Anorectal region malignant melanoma

A retrospective study of eight patients who had suffered from malignant melanoma in the anorectal region was carried out. The initial presentation, histological findings, treatment, and survival are described. Mean survival was 18 months; however, one patient survived 147 months after initial diagnosis. An inverse correlation was noted between depth of tumor penetration and the number of giant multinucleated cells. No correlation was found between survival and histological findings or therapy regimen.     

肛管直肠恶性黑色素瘤的临床病理特点并文献复习

目的:探讨肛管直肠恶性黑色素瘤的临床病理特征、免疫表型、诊断及鉴别诊断.方法:对5例肛管直肠恶性黑色素瘤病例的组织形态、免疫组化等进行观察,并复习相关文献.结果:5例患者男性2例,女性3例,年龄60～84岁,平均70.2岁,临床主要为直肠出血、直肠肿块和疼痛等表现,镜下以上皮样和梭形细胞为主要成分,瘤细胞呈巢团或片状分...     

肛管直肠恶性黑色素瘤：42例诊断与治疗

目的：肛管直肠恶性黑色素瘤（AMM的）是一种罕见的和积极的恶性肿瘤,其治疗仍controversial.This调查研究和总结我们的经验诊断,治疗和AMM.Methods误诊：从1980年8月至十二月2009,42与AMM的患者在我们hospital.The这些患者治疗的临床资料进行回顾性分析,包括主要症状,治疗和prognosis.Further免疫抗体分析使用的S - 100蛋白,液压集成块- 45抗原和波形蛋白活性进行了22 specimens.Results：在42例的投诉主要是便血（四十二分之二十三,55.0％）,（42分之12,28.6％）,肛门群众,改变大便性状（4 / 42,9.5％）,和或肛门里急后重疼痛（3 / 42,7.1％）。误诊率是62％（42分之26）,最常见的误诊痔（9 / 26,34.6％）组成,息肉（11/26,42.3％）和直肠癌（6 / 26,23.1％）.28例腹会阴切除术,10例行局部广泛切除,3例行姑息性手术,手术和没有operation.After 1,15例患者进行放疗,化疗和21日进行了8个与这两个治疗。 22例1年内死亡,11在2年,5起3年内,并在四余年的平均存活时间为11个月,1 45 months.The的免疫组化结果最长,显示的S - 100蛋白存在于所有22例（100％）,液压集成块- 45是在22染色（95.5％）21 22（86.4％）和波形蛋白19。结论：AMM的是一个贫穷的预后和资质的罕见疾病被误诊。便血是最常见的symptom.Immunohistochemical染色利于AMM.Operation诊断是主要治疗,操作类型应该是个性化。     

Anorectal melanoma: surgical management guidelines according to tumour thickness

Management of patients with anorectal melanoma is still controversial. To reach a rationale therapeutic approach, we reviewed our experience obtained over the past decade. In all, 19 consecutive patients with the diagnosis of anorectal melanoma were included in this retrospective survey. Details of the patients' presentation, symptoms, tumour size and histology and tumour state were recorded, and the primary therapeutic procedures were evaluated in detail. The size of the tumours ranged between 0.5 and 7 cm in diameter. The median tumour thickness was 10 mm (range 0.6-40 mm). At diagnosis, six of 19 patients already presented with either regional or distant metastases. The remaining 13 patients were treated with curative intend, either by abdomino-perineal resection (APR) or wide local excision (WLE). The form of operative therapy, however, had no impact on overall survival. Nevertheless, the incidence of local recurrences was lower after APR even for patients with less favourable tumours. In conclusion, WLE alone is not sufficient for local tumour control of thick anorectal melanoma.     

Anorectal melanoma. A case report and brief review of the literature.

Anorectal melanoma in an uncommon tumor that has a poor prognosis. We present a case of anorectal melanoma and review the literature pertaining to prognosis and treatment. Although no controlled trials of treatment of anorectal melanoma have been done, the evidence suggests that conservative excision confers comparable survival with less morbidity than radical surgery.     

Anorectal melanoma with a KIT-activating mutation, which is a target for tyrosine kinase inhibitor

Recent advances in our understanding of the genetic mutations associated with melanoma have led to the classification of distinct melanoma subtypes. A number of reports have consistently demonstrated that mucosal and acral melanomas more commonly harbor KIT-activating mutations than do other subtypes. Success in treating gastrointestinal stromal tumors with imatinib has led to speculation that KIT-mutated melanoma might also be effectively managed using this approach. A 78-year-old woman presented with a 4-month history of rectal bleeding. A colonoscopy revealed a black polypoid mass, 30?mm in diameter, originating near the dentate line, and a biopsy revealed malignant melanoma. Computed tomography showed multiple liver and lung metastases. A KIT mutation analysis showed the L576P mutation in exon 11. The patient did not want to undergo chemotherapy including a tyrosine-kinase inhibitor, so palliative radiotherapy for rectal symptoms was performed, but the patient died 4?months later due to disease progression. We describe the first case of anorectal melanoma with a KIT-activating mutation in Japan and summarize findings from the literature regarding the efficacy of KIT kinase inhibitors on this melanoma subtype.     

Primary Anorectal Melanoma

Primary malignant melanoma of the anus and rectum is a rare and aggressive neoplasm that tends to invade locally and metastasize early in the course of the disease. It is often misdiagnosed as hemorrhoids or as one of the other benign anorectal conditions and is thus linked to an overall poor prognosis and a 5-year survival rate of less than 20%. Optimal treatment is still controversial, and current evidence does not show any preferential survival benefit from abdominoperineal resection over wide local excision. Chemotherapy or radiotherapy may be used for advanced disease. We report a 71-year-old female presenting with painful bowel movements and blood in stools. She was eventually found to have a mass arising from the anorectal junction with regional lymph node involvement. The patient underwent an abdominoperineal resection and is currently scheduled for chemotherapy.Key words: Primary anorectal melanoma, Abdominoperineal resection, Chemotherapy     

Anorectal anatomy and embryology

The anal canal is complex in its anatomy and its embryologic origin. The intricate and changing histology of the anal canal explains the different types of anal cancer. In addition, an understanding of the venous and the lymphatic drainage of the anal canal helps to explain its methods of dissemination. Finally, the basis for the treatment of anal cancer is derived from the cancer's anatomic origins.     

直肠肛管恶性黑色素瘤的诊治

直肠肛管恶性黑色素瘤（anorectal malignant melanoma,ARMM）是一种少见的肿瘤,仅占到所有黑色素瘤的1％左右。由于大多数患者在诊断时处于疾病的后期,所以预后极差,据报道经积极治疗的患者5年生存率仅在10％左右。目前国内外对本病的研究多为小样本的分散报道。     

直肠癌腹腔镜超低位前切除术后的肛门动力学与肛门功能的相关性研究

目的 探讨腹腔镜下直肠癌超低位前切除术后的肛门动力学变化以及肛门功能恢复情况的相关性.方法 选取确诊为直肠癌患者124例,随机分为腹腔镜超低位前手术切除组和开腹手术组.并于术后1个月、3个月、6个月随诊并评定患者的肛门动力学以及肛门功能的情况.结果 腹腔镜组和开腹组相比,腹腔镜组的住院时间(11.3±3.7)d、术中出血量(116.3±66.5)mL、手术时间(170.5±57.7)min以及术后肠道功能恢复时间(2.5±1.0)d上明显优于开腹组,差异具有统计学意义(P<0.05);但是两组在术中淋巴结清扫上无明显差异,不具统计学意义(P>0.05).腹腔镜组术后3个月和6个月的肛门最大收缩压、最大静息压、静息向量容积以及收缩向量容积明显优于开腹手术组,差异具有统计学意义(P<0.05).腹腔镜组和开腹手术组在术后1个月和6个月肛门功能方面比较发现,腹腔镜手术组的排便感觉、肛门控制力、排便时间以及便意感方面优于开腹手术组,差异具有统计学意义(P<0.05),但两组在术后6个月的排便次数方面比较,无统计学意义(P>0.05).结论 直肠癌患者腹腔镜下超低位前切除术后的肛门动力学及肛门功能的恢复情况,明显优于传统开腹手术组,效果好,值得医院推广使用.     

肛管直肠恶性黑色素瘤患者的生存分析

目的探讨原发性肛管直肠恶性黑色素瘤(anorectalmalignantmelanoma,AMM)患者的生存状况。方法回顾性随访1994至2004年广西医科大学第一附属医院治疗的8例AMM;检索CNKI全文数据库,收集国内同期有随访资料的个案报道共48篇136例,建立数据库,应用寿命表法(SPSS10.0forwindows)对AMM进行生存分析。结果AMM的1、2、3、5和10年生存率分别为47.25%、34.17%、27.28%、17.78%、8.89%,中位生存时间为16.78个月;其中男性的1、2、3、5和10年生存率分别为37.03%、27.15%、27.15%、27.15%和13.58%,中位生存时间13.80个月,女性的1、2、3、5年生存率分别为47.92%、27.71%、22.17%、7.39%,中位生存时间16.78个月。男女性整体生存状况比较无差异(P=0.4511),分年龄段(≤40岁,~60岁和>60岁)整体生存状况比较无差异(P=0.1958)。结论AMM预后极差,其预后无显著性别和年龄差异。     

Radiation Therapy and Malignant Fistulae of Anorectal Cancers

PurposeAlthough fistulization is a well-studied late toxic effect of radiation therapy (RT), anorectal cancers (ARCs) can present with malignant fistulae (MF) and negatively affect quality of life. The effect of RT, often combined with concurrent chemotherapy, on MF needs systematic analysis, because practitioners are concerned that RT may exacerbate MF. We reviewed our institutional series evaluating the hypothesis that RT worsens MF.Methods and MaterialsA single-institutional retrospective analysis of patients with ARC receiving RT from 2006 to 2019 was performed. These patients were screened for MF. Any MF resected before RT and RT not directed at the site of MF were excluded. Effects were assessed by review of available follow-up documentation and imaging.ResultsA total of 639 patients with ARC were reviewed, and 47 had MF (7.4%). With a median follow-up of 22 months (range, 2-133 months), RT improved MF in 17 of 29 evaluable patients (59%), with 9 of 29 (31.0%) having resolution. The median time to improvement was 50 days (range, 25-117 days); the median duration of improvement was 161 days (range, 0-1941 days). Malignant fistulae persisted in 12 of 29 patients (41%), with persistent local disease in all cases; in 2 cases, MF worsened concomitant with local progression.ConclusionsIn all, 7.4% of patients with ARC presented with MF. Radiation therapy led to improvement or resolution in more than half of evaluable patients. Persistence or worsening of MF was only observed in patients with refractory or progressive local disease. Based on our findings, MF is not a contraindication to RT and may be considered as an independent indication for palliative RT.