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Annali Italiani Di Chirurgia Mar 2015The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma. (Review)
Review
AIM
The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma.
MATERIAL
A 71 years old white man presented in our Institute with anal pain, tenesmus, blooding rectal during the last five months. The ano-rectal examination showed a brownish painful mass in the anal canal. The colonscopy and endoscopy showed a big stenotic mass from anal canal to medium rectum with a diameter of approximately 90 mm.
RESULTS
Biopsy of the rectal mass was performed and the histopatological examination showed malignant ephitelioid cells, pigmented melanoma. The patient was treated by abdominoperineal resection with dissection of lymph nodes. Result of histopatological examination was ulcerated Malignant melanoma of the anal canal, growing polypoid with spindle cells and epithelioid infiltrating the mucosa, submucosa and the internal sphincter muscle. Vascular invasion. Subtotal lymph node metastasis in 3 of 17.
DISCUSSION
Anorectal melanoma is an uncommon and aggressive disease. The anorectum is the third most common location of malignant melanoma after the skin and retina. Lesions are difficult to diagnose because many are amelanotic and patients present with nonspecific complaints such as anal discomfort or rectal bleeding. After diagnosis, the main treatment available is surgical resection. Sentinel lymph node mapping has an unclear role in its management. Adjuvant therapy has long been recommended; however, there are no strong data to support its use.
CONCLUSIONS
There is no convincing evidence to indicate that abdominoperineal resection did not improve the survival rate of patients with malignant rectal melanoma as compared to the wide local excision, while the wide local excision had advantages in lower surgical risk and allowing patients to avoid permanent colostomy.
Topics: Aged; Humans; Lymphatic Metastasis; Male; Melanoma; Neoplasm Invasiveness; Rectal Neoplasms; Ulcer
PubMed: 25818193
DOI: No ID Found -
Clinical Case Reports Jan 2016Primary mucosal melanoma occurs in under 2% of melanomas. Anorectal melanoma is a rare disorder, approximately accounting for 1% of all anorectal carcinomas. Primary...
Primary mucosal melanoma occurs in under 2% of melanomas. Anorectal melanoma is a rare disorder, approximately accounting for 1% of all anorectal carcinomas. Primary anorectal melanoma presents predominantly in women, in the 4th-6th decade of life. Typical clinical manifestations include rectal bleeding and tenesmus. The prognosis remains poor.
PubMed: 26783446
DOI: 10.1002/ccr3.413 -
Diseases of the Colon and Rectum Mar 2023A 68-year-old woman presented with rectal bleeding, urgency, and tenesmus. A digital rectal examination confirmed a craggy mass infiltrating into the sphincter complex....
A 68-year-old woman presented with rectal bleeding, urgency, and tenesmus. A digital rectal examination confirmed a craggy mass infiltrating into the sphincter complex. Follow-up colonoscopy noted a low-rectal tumor (3 cm from the dentate), and histopathology confirmed a moderately differentiated adenocarcinoma. Subsequent staging with MRI confirmed a 5-cm circumferential low-rectal neoplasm with extramural vascular invasion and threatened circumferential resection margin. The neoplasm abutted the posterior vaginal wall and was invading the internal sphincter complex. Four enlarged mesorectal nodes (>7 mm) and several enlarged right pelvic sidewall nodes (largest at 17 mm) were also observed. There was no evidence of distant disease. The patient underwent long-course neoadjuvant chemoradiotherapy. Restaging showed a good treatment response with some regression and no involvement/encroachment of the vagina. All the mesorectal nodes had reduced in size (~4 mm), and all but one of the right pelvic sidewall nodes had also decreased in size. However, 1 pelvic sidewall node (obturator fossa) still remained at 10 mm. After the tumor board discussion, a decision to proceed to abdominoperineal resection with right sidewall clearance was made. Final histopathology confirmed a moderately differentiated adenocarcinoma with no mesorectal nodal involvement (19 nodes sampled), and 1 of 7 sidewall nodes had evidence of metastatic adenocarcinoma.
Topics: Female; Humans; Aged; Lymph Nodes; Rectal Neoplasms; Rectum; Pelvis; Adenocarcinoma; Neoplasm Staging; Neoadjuvant Therapy
PubMed: 36728599
DOI: 10.1097/DCR.0000000000002706 -
Best Practice & Research. Clinical... Feb 2014Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis... (Review)
Review
Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%.
Topics: Digestive System Surgical Procedures; Endometriosis; Female; Fertility; Humans; Infertility, Female; Interdisciplinary Communication; Intestinal Diseases; Laparoscopy; Patient Care Team; Pelvic Pain; Pregnancy; Pregnancy Rate; Recovery of Function; Standard of Care; Treatment Outcome
PubMed: 24485255
DOI: 10.1016/j.bpg.2013.11.008 -
Clinics in Colon and Rectal Surgery Sep 2016Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage,...
Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement.
PubMed: 27582654
DOI: 10.1055/s-0036-1584505 -
Gynecologic Oncology Sep 1989Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic...
Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic malignancy. Very low end-to-end anastomosis of the colon to the rectum has been associated with fecal frequency and tenesmus in up to 70% of cases. The construction of a rectal J-pouch low-pressure reservoir has been reported to have a salutary effect on these symptoms. Between March 1987 and April 1988, a pilot study was carried out in which 11 patients with primary or recurrent gynecologic malignancy who underwent low anterior resection of the colon requiring very low coloproctostomy (below 6 cm) had construction of a rectal J-pouch reservoir with a Strasbourg-Baker end-to-side coloproctostomy. No postoperative complications were noted in this small series of patients. No patient has had more than three stools per day since surgery. Antidiarrheal medication was not required. All patients denied tenesmus. It was concluded that the rectal J-pouch reservoir offered a surgical technique for avoiding tenesmus and fecal frequency in very low end-to-end anastomosis of colon to rectum.
Topics: Adult; Aged; Anastomosis, Surgical; Colon, Sigmoid; Defecation; Female; Genital Neoplasms, Female; Humans; Middle Aged; Pilot Projects; Rectum; Time Factors
PubMed: 2767529
DOI: 10.1016/0090-8258(89)90177-7 -
Acta Chirurgica Belgica 2008Malignant rectal melanoma is a rare tumour. We report a case of a 66-year-old man who presented with a two-month history of rectal bleeding, pain, and tenesmus. A...
Malignant rectal melanoma is a rare tumour. We report a case of a 66-year-old man who presented with a two-month history of rectal bleeding, pain, and tenesmus. A semicircular rectal tumour was seen, just above the dentate line. Biopsies proved it to be an amelanotic malignant melanoma, as protein S100, melanoma antigen HMB45 and Melan-A expression were found. CT scan and rectal ultrasound showed invasion into the internal sphincter and several enlarged perirectal nodes. No distant lesions were detected on CT scan, nor on PET scan. An abdominoperineal resection was performed as a substantial part of the internal anal sphincter was invaded. Histology confirmed an amelanotic malignant melanoma. The patient recovered well from the operation, and received no adjuvant therapy. Four months later, multiple liver metastases were seen on CT scan. With this case we want to illustrate that malignant rectal melanoma can be difficult to diagnose, as patients have non-specific symptoms, and histology may be misleading. One should always check for protein S-100, melanoma antigen HMN-45 and Melan-A expression, as they are strongly suggestive of melanoma. Wide local excision is the preferred procedure when technically feasible, but abdominoperineal resection has to be done if the tumour invades a substantial portion of the anal sphincter or is circumferential. Rectal melanoma has a poor outcome with a 5-year survival rate of between 10-20%. The extent of the disease correlates with the overall survival. The role of radiotherapy, chemotherapy or immunotherapy looks promising, but further investigations are needed.
Topics: Aged; Anal Canal; Humans; Immunohistochemistry; Liver Neoplasms; Male; Melanoma, Amelanotic; Neoplasm Invasiveness; Prognosis; Rectal Neoplasms
PubMed: 19241934
DOI: 10.1080/00015458.2008.11680332 -
The Pan African Medical Journal 2018Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-year-old male patient, who... (Review)
Review
Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-year-old male patient, who presented at the Emergency Department, complaining of constipation, tenesmus and rectal pain. History and digital examination revealed a rectal seed bezoar due to sunflower seeds, impacted in the lower rectum. The patient underwent manual disimpaction under general anaesthesia, after conservative measures failed. Seed bezoars represent a different pathophysiological process compared to fibre bezoars. They are usually found in the rectum of patients without predisposing factors, causing constipation and anorectal pain. History taking and digital rectal examination are the cornerstones of diagnosis, with manual disimpaction under general anaesthesia being the procedure of choice.
Topics: Bezoars; Constipation; Emergency Service, Hospital; Fecal Impaction; Helianthus; Humans; Male; Middle Aged; Seeds
PubMed: 31065317
DOI: 10.11604/pamj.2018.31.157.12539 -
Mymensingh Medical Journal : MMJ Oct 2022Solitary rectal ulcer syndrome (SRUS) is an uncommon benign rectal disorder. Typically, young adults are affected and it is rare in children. Straining during...
Solitary rectal ulcer syndrome (SRUS) is an uncommon benign rectal disorder. Typically, young adults are affected and it is rare in children. Straining during defecation, self-induced trauma and paradoxical contraction of puborectalis muscle are the major contributing factors of this condition. Clinical features of SRUS are rectal bleeding, mucorrhoea, excessive straining during defecation, tenesmus, feeling of incomplete defecation and constipation. A complete and thorough history is most important for diagnosis of SRUS. Rectal bleeding may be misinterpreted as originating from an anal fissure caused by constipation or as other causes of rectal bleeding such as a juvenile polyp. The best and most accurate diagnostic method of SRUS is rectal biopsy. The major histological feature of SRUS is fibromuscular obliteration of the lamina propria. Avoiding straining, regular toilet habit, use of bulk laxatives, steroid and sucralfate enemas are the mainstay of treatment. Biofeedback mechanism is another treatment option. Because the clinical presentation varies, the diagnosis requires a high index of suspicion for both the clinician and the pathologist.
Topics: Child; Constipation; Diagnostic Errors; Gastrointestinal Hemorrhage; Humans; Laxatives; Rectal Diseases; Steroids; Sucralfate; Ulcer; Young Adult
PubMed: 36189574
DOI: No ID Found -
Digestive and Liver Disease : Official... Apr 2021Ulcerative colitis, a chronic inflammatory condition that affects the colon from rectum to caecum, is characterized by periods of increased bowel movements, blood in... (Comparative Study)
Comparative Study Review
Ulcerative colitis, a chronic inflammatory condition that affects the colon from rectum to caecum, is characterized by periods of increased bowel movements, blood in feces, rectal urgency, tenesmus, and abdominal pain, with periods of remission and flares of disease, which negatively impact quality of life. A number of therapeutic options are available for patients with moderate-to-severe ulcerative colitis, however, no clear treatment algorithm exists. Therapeutic goals include short-term benefits for patients (i.e., the reduction/absence of symptoms, essentially stool frequency and rectal bleeding) and long-term benefits (i.e., sustained clinical remission, steroid-free remission, and mucosal healing). Therapies currently approved and available for the treatment of moderate-to-severe ulcerative colitis include monoclonal antibodies such as those targeting anti-tumor necrosis factor α (i.e., infliximab, adalimumab, golimumab), anti-adhesion molecules (i.e., vedolizumab), anti-interleukin 12/23 agents (i.e., ustekinumab), and Janus Kinase inhibitors (i.e., tofacitinib). Surgical approaches should also be considered in patients refractory to medical therapy or with complications (including toxic megacolon or colonic dysplasia/cancer). This review provides an overview of currently available treatment options for patients with moderate-to-severe ulcerative colitis and summarizes factors that should be considered during the therapeutic decision.
Topics: Anastomosis, Surgical; Cell Adhesion Molecules; Colitis, Ulcerative; Humans; Interleukin-12; Interleukin-23; Janus Kinase Inhibitors; Proctocolectomy, Restorative; Randomized Controlled Trials as Topic; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor Inhibitors
PubMed: 33051163
DOI: 10.1016/j.dld.2020.09.022