The online version of this article (doi:10.1186/1477-7819-10-209) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
BEB has made substantial contributions to conception, bibliography and drafting the manuscript. AS has been involved in drafting the manuscript. CL has been involved in bibliography research and conception of pathology figures. IM and KM have been involved in or revising it critically for important intellectual content. KA has given final approval of the version to be published. All authors read and approved the final manuscript.
Colonic adenocarcinoma revealed by metastatic anorectal fistula is rare, with few cases in the literature. Such lesions can be taken for the more common manifestation of a benign perianal abscess or fistula. Once diagnosed, the management of such conditions remains controversial. We herein report two cases with perianal fistula that were subsequently found to have developed perianal adenocarcinoma on biopsy. Further colonic investigation revealed a rectosigmoid adenocarcinoma. Histology and immunohistochemical staining was identical in both primary and metastatic tumors. Preoperative chemoradiation with further rectal low anterior resection and local excision of metastatic anal fistula was performed. There is no recurrence after 3 years of follow-up.
Guiss RL: The implantation of cancer cells within a fistula in ano. Surgery. 1954, 36: 136-139. PubMed
Killingback M, Wilson E, Hughes ESR: Anal metastases from carcinoma of the rectum and colon. Aust NZ J Surg. 1965, 34: 178-187. 10.1111/j.1445-2197.1965.tb04353.x. CrossRef
Parnes IH: An interesting case of cancer of the sigmoid with concomitant cancer in anal fistula. Mt Sinai J Med. 1976, 43: 476-479. PubMed
Ueta K, Umekita N, Matsumine T: A case of metastatic carcinoma found at an anal fistula (in Japanese). J Jpn Surg Assoc. 1991, 52: 1323-1326.
Thomas DJ, Thompson MR: Implantation of metastasis from adenocarcinoma of sigmoid colon into fistula in ano. J R Sci Med. 1992, 85: 361-
Tohira H, Imai N, Tateyama K, Ozeki Y, Yamamoto S: A case of rectal cancer seeding to anal fistula. (In Japanese). Geka. 1998, 60: 853-856.
Tokuhara K, Yamanaka H, Ito D, Koshiba T, Sato M, Kogire M: A case of metastatic carcinoma at an anal fistula (in Japanese). Jpn J Gastroenterol Surg. 2001, 34: 1690-1694. 10.5833/jjgs.34.1690. CrossRef
Yoshimura H, Ienaga T, Ueda S, Ota T: A case of metastatic carcinoma of anal fistula caused implantation from rectal cancer (in Japanese). Jpn J Gastroenterol Surg. 2001, 34: 1363-1366. 10.5833/jjgs.34.1363. CrossRef
Kouraklis G, Glinavou A, Kouvaraki M, Raftopoulos J, Karatzas G: Anal lesion resulting from implantation of viable tumor cells in a pre-existing anal fistula. A case report. Acta Chir Belg. 2002, 102: 212-213. PubMed
Yagihashi N, Ohsawa T, Narita J, Iwabuchi T, Tsuge T: A case of carcinoma metastatic to an anal fistula treated by pelvic exenteration (in Japanese). J Jpn Surg Assoc. 2002, 63: 2224-2228. 10.3919/jjsa.63.2224. CrossRef
Shimoyama M, Suda T, Iiai T, Okamoto H, Hatakeyama K: A case of metastatic carcinoma of an anal fistula caused by implantaion of rectal cancer (in Japanese). J Jpn Surg Assoc. 2003, 64: 1434-1438. 10.3919/jjsa.64.1434. CrossRef
Tomimaru Y, Ohue M, Noura S, Tanida T, Miyashiro I, Yano M, Ohigashi H, Sasaki Y, Ishikawa O, Imaoka S: A case of anal fistula cancer probably developing from intraluminal dissemination of rectal cancer. (in Japanese). Gan To Kagaku Ryoho. 2005, 32: 1776-1778. PubMed
Wakatsuki K, Oeda Y, Isono T, Yoshioka S, Nukui Y, Yamazaki K, Nabeshima S, Miyazaki M: Adenocarcinoma of the rectosigmoid colon seeding into pre-existing anal fistula. Hepatogastroenterology. 2008, 55 (84): 952-955. PubMed
Ryall C: Cancer infection and cancer recurrence. Lancet. 1907, 2: 1311-1316. CrossRef
Ramalingam P, Hart WR, Goldblum JR: Cytokeratin subset immunostaining in rectal adenocarcinoma and normal anal glands. Arch Pathol Lab Med. 2001, 125: 1074-1077. PubMed
- Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review
El Bachir Benjelloun
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II