Abstract
Purpose
The purpose of this study was to evaluate the clinical features, pathology, and etiology of adenocarcinoma in patients with anal fistulae.
Methods
We identified seven patients diagnosed with adenocarcinoma associated with anal fistulae from a retrospective chart review.
Results
Five patients were diagnosed with primary adenocarcinoma associated with anal fistulae. Two patients were diagnosed with secondary adenocarcinoma associated with anal fistulae originating from rectal cancer on the proximal side. The primary adenocarcinomas included cancers arising from long-standing anal fistulae fulfilling established diagnostic criteria in two patients, and cancer arising from short-duration anal fistulae in three patients. Excision of the fistula was performed based on the initial diagnosis of the anal fistula for all five patients. Increased suspicion of cancer was due to the existence of gelatinous material in the anal fistula in three patients and induration in the resected specimens in two patients. The etiologies of the secondary adenocarcinomas associated with anal fistulae included implantation in the anal fistula from rectal cancer and fistula formation originating due to the progression of rectal cancer.
Conclusion
Anal fistulae are commonly seen in the coloproctology clinic, but special attention to similar conditions associated with malignant disease is needed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rosser C. The relation of fistula in ano to cancer of the anal canal. Trans Am Proctol Soc. 1934;35:65–71.
Sumikoshi Y, Okada M, Iwadare J, Takenoshita J, Yanagida T, Ariwa R. Fistula cancers (in Japanese with English abstract). J Jpn Soc Coloproctol. 1981;34:467–72.
Skir I. Mucinous carcinoma associated with fistulas of long-standing. Am J Surg. 1948;75:285–9.
Irving HP. An interesting case of cancer of the sigmoid with concomitant cancer in an anal fistula. Mt Sinai J Med. 1976;43:476–9.
Shinohara T, Hara H, Kato Y, Asano M, Nakazawa Y, Kato T, et al. Implantation of rectal cancer cells in a fistula in ano: report of a case. Surg Today. 2001;31:1094–6.
Ishiyama S, Inoue S, Kobayashi K, Sano Y, Kushida N, Yamazaki Y, et al. Implantation of rectal cancer in an anal fistula: report of a case. Surg Today. 2006;36:747–9.
Wind P, Douard R, Poupardin E, Cugnenc PH. Anal implantation of exfoliated tumor cells from a rectal adenocarcinoma after stapled anastomosis. Eur J Surg. 1999;165:905–6.
Basha G, Ectors N, Penninckx F, Filez L, Geboes K. Tumor cell implantation after colonoscopy with biopsies in a patient with rectal cancer: report of a case. Dis Colon Rectum. 1997;40:1508–10.
Umpleby HC, Williamson RC. Anastomotic recurrence in large bowel cancer. Br J Surg. 1987;74:873–8.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63:1–12.
Sumikoshi Y, Takano M, Okada M, Hiratsuka Y, Satoh S. Classification for anal fistulas (in Japanese). J Jpn Soc Coloproctol. 1972;25:177–84.
Japanese Society for Cancer of the Colon and Rectum: Japanese classification of colorectal carcinoma. 2nd English ed. Tokyo: Kanehara & Co., Ltd.; 2009.
Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistula and its implications for patient management. Radiographics. 2000;20:623–37.
Okada K, Shatari T, Sasaki T, Tamada T, Suwa T, Furuuchi T, et al. Is histopathological evidence really essential for making a surgical decision about mucinous carcinoma arising in a perianal fistula? Report of a case. Surg Today. 2008;38:555–8.
Gaertner WB, Hagerman GF, Finne CO, Alavi K, Jessurun J, Rothenberger DA, et al. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. Dis Colon Rectum. 2008;51:1061–7.
Ong J, Jit-Fong L, Ming-Hian K, Boon-Swee O, Kok-Sun H, Eu KW. Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from a single institution. Tech Coloproctol. 2007;11:34–8.
Nakajima K, Kobayashi A, Koda T, Minagawa N, Nishizawa Y, Nishizawa Y, et al. Carcinoma associated with anal fistula: a clinicopathologics study in 15 patients (in Japanese with English abstract). J Jpn Soc Coloproctol. 2010;63:346–58.
Traube J, Simpson S, Riddell RH, Levin B, Kirsner JB. Crohn’s disease and adenocarcinoma of the bowel. Dig Dis Sci. 1980;25:939–44.
Sato K, Azuma H, Miyakura Y, Horie H, Hamada T, Koinuma K, et al. A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer (in Japanese with English abstract). J Jpn Soc Coloproctol. 2010;63:61–7.
Miyakura Y, Iwai H, Togashi K, Horie H, Nagai H, Kishaba Y, et al. Mucinous cystadenocarcinoma of the appendix invading the ascending colon with fistula formation: report of a case. Surg Today. 2007;37:806–10.
Takahashi M, Fukuda T. Ileorectal fistula due to a rectal cancer—a case report. Int J Surg Case Rep. 2011;2:20–1.
Kobayashi G, Fujita N, Noda Y, Ito K, Horaguchi J, Obana T, et al. Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs. J Gastroenterol. 2010;45:1080–9.
Tarazi R, Nelson RL. Anal adenocarcinoma: a comprehensive review. Semin Surg Oncol. 1994;10:235–40.
Conflict of interest
None of the authors have any conflicts of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yamada, K., Miyakura, Y., Koinuma, K. et al. Primary and secondary adenocarcinomas associated with anal fistulae. Surg Today 44, 888–896 (2014). https://doi.org/10.1007/s00595-013-0629-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-013-0629-y