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Journal of Medical Primatology Aug 2022A 7-year-old vervet monkey (Chlorocebus pygerythrus) died 8 days after surgery to repair the rectal prolapse. The animal had a history of tenesmus in a week leading up...
A 7-year-old vervet monkey (Chlorocebus pygerythrus) died 8 days after surgery to repair the rectal prolapse. The animal had a history of tenesmus in a week leading up to the rectal prolapse. At necropsy enlargement and dilatation of seminal vesicles that appeared to cause posterior compression of the rectum leading to luminal narrowing. It was concluded that enlargement of the seminal vesicles may have serious consequences such as rectal obstruction and tenesmus leading to prolapse of the rectum in vervet monkeys and should be considered a rare cause of lower gastrointestinal disorders in this species and probably other species of nonhuman primates as well.
Topics: Animals; Chlorocebus aethiops; Male; Rectal Prolapse; Seminal Vesicles
PubMed: 35462443
DOI: 10.1111/jmp.12578 -
DEN Open Apr 2022Rectal tonsils are localized hyperplastic lymphoid tissues in the rectum, and the initial endoscopic findings are consistent with those for neoplastic lesions. However,...
Rectal tonsils are localized hyperplastic lymphoid tissues in the rectum, and the initial endoscopic findings are consistent with those for neoplastic lesions. However, rectal tonsils are benign entities, and the diagnosis should be made cautiously. A 70-year-old man presented with pain on defecation with rectal bleeding. Colonoscopy revealed a 3-cm protruding mass in the rectum with mucosal erosion, but no malignant features were observed on forceps biopsy. Endoscopic ultrasonography (EUS) showed that the lesion was a hypoechoic mass without blood flow. Fine needle aspiration under EUS revealed no malignant components, although the size of the lesion had shrunk, and symptoms, such as blood-stained stool, tenesmus, and discomfort during defecation, had resolved. A second forceps biopsy showed intermediate-sized lymphocytes without lymphoepithelial lesions. Based on immunostaining, the lesion was diagnosed as a rectal tonsil. Rectal tonsils occur due to localized proliferation of reactive lymphoid follicles in the submucosa or muscularis mucosa. However, endoscopic diagnosis is difficult since less invasive treatment is performed for neoplastic lesions of the rectum to preserve the function of the anal sphincter. Diagnosis and treatment of small lesions might be possible by endoscopic resection; however, for relatively large lesions, formulating a diagnosis based only on biopsy specimens becomes even more difficult. Therefore, repeated biopsies might be helpful for the diagnosis of rectal tonsils and for excluding other neoplasms.
PubMed: 35310746
DOI: 10.1002/deo2.34 -
World Journal of Clinical Cases Dec 2021Anorectal melanoma is a tumour that is difficult to identify due to its rarity and variability of presentation. Insufficient data published in the literature do not...
BACKGROUND
Anorectal melanoma is a tumour that is difficult to identify due to its rarity and variability of presentation. Insufficient data published in the literature do not allow for diagnostic and treatment guidelines to be established. Anorectal melanoma has the worst prognosis among mucosal melanomas and is frequently misdiagnosed by standard identification methods.
CASE SUMMARY
A 66-year-old woman presented with intermittent anal bleeding, pain, and tenesmus in the past month, with no associated weight loss. Colonoscopy revealed a cauliflower-like tumour with a diameter of 1.5 cm, with exulcerated areas and an adherent clot but without obstruction. Biopsy results identified an inflammatory rectal polyp with nonspecific chronic rectitis. Tumour markers CA 19-9 and CEA were within the normal range. After 6 mo, due to the persistence of symptoms, a pelvic magnetic resonance imaging scan was performed. A lesion measuring 2.8 cm × 2.7 cm × 2.1 cm was identified at the anorectal junction, along with two adjacent lymphadenopathies. No distant metastases were detected. Immunohistochemistry was performed on the second set of biopsies, and a diagnosis of anorectal melanoma was established. Surgical treatment by abdominoperineal resection was performed. Evolution was marked by the appearance of lung metastases at 1 mo postoperatively, detected on a positron emission tomography-computer tomography scan, and perineal recurrence after 5 mo. After molecular testing, the patient was included in an immunotherapy trial.
CONCLUSION
This case highlights the difficulty of establishing a definitive early diagnosis of anorectal melanoma, the importance of performing histological analysis on a well-represented biopsy specimen, and the poor prognosis, even with radical surgery.
PubMed: 35071568
DOI: 10.12998/wjcc.v9.i36.11369 -
Cureus Nov 2021This prospective study aimed to determine the outcomes and postoperative complications of hemorrhoid disease (HD) treated by hemorrhoidal laser procedure (HeLP).
AIM
This prospective study aimed to determine the outcomes and postoperative complications of hemorrhoid disease (HD) treated by hemorrhoidal laser procedure (HeLP).
BACKGROUND
We, herein report the results of 18 months of methodical use of mini-invasive laser procedures in 100 patients with grades 2 and 3 hemorrhoids and minimum to a mild degree of rectal prolapse. The surgical technique is called HeLP.
METHODS
Data were collected on the duration of the procedure, intraoperative complications, postoperative pain, the declivity of hemorrhoids, persistency or complete resolution, and recurrence of hemorrhoids were collected prospectively.
RESULTS
No evidence of intraoperative complications occurred. The median follow-up was nine months. Postoperative pain was not significant or null in most patients. There was no rectal tenesmus or alteration of defecation habits. Plateau of hemorrhoid symptoms and downgrading of hemorrhoid size reached approximately three to seven months post-procedure. The frequency of pain, bleeding, pruritus ani, and acute hemorrhoidal syndrome decreased by 75-80%. There was a significant reduction in hemorrhoids with the rate of recurrence being 7% over 12 months of follow-up.
CONCLUSION
Our study evaluated and demonstrated that HeLP is an effective, safe, and non-painful procedure for the management of patients with the symptomatic second or third degree of hemorrhoid with mild to the minimum degree of rectal mucosal prolapse. It is a suitable ambulatory treatment.
PubMed: 34804743
DOI: 10.7759/cureus.19497 -
Journal of the American Veterinary... Nov 2021A 4-month-old 4.2 kg sexually intact female mixed-breed dog was evaluated for rectal and vesicular tenesmus, intermittent rectal prolapse, fecal incontinence, and an...
CASE DESCRIPTION
A 4-month-old 4.2 kg sexually intact female mixed-breed dog was evaluated for rectal and vesicular tenesmus, intermittent rectal prolapse, fecal incontinence, and an anogenital cleft.
CLINICAL FINDINGS
Rectal prolapse and an anogenital cleft were confirmed on physical examination. Results of a CBC and serum biochemical analysis were within respective reference ranges, and abdominal ultrasonography revealed no abnormalities. Urinalysis revealed evidence of a urinary tract infection.
TREATMENT AND OUTCOME
An H-perineoplasty was performed and the prolapse was reduced. The repair partially dehisced and was repaired (with concurrent reduction of a recurrent rectal prolapse) but dehisced again. There was limited tissue available for additional reconstruction. In another surgical procedure, the rectum was allowed to prolapse, the most dorsal 40% of the prolapsed rectal tissue was resected, and the rectal tissue margin and skin in this region were apposed. The remaining rectal tissue flap was folded ventrally, and the lateral margins of the aborad aspect were sutured to the dorsolateral vestibular mucosa. In a subsequent surgery, 2.5 to 3 cm of the rectal tissue flap was excised. The remainder was used to create ventral margins for the rectum and vestibular mucosa. The perineal skin between the anus and dorsal vulvar commissure was closed. The patient experienced mild cutaneous partial dehiscence of the repair that healed by second intention. Over an 18-month follow-up period, some fecal incontinence persisted, but straining resolved and urinary tract infection did not recur.
CLINICAL RELEVANCE
For the dog of this report, the use of rectal mucosa in surgical repair of an anogenital cleft provided an acceptable clinical outcome.
Topics: Animals; Dog Diseases; Dogs; Fecal Incontinence; Female; Perineum; Plastic Surgery Procedures; Rectal Prolapse; Rectum; Treatment Outcome
PubMed: 34793324
DOI: 10.2460/javma.20.10.0575 -
Annals of Palliative Medicine Oct 2021Melanoma is derived from malignancies of melanocytes. Anorectal melanoma differs significantly from cutaneous melanoma in clinical presentation, genetic profile, staging...
Melanoma is derived from malignancies of melanocytes. Anorectal melanoma differs significantly from cutaneous melanoma in clinical presentation, genetic profile, staging system, and response to treatment. Anorectal melanoma is seldom diagnosed because most melanoma occurrences are found in the skin tissues. Here, we report 1 case of advanced anorectal melanoma, including its clinical presentation, laboratory findings, imaging, surgical treatment, and pathology. The patient complained of hematochezia and tenesmus. Colonoscopy, computed tomography (CT) scan and digital rectal examination (DRE) revealed a mass near the pectinate line. The patient underwent proctectomy along with colostomy, and subsequent pathological examinations suggested anorectal melanoma with serosa involvement (positive markers: S100, HMB-45, etc.). Evidence-based analyses (single-nucleotide polymorphism (SNPs) and programmed death-ligand 1 (PD-L1) expression) were conducted on the tumor tissue to identify the sensitivity to adjuvant therapies. SNP tests suggested no definite efficacies of commonly used chemotherapeutic agents, with PD-L1 expression implying poor sensitivity to PD-L1 inhibitors. The postoperative recovery was uneventful and the patient was discharged on day 7 after admission. However, the patient refused adjuvant therapies and died 11 months after surgery. In conclusion, anorectal melanoma tends to be mistaken for other common diseases in this region owing to its non-specific clinical presentations. Multidisciplinary treatments are recommended to yield the best possible outcome, despite poor prognosis.
Topics: Anus Neoplasms; B7-H1 Antigen; Chemotherapy, Adjuvant; Drug Resistance, Neoplasm; Fatal Outcome; Humans; Immune Checkpoint Inhibitors; Melanoma; Precision Medicine; Rectal Neoplasms; Skin Neoplasms
PubMed: 34763479
DOI: 10.21037/apm-21-2240 -
Cureus Sep 2021Neuroendocrine prostate cancer (NEPC) is a rare entity representing 1% of all prostate malignancies, associated with poor prognosis and often concomitant with...
Neuroendocrine prostate cancer (NEPC) is a rare entity representing 1% of all prostate malignancies, associated with poor prognosis and often concomitant with paraneoplastic syndromes such as Cushing's syndrome (CS) with ectopic adrenocorticotropic hormone (ACTH) production. We present a case of a 56-year-old man with recent lower urinary tract symptoms hospitalized for pelvic pain, rectal tenesmus, and fatigue. A CT scan documented a large prostatic mass, adenomegalies, and hepatic lesions. Bone scintigraphy showed dispersed osteoblastic metastization. The patient had uncontrolled hypertension and hypokalemia that lead to the diagnosis of paraneoplastic ACTH-dependent CS. Prostate biopsy confirmed small cell NEPC. Potassium supplementation, anti-hypertensive medication, and metyrapone were initiated. The patient was proposed for palliative chemotherapy but died within a few days from a urinary tract infection. The authors aim to draw attention to a case of paraneoplastic CS, a rare manifestation, within the rarity that is NEPC.
PubMed: 34703694
DOI: 10.7759/cureus.18160 -
The American Journal of Case Reports Oct 2021BACKGROUND Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the... (Review)
Review
BACKGROUND Anorectal mucosal melanoma (AMM) is a rare and aggressive neoplasm, with a 5-year survival rate of 10%. Due to its rarity and nonspecific symptoms, the diagnosis is often made late. Surgical resection remains the criterion standard for treatment of anorectal melanoma. CASE REPORT We present the case of an 81-year-old woman presenting with hematochezia, anal secretion, tenesmus, difficulty in defecation, and perianal pain. On physical examination, there was a prolapse of a 5-cm melanocytic nodule in the anal canal, hard on palpation. Biopsy confirmed anorectal melanoma. Staging revealed anal and metastatic disease, with adrenal, lymphatic, and hepatic involvement. As the patient continued to have bleeding, severe pain, and difficulty in defecation, she was submitted to a wide local excision. At 5-month follow-up, the anal lesion had relapsed, and the patient died 10 months after the procedure. CONCLUSIONS AMM is a rare and extremely aggressive tumor. Symptoms are nonspecific but early diagnosis should be pursued to allow curative treatment. Surgical resection with free margins is the goal of surgical treatment. New therapies are being studied, including immunotherapy, which can improve the dismal prognosis of this rare disease.
Topics: Aged, 80 and over; Anal Canal; Anus Neoplasms; Female; Humans; Melanoma; Neoplasm Staging; Rectal Neoplasms; Rectum
PubMed: 34699518
DOI: 10.12659/AJCR.933032 -
BMC Gastroenterology Oct 2021Gastrointestinal hemangiomas are very rare and are even rarer in the mesorectum. It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the...
BACKGROUND
Gastrointestinal hemangiomas are very rare and are even rarer in the mesorectum. It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the mesorectum. For clinicians, to correctly identify the imaging features of mesorectal hemangiomas is important.
CASE PRESENTATION
We herein describe a case of a 31-year-old male that presented with hematochezia and sensation of rectal tenesmus. Both the rectal MRI and contrast-enhanced CT scan of the whole abdomen indicated rectal wall thickening, marked dilatation, and tortuous vessels around the rectum. In addition, a contrast-enhanced portal venous phase CT scan showed the dilation of portal vein, splenic vein and inferior mesenteric vein. The dilated inferior mesenteric vein extending down to the mesorectum, and became marked dilatation and tortuous vessels around the rectum. The patient underwent laparoscopic surgical resection of the mesorectal lesion and the involved portions of the rectum. The surgical samples underwent pathological analysis, and a diagnosis of cavernous hemangioma was confirmed. Seven days after surgery, the patient was discharged without postoperative complications.
CONCLUSIONS
This case highlights the imaging features of mesorectal hemangiomas. In addition, in this current case, the mesorectal hemangioma more likely originated in the mesorectum.
Topics: Adult; Hemangioma, Cavernous; Humans; Laparoscopy; Magnetic Resonance Imaging; Male; Rectal Neoplasms; Rectum
PubMed: 34654369
DOI: 10.1186/s12876-021-01949-5 -
BMJ Case Reports Oct 2021The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is...
The article presents a series of four patients with primary anorectal melanoma presenting to our institute between 2016 and 2021. The primary objective of the series is to give an overview of the variable presentation of this rare entity from a high-volume colorectal tertiary care centre in a developing country. The patients ranged in age from 55 to 73 years and were mostly women (except one). The clinical presentation varied from bleeding per rectum to tenesmus and mucus in stools, overlapping with those of inflammatory bowel disease and primary anorectal adenocarcinoma. All patients were treated with surgery (laparoscopic or open), ranging from local excision to abdominoperineal resection. All our patients had a good outcome after surgery with no mortality at 30 or 90 days after surgery. The article aims to present a comprehensive overview of the various options of management with evidence from the surgical literature.
Topics: Adenocarcinoma; Aged; Female; Humans; Melanoma; Middle Aged; Rectal Neoplasms; Rectum; Skin Neoplasms
PubMed: 34598968
DOI: 10.1136/bcr-2021-245449