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Cureus Sep 2023Endometriosis is the presence of uterine glands and stroma outside of the uterus. It is highly prevalent in women of reproductive age. It is usually found in the pelvis,...
Endometriosis is the presence of uterine glands and stroma outside of the uterus. It is highly prevalent in women of reproductive age. It is usually found in the pelvis, with most cases being found on the peritoneum, ovaries, or deep in the pelvis. Extraperitoneal endometriosis is uncommon. Perianal endometriosis has an incidence of only 0.2%. We present the case of a 37-year-old woman with recurrent pain and swelling in the perineum at the site of a previous episiotomy scar. Initial imaging and assessment determined this to be scar tissue. Following re-presentation, it was mistakenly diagnosed as a perianal abscess, and the patient underwent incision and drainage. The wound failed to heal with significant induration. Further assessment of the wound was undertaken under general anesthesia. An excision of the affected area was performed, with histological analysis confirming endometriosis. This case highlights that extra-peritoneal endometriosis is a rare but treatable cause of recurrent, cyclical pelvic pain and swelling in the perineum. A high index of clinical suspicion is required due to its ability to mimic other pathologies, including abscesses and cysts. The primary management of perianal endometriosis is surgical excision. Where complete excision is not possible, medical management with hormone therapy should be considered.
PubMed: 37809144
DOI: 10.7759/cureus.44840 -
In Vivo (Athens, Greece) 2018Neoplastic lesions of perianal glands account for approximately 10% of all skin cancer cases in dogs. They occur in many dog breeds, usually in male animals aged over 6...
BACKGROUND/AIM
Neoplastic lesions of perianal glands account for approximately 10% of all skin cancer cases in dogs. They occur in many dog breeds, usually in male animals aged over 6 years. Due to their hormone-dependency, tamoxifen can be used in antineoplastic treatment. The aim of the study was to measure epidermal growth factor (EGF) levels in the serum of dogs with perianal tumours after tamoxifen treatment and to use it as a prognostic factor for further treatment.
MATERIALS AND METHODS
The study was performed on 19 male dogs aged between 6 and 14 years, diagnosed with neoplastic hyperplasia in the perianal region. The control group comprised 10 healthy dogs brought in for routine castration. The research material comprised blood drawn from the animals and tumour specimens for histopathology. The study group received 1-month treatment with tamoxifen. Blood serum was then tested for 17-β oestradiol level, and for EGF level on the first day of the therapy and 6 months after treatment completion.
RESULTS
Hepatoid gland adenomas were diagnosed in 10 cases, and hepatoid gland epitheliomas in nine cases. Elevated 17-β oestradiol levels were observed in all dogs. On the first day of treatment with tamoxifen, the serum EGF levels in all study groups were higher than in the control group. At the 6-month follow-up, the EGF levels were significantly reduced in hepatoid gland adenoma cases compared to those taken on the first day of treatment of tamoxifen, while in animals with hepatoid gland epithelioma, it was greatly increased and was correlated with relapse.
CONCLUSION
Perianal gland tumours are characterised by EGF overexpression, which can be helpful in early-stage prognosis and treatment. An increase in EGF levels 6 months after tamoxifen therapy correlates with disease progression and may be a useful prognostic factor.
Topics: Adenoma; Anal Gland Neoplasms; Animals; Carcinoma; Dogs; Epidermal Growth Factor; Male; Tamoxifen
PubMed: 30150441
DOI: 10.21873/invivo.11361 -
The Anatomical Record Nov 1998Apocrine sweat glands in the circumanal glands of the dog are not connected morphologically with the lobules of the circumanal glands. However, an apparent functional...
Apocrine sweat glands in the circumanal glands of the dog are not connected morphologically with the lobules of the circumanal glands. However, an apparent functional association has been demonstrated and it is possible that the apocrine sweat glands might serve as excretory ducts for degenerated polyhedral cells of the circumanal glands. In this study, we examined the ultrastructure of the apocrine sweat glands in the circumanal glands of the dog in an effort to define more precisely the relationship between the apocrine sweat glands and the circumanal glands. Paraffin sections stained with azan and sections after immunohistochemical staining with antibodies against actin were examined by light microscopy. Samples fixed by aldehyde perfusion were examined with the electron microscope. Diameters of apocrine sweat glands and height of cells in the secretory epithelium varied considerably. Immunohistochemical staining for actin was weakly positive in the supranuclear regions of secretory cells and very intense in myoepithelial cells. In secretory cells, the endoplasmic reticulum was well-developed. Multivesicular bodies were abundant and were discharged into lumens. Apocrine secretion and exocytosis were observed at luminal surfaces of secretory cells. There were three types of large granule in the cytoplasm: giant mitochondria without cristae; membrane-enclosed globules with or without myelin-like contents; and electron-dense, homogeneous, globular structures. Luminal surfaces were always covered with microvilli, and extensive folding of the cell membrane was found in basal regions. Bundles of actin filaments were dispersed throughout the cytoplasm. In the lumens of apocrine tubules, we observed shed secretory cells with well-preserved normal fine structures. We also noted the differentiation of secretory cells that was due to cell renewal. Apocrine sweat glands in the circumanal glands of the dog appear to be more active than those on the general body surface in terms of apocrine secretion, exocytosis, and the release of multivesicular bodies. Shed secretory cells containing large granules, as well as degenerated polyhedral cells from the circumanal glands, might contribute, to some extent, to the subtle composition of sweat from these apocrine sweat glands.
Topics: Animals; Cytoplasmic Granules; Dogs; Endoplasmic Reticulum; Epithelial Cells; Exocytosis; Female; Male; Microscopy, Electron; Perianal Glands; Sweat Glands
PubMed: 9811218
DOI: 10.1002/(SICI)1097-0185(199811)252:3<403::AID-AR8>3.0.CO;2-F -
Revista Espanola de Enfermedades... Jun 2023Extramammary Paget's disease is a rare cutaneous malignancy affecting areas with a high concentration of apocrine glands. The authors present a 77-year-old male followed...
Extramammary Paget's disease is a rare cutaneous malignancy affecting areas with a high concentration of apocrine glands. The authors present a 77-year-old male followed in the General Surgery consultation due to anal pruritus complaints with an evolution of around 20 years and recent lower gastrointestinal bleeding. A colonoscopy was requested and the patient was observed by Gastroenterology team in this context. The objective examination showed an erythematous-whitish plaque with well-defined, slightly exudative and verrucous limits in the perianal region. Definitive diagnosis was possible by biopsy of the referred lesion carried out by Dermatology, and the histological findings were compatible with Paget's disease: intraepithelial infiltration by large atypical neoplastic cells and hypochromic halo and positive immunostaining for cytokeratin 7. Perianal Paget's disease, often underdiagnosed, may be associated with colorectal neoplasms. We present this case due to its rarity, in order to draw attention to this diagnosis.
Topics: Male; Humans; Aged; Paget Disease, Extramammary; Adenocarcinoma; Skin Neoplasms
PubMed: 36177816
DOI: 10.17235/reed.2022.9224/2022 -
The Anatomical Record Mar 1998The circumanal glands of the dog are thought to be a glandular tissue, but there is some controversy as to whether they should be classified as exocrine or endocrine. In...
BACKGROUND
The circumanal glands of the dog are thought to be a glandular tissue, but there is some controversy as to whether they should be classified as exocrine or endocrine. In this study, we examined the nature of the circumanal glands to determine whether they should be described as exocrine, endocrine, or something else altogether. In addition, we investigated the cell degeneration in lobules of the circumanal glands in relation to the apocrine glands.
METHODS
Light microscopic observations were made of paraffin sections stained with hematoxylin and eosin, and after immunohistochemical staining with antibodies against alpha-smooth muscle actin, keratin, filaggrin, and 3beta-hydroxysteroid dehydrogenase/isomerase (3beta-HSD). Samples were also examined by electron microscopy after fixation by aldehyde perfusion.
RESULTS
The lobules of circumanal glands could be divided into two types on the basis of the presence or absence of cysts. Four layers (I-IV) were detected in the lobules with cysts. The outermost layer (layer I or the basal layer) consisted of flattened cells that contained bundles of tonofilaments and were stained immunohistochemically with the antibody against keratin. Layer II (the polyhedral or "spinous" layer) consisted of polyhedral cells that contained bundles of tonofilaments. These cells were connected to adjacent cells by desmosomes, interdigitations, and gap junctions, and they were immunopositive for keratin. A small number of polyhedral cells were immunopositive for 3beta-HSD. Layer III (the granular layer) was composed of flattened cells that contained hematoxylin-stainable granules and were moderately immunopositive for filaggrin. The innermost layer (layer IV or the horny layer) consisted of keratin. Lobules without cysts consisted only of layer I (the basal layer) and layer II (the polyhedral layer). Lobules of the circumanal glands were not directly connected to apocrine glands. Polyhedral cells degenerated and were phagocytosed by basal cells at a periphery of lobules. Then, basal cells phagocytosing degenerated polyhedral cells escaped from lobules, moved into the walls of apocrine glands, and, finally, dropped into the lumen of apocrine glands.
CONCLUSIONS
Lobules of the circumanal glands have many characteristics of epidermis (a basal layer, a polyhedral or "spinous layer," a granular layer, and a horny layer) and they should not be classified as glandular tissue. The cysts in lobules can be interpreted as "closed hair canals." We suggest that steroid metabolism might occur in the polyhedral cells of the lobules.
Topics: Actins; Animals; Dogs; Female; Immunohistochemistry; Male; Microscopy, Electron; Muscle, Smooth; Perianal Glands
PubMed: 9517843
DOI: 10.1002/(SICI)1097-0185(199803)250:3<251::AID-AR1>3.0.CO;2-3 -
The Pan African Medical Journal 2022Adnexal carcinomas are rare, accounting for less than 1% of skin carcinomas. Sclerosus carcinoma of the sweat glands was first described by Goldstein et al. in 1982. We...
Adnexal carcinomas are rare, accounting for less than 1% of skin carcinomas. Sclerosus carcinoma of the sweat glands was first described by Goldstein et al. in 1982. We here report the case of a 33-year-old female patient with a retracted perianal skin lesion. Histological examination of perilesional skin biopsy, immunohistochemistry, and negative results of laboratory tests, radiological and endoscopic investigations allowed for the diagnosis of eccrine sclerosus carcinoma. This is a rare tumor, usually characterized by facial localization and slow but aggressive progression. It poses problems in differential diagnosis with benign and malignant tumors; hence the challenge encountered by pathologist of suspecting this carcinoma in patients with any sclerotic and infiltrating skin lesion characterized by slow progression, in a context of preservation of the general state and in the absence of neoplastic history as well as of feeling free to ask for new deep biopsies when in doubt.
Topics: Adult; Breast Neoplasms; Carcinoma; Carcinoma, Skin Appendage; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Skin Neoplasms; Sweat Gland Neoplasms
PubMed: 35865833
DOI: 10.11604/pamj.2022.41.329.28965 -
Cureus Nov 2022Most patients with advanced cancer experience debilitating pain, which significantly affects their quality of life and has both physical and psychological implications....
Most patients with advanced cancer experience debilitating pain, which significantly affects their quality of life and has both physical and psychological implications. Opioids have been the mainstay of treatment for chronic cancer pain, but some people develop serious adverse effects or may become refractory to opioid use. There is always a need and search for alternative non-opioid analgesics with an acceptable safety profile, and one such drug is ketamine. In this era of evolving analgesic therapeutics, ketamine has been noted to have favourable results. Ketamine, a phencyclidine analogue, is an N-methyl-D-aspartate antagonist (NMDA), and it has been shown to have an analgesic effect at sub-anaesthetic doses by blocking NMDA-induced pain sensitization and enhancing opioid receptor sensitization. This is a case report of a 46-year-old Indian female with recurrent metastatic adenocarcinoma endometrium (International Federation of Obstetrics and Gynecology (FIGO) Grade II) involving the vaginal vault, rectum, and adrenal glands, along with para-rectal, bilateral iliac, and retroperitoneal nodal metastases, in which ketamine infusion was used successfully to alleviate the pain that was initially not controlled with an incremental dose of opioids. The patient presented with progressive pain in the peri-anal region, rated 8/10 on the Numerical Pain Rating Scale (NRS), following which she was treated with escalating doses of intravenous (IV) fentanyl, but with little to no relief. In view of the patient's opioid-resistant pain, she was started on a low-dose ketamine IV infusion (50 mg in 50 ml of 0.9% NS) as "burst therapy," at infusion rates of 0.02 mg/kg/hr-0.08 mg/kg/hr, with adequate pain relief occurring at 0.08 mg/kg/hr. Literature suggests weight-based dosing of ketamine ranging from 0.06 mg/kg/hr to 0.8 mg/kg/hr was previously used to achieve satisfactory results. In this patient, even lower doses were effectively used to achieve optimum long-term analgesia, cause an upliftment in the patient's overall mood and quality of life, and cause a significant reduction in opioid usage. However, further research is required to assess the efficacy of ketamine at such doses and its effect on opioid consumption. This case report will promote further study regarding optimum IV ketamine dosing and administration in the management of opioid-refractory pain in cancer patients, especially in the Indian population.
PubMed: 36545179
DOI: 10.7759/cureus.31662 -
Journal of the American Veterinary... Apr 2002To evaluate efficacy and cost of using cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs. (Clinical Trial)
Clinical Trial
OBJECTIVE
To evaluate efficacy and cost of using cyclosporine and ketoconazole for the treatment of perianal fistulas in dogs.
DESIGN
Clinical trial.
ANIMALS
12 dogs with perianal fistulas.
PROCEDURE
Dogs received cyclosporine and ketoconazole orally (target whole blood trough cyclosporine concentrations of 400 to 600 ng/ml). Study endpoints were resolution of clinical signs, remission, and recurrence of disease. Adverse effects and cost of medications were reported. Results were compared with those from previous studies in humans and in dogs in which single agent cyclosporine treatment for perianal fistulas was used.
RESULTS
All dogs had resolution of clinical signs. Eight dogs went into remission; however, 5 of those 8 had recurrence of fistulas. Adverse effects of treatment were minimal and well tolerated. Cost of treatment was comparable to traditional surgical options and less than single agent cyclosporine treatment.
CONCLUSIONS AND CLINICAL RELEVANCE
Administration of cyclosporine with ketoconazole is an effective and cost-comparable treatment for perianal fistulas in dogs.
Topics: Administration, Oral; Animals; Cyclosporine; Dog Diseases; Dogs; Drug Interactions; Drug Therapy, Combination; Female; Immunosuppressive Agents; Ketoconazole; Male; Perianal Glands; Rectal Fistula; Recurrence; Treatment Outcome
PubMed: 12420778
DOI: 10.2460/javma.2002.220.1009 -
European Journal of Biochemistry Aug 1980The present study applied the twin-ion technique of gas chromatography/mass spectrometry to establish 7 alpha-hydroxylation of 5 alpha-androstane-3 beta, 17 beta-diol by...
C19-Steroid metabolism by canine prostate, epididymis and perianal glands. Application of the twin-ion technique of gas chromatography/mass spectrometry to establish 7 alpha-hydroxylation.
The present study applied the twin-ion technique of gas chromatography/mass spectrometry to establish 7 alpha-hydroxylation of 5 alpha-androstane-3 beta, 17 beta-diol by canine prostate, epididymis and perianal glands. 5 alpha-[4-14C, 7 beta-2H0.52]Androstane-3 beta, 17 beta-diol (0.5 microM) was incubated for 60 min at 37 degrees C with minced canine prostate and epididymis in 50 ml 0.067 M phosphate buffer (pH 7.4) containing NADPH (0.2 mM). The principal radioactive metabolite fraction was isopolar in thin-layer chromatography with 5 alpha-androstane-3 beta, 7 alpha, 17 beta-triol and contained 24% (prostate incubation) and 23% (epididymis incubation) of the radioactivity added. Following gas chromatography of the trimethylsilyl ether derivative of these metabolites, the peak with the retention time of the derivative of 5 alpha-androstane-3 beta, 7 alpah, 17 beta-triol yielded a mass spectrum consistent with that of the authentic standard triol and gave the characteristic twin-ion, though with some loss of deuterium. Incubation of 5 alpha-[4-14C, 7 beta-2H0.46]dihydrotestosterone (7 microM) and minced canine perianal glands and NADPH (0.2 mM) gave in 5% yield a transformation product with an RF-value of 5 alpha-androstane-3 beta, 7 alpha, 17 beta-triol. One half of the chromatographic fraction was subjected to gas chromatography/mass spectrometry as the free steroid, the other as the CrO3-oxidation product. The site of hydroxylation was identified as 7 alpha from the gas chromatography retention time of the free 7 beta-deuterated (twin-ion) triol and mass-spectrometry loss of deuterium in the 3,7,17-trione produced by mild CrO3 oxidation. Results of a comparative study of the metabolism of [4-14C]testosterone and 5 alpha-dihydro[4-14C]-testosterone with minced canine perianal glands and shoulder skin showed that, whereas both tissues contain a high level of 3 beta-hydroxysteroid oxidoreductase, only the perianal glands were able to transform radioactive testosterone to the 5 alpha-reduced derivatives and thence to the 7 alpha-hydroxylated product.
Topics: Androgens; Androstane-3,17-diol; Animals; Carbon Radioisotopes; Deuterium; Dihydrotestosterone; Dogs; Epididymis; Gas Chromatography-Mass Spectrometry; Hydroxylation; Male; Organ Specificity; Perianal Glands; Prostate; Skin; Testosterone
PubMed: 7408872
DOI: 10.1111/j.1432-1033.1980.tb04776.x -
Polish Journal of Radiology 2016To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India.
BACKGROUND
To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India.
MATERIAL/METHODS
This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery.
RESULTS
The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment.
CONCLUSIONS
MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.
PubMed: 28096904
DOI: 10.12659/PJR.899315