesions should not be assumed to be benign. Early biopsy, adequate tissue sampling, deeper or repeated sections, and appropriate immunohistochemical studies are critical. Management should be disease-specific and multidisciplinary: chemotherapy with or without radiotherapy for lymphoma, chemoradiotherapy for anal squamous cell carcinoma, radical surgery for fistula-associated mucinous adenocarcinoma, and wide excision with long-term surveillance for aggressive angiomyxoma.
Case Review: The cases included diffuse large B-cell lymphoma involving an anal fistula, fistula-associated squamous cell carcinoma, mucinous adenocarcinoma arising in a chronic fistula, and aggressive angiomyxoma of the anorectal and ischioanal region. Clinical findings were compared with operative, MR imaging, and histopathologic findings.
Key Findings: Several diagnostic pitfalls were identified. In the lymphoma case, the fistula tract was mainly composed of granulation tissue and inflammatory cells, and the tumor could have been missed without examination of multiple tissue sections. Immunohistochemistry confirmed diffuse large B-cell lymphoma. In squamous cell carcinoma, a persistent ulcer, mass, or non-healing fistula wound was an important warning sign. In mucinous adenocarcinoma, new pain, induration, or mucinous discharge from a long-standing fistula suggested malignant transformation; CK7(+) and CK20(-) staining supported primary anal gland origin in one case. Aggressive angiomyxoma presented as a slow-growing perineal mass and showed a myxoid tumor with desmin, estrogen receptor, and progesterone receptor positivity. MRI helped define the extent of disease, but tissue diagnosis remained essential.
Conclusion: Atypical, recurrent, rapidly enlarging, or treatment-resistant anal lesions should not be assumed to be benign. Early biopsy, adequate tissue sampling, deeper or repeated sections, and appropriate immunohistochemical studies are critical. Management should be disease-specific and multidisciplinary: chemotherapy with or without radiotherapy for lymphoma, chemoradiotherapy for anal squamous cell carcinoma, radical surgery for fistula-associated mucinous adenocarcinoma, and wide excision with long-term surveillance for aggressive angiomyxoma.