Adenocarcinoma Associated with Anal Fistula

Kang, Sung Bum; Heo, Seung Chul; Jung, Seung Yong; Choi, Hyo Seong; Park, Kyu Joo; Park, Jae Gahb

Abstract

PURPOSE: Although adenocarcinoma associated with anal fistula is rare, missed diagnosis may result in progression of the tumor and poor outcome. This study is aimed to determine the clinical features of adenocarcinoma associated with anal fistula.
METHODS
The medical records of 8 (0.4%) cases associated with anal fistula, out of 1978 anorectal adenocarcinoma treated at Seoul National University Hospital between 1979 and 2000, were reviewed.
RESULTS
The median age at diagnosis of cancer was 57 years (range, 39 to 62 years) and sex ratio was 7 to 1 with male predominance. The median duration of anal fistula before diagnosis of cancer was 8.5 years (range, 4 to 30 years). Major symptoms at diagnosis of cancer were perianal pain (38%) and discharge (38%). Perianal mass was palpable in all patients. All patients except for one case, in which palliative T-colostomy was performed due to extensive invasion despite preoperative radiation therapy, were treated with abdominoperineal resection: 4 in curative resection and 3 in palliative rsection. There were 4 (50%) in stage IV, 3 (38%) in stage III, and 1 (12%) in stage II. On median follow-up of 16 months (range, 3 to 72 months), systemic recurrences of 2 cases at lung or intraperitoneal cavity and 1 local recurrence at posterior vaginal wall were developed after curative resection.
CONCLUSIONS
Adenocarcinoma associated with anal fistula had the history of long-standing anal fistula and perianal mass on physical examination. These tumors were detected at advanced stage and their outcomes were poor. Therefore, in the anal fistula combined with long-standing history or perianal mass, a high index of suspicion for malignancy is necessary and a generous biopsy of fistulous tract should be performed to rule out concomitant adenocarcinoma.