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An Exceptional Adenocarcinoma in a Girl

An Exceptional Adenocarcinoma in a Girl Hindawi Case Reports in Oncological Medicine Volume 2018, Article ID 4017043, 3 pages https://doi.org/10.1155/2018/4017043 Case Report 1 1 1 2 Bangaly Traore , Ibrahima Kalil Cisse, Malick Bah, and Ahmed Monzomba Keita Surgical Oncology Unit, Donka University Hospital, Faculty of Medicine, University of Conakry, Conakry, Guinea Laboratory of Anatomo-Pathology, University Hospital Centre of Donka, Faculty of Medicine, University of Conakry, Conakry, Guinea Correspondence should be addressed to Bangaly Traore; ucodonka@gmail.com Received 29 September 2017; Accepted 25 February 2018; Published 1 April 2018 Academic Editor: Constantine Gennatas Copyright © 2018 Bangaly Traore et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Anal adenocarcinoma is very rare and usually occurs in the elderly. We present a case of a 12-year-old girl with an anal margin painful tumor infiltrating the lower rectum, with perineal and vulvar permeation nodules and bilateral fixed inguinal and iliac lymph nodes. Histology showed anal adenocarcinoma with mucosecreting component and independent cells. She had no extra pelvic metastasis on CTscan. She underwent a colostomy and palliative care. *is exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. *e precarious social context and the age of onset make it difficult to manage this rare cancer. Immunohistochemical study (IHC) was not performed. 1. Background *e patient was negative for human immunodeficiency Anal cancers are rare. *ey represent 1.5 to 2.5% of digestive virus (HIV). She is anemic. Computed tomography (CT) tract cancers [1, 2] and 6% of anorectal cancers [2, 3]. Most are showed anal and rectocanal thickening with inguinal and squamous cell carcinomas, accounting for less than 10% of all iliac lymph node involvement (Figures 3(a) and 3(b)); there anal cancers [4]. Anal adenocarcinoma is considered more was no extra pelvic metastasis. aggressive than squamous cell carcinoma (SCC) [4]. More For our 12-year-old girl who presents an ADK of the than two-thirds occur after age 65. Anal adenocarcinoma anus classified cT4N3M0, we realized a colostomy in gun occurrence in children is very rare. In this study, we discuss barrel. Anemia was corrected after transfusion of globular one case of anal adenocarcinoma in a 12-year-old girl. concentrate. Chemotherapy could not be administered be- cause of lack of financial resources. Evolution without an- ticancer treatment was a locoregional tumor progression. 2. Case Presentation *e patient is under tramadol to calm the sometimes intense A 12-year-old girl, whose parents are separated, was sent to perineal pain. us in May 2017 for painful swelling and pruritus of the anal margin. Eight months before the first signs, a notion of 3. Discussion multiple anal intercourses is reported. Because of the notion of anal intercourses, she was examined in several hospital Anal adenocarcinoma occurrence in a 12-year-old child is and social departments without successful outcomes. extremely rare. *e average age is 65 years or older [5, 6]. To She presented a large circumferential tumor, budding, our knowledge, our patient could be the youngest patient ulcerated, and painful tumor of the anal margin, with perineal worldwide. Anal adenocarcinoma can be separated into three and vulvar permeation nodules and bilateral fixed inguinal main categories: tumors arising from the mucosal surface, and iliac lymph nodes (Figure 1). anal glands, or along fistulous tracts [1, 4]. *e origin is the Histology showed anal adenocarcinoma with muco- anal mucosa and rarely as in our patient, perianal. *is patient secreting component and independent cells (Figure 2). has no family history of cancer. Anal intercourse could be 2 Case Reports in Oncological Medicine (a) Figure 1: Anal margin tumor with perineal and vulvar permeation nodules and bilateral inguinal lymph nodes. (a) (b) Figure 3: Anal and rectocanal thickening with inguinal and iliac lymph node involvement on CT scan. perianal gland type, while CK7 will be positive in perianal type and variably positive in rectal type [8, 11, 12]. But clinical (b) history allows us to retain the anus as a primitive site in our patient. She was seen in stage III of her disease, while more than 61% of Chang et al.’s [10] patients were diagnosed with stages I and II. *e advanced stage is due to the precarious social context and several detours in the hospital services without better multidisciplinary approach. Current adeno- carcinoma management is controversial, and experience with this disease remains largely anecdotal or based on very small series. *e goal standard of anal adenocarcinoma treatment is surgery framed by radiochemotherapy or chemotherapy [4, 5, 10, 13, 14]. Surgical treatment depends on tumor size, stage, and physical performance. Wide excision is reserved for tumors smaller than or equal to 2 cm, and then abdomi- Figure 2: Anal adenocarcinoma with mucosecreting component noperineal amputation is indicated for tumors greater than and independent cells. 2 cm [10]. In our patient who had a large tumor of the anus, infiltrating the perineum, the vulva, the anal canal, and the the risk factor. *is notion of sexual intercourse should have lower rectum, we performed a colostomy. *is palliative surgery made it possible to reduce the anal pain while waiting the human papillomavirus DNA detected on the tumor tissue whose role is reported by some authors [7]. Other risk factors for the chemotherapy, which was never carried out because of the financial problems. In this context of privileged palliative (tobacco, HIV, Cronh’s disease, and chronic fistula) [8, 9] are not found in our patient. *e clinical signs are the same as care, radiotherapy and/or surgical treatment are only dis- those of SCC of the anus. Mass, anal pain, and pruritus were cussed according to the outcomes of neoadjuvant chemo- the signs of onset in our patient. But other signs such as therapy. We think that radiotherapy would be poorly hemorrhage anal discharge may be associated [10]. It is indicated because of the growth cartilages in this 12-year-old difficult to differentiate anal cancer from the lower rectal girl. If chemotherapy was available, we would have admin- cancer with invasion of the anus in this 12-year-old patient. istered the FOLFOX4 protocol and, depending on the clinical We did not perform immunohistochemistry, but the cyto- response, performed a posterior pelvectomy and bilateral keratin (CK20) is positive for rectal type and negative for inguinoiliac lymph node dissection. Case Reports in Oncological Medicine 3 4. Conclusion *is exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. *e precarious social context and the age of onset make it difficult to manage. Conflicts of Interest *e authors declare that they have no conflicts of interest. References [1] N. N. Mahmoud and R. D. Madoff, “Investigation and management of malignant anal-canal tumours,” in Progress in Colorectal Surgery, J. Beynon and D. Nicholas, Eds., pp. 115–134, 2005. [2] R. Siegel, D. Naishadham, and A. Jemal, “Cancer statistics, 2013,” CA: A Cancer Journal for Clinicians, vol. 63, no. 1, pp. 11–30, 2013. [3] R. Glynne-Jones, P. J. Nilsson, C. Aschele et al., “Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for di- agnosis, treatment and follow-up,” Annals of Oncology, vol. 25, no. 3, pp. iii10–iii20, 2014. [4] S. Anwar, H. Welbourn, J. Hill, and D. Sebag-Montefiore, “Adenocarcinoma of the anal canal-a systematic review,” Colorectal Disease, vol. 15, no. 12, pp. 1481–1488, 2013. [5] M. F. Marquez, ´ F. J. V. Albendea, R. B. Lozano et al., “Ad- enocarcinoma of the anal canal,” Narrative Review Cirug´ıa Española, vol. 91, no. 5, pp. 281–286, 2013. [6] J. Shia, “An update on tumors of the anal canal,” Archives of Pathology & Laboratory Medicine, vol. 134, pp. 1601–1611, [7] D. Leonard, D. Beddy, and E. Dozois, “Neoplasms of anal canal and perianal skin,” Clinics in Colon and Rectal Surgery, vol. 24, no. 1, pp. 54–63, 2011. [8] R. Tarazi and R. L. Nelson, “Anal adenocarcinoma: a com- prehensive review,” Seminars in Surgical Oncology, vol. 10, no. 3, pp. 235–240, 1994. [9] M. P. Kulkarni, Y. A. Momin, A. B. Pandav, and K. R. Sulhyan, “Adenocarcinoma of the anal canal: a report of two cases with review of literature,” Indian Journal of Pathology and Mi- crobiology, vol. 59, no. 3, pp. 404–406, 2016. [10] G. J. Chang, R. J. Gonzalez, J. M. Skibber et al., “A twenty-year experience with adenocarcinoma of the anal canal,” Diseases of the Colon & Rectum, vol. 52, no. 8, pp. 1375–1380, 2009. [11] N. A. Wong, T. Shirazi, D. W. Hamer-Hodges, A. P. Corfield, and A. M. Lessells, “Adenocarcinoma arising within a Crohn’s-related anorectal fistula: a form of anal gland carcinoma?,” Histopathology, vol. 40, no. 3, pp. 302–304, 2002. [12] M. Lisovsky, K. Patel, K. Cymes, D. Chase, T. Bhuiya, and N. Morgenstern, “Immunophenotypic characterization of anus gland carcinoma: loss of p63 and cytokeratin 5/6,” Ar- chives of Pathology & Laboratory Medicine, vol. 131, no. 8, pp. 1304–1311, 2007. [13] S. A. Salati and A. Al Kadi, “Anal cancer - a review,” International Journal of Health Sciences, vol. 6, no. 2, pp. 206–230, 2012. [14] N. Bertelson, J. Blumetti, J. Cintron et al., “Anal adenocar- cinoma: outcomes in an uncommon malignancy,” American Journal of Surgery, vol. 81, no. 11, pp. 1114–1117, 2015. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

An Exceptional Adenocarcinoma in a Girl

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Hindawi Publishing Corporation
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Copyright © 2018 Bangaly Traore et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2018, Article ID 4017043, 3 pages https://doi.org/10.1155/2018/4017043 Case Report 1 1 1 2 Bangaly Traore , Ibrahima Kalil Cisse, Malick Bah, and Ahmed Monzomba Keita Surgical Oncology Unit, Donka University Hospital, Faculty of Medicine, University of Conakry, Conakry, Guinea Laboratory of Anatomo-Pathology, University Hospital Centre of Donka, Faculty of Medicine, University of Conakry, Conakry, Guinea Correspondence should be addressed to Bangaly Traore; ucodonka@gmail.com Received 29 September 2017; Accepted 25 February 2018; Published 1 April 2018 Academic Editor: Constantine Gennatas Copyright © 2018 Bangaly Traore et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Anal adenocarcinoma is very rare and usually occurs in the elderly. We present a case of a 12-year-old girl with an anal margin painful tumor infiltrating the lower rectum, with perineal and vulvar permeation nodules and bilateral fixed inguinal and iliac lymph nodes. Histology showed anal adenocarcinoma with mucosecreting component and independent cells. She had no extra pelvic metastasis on CTscan. She underwent a colostomy and palliative care. *is exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. *e precarious social context and the age of onset make it difficult to manage this rare cancer. Immunohistochemical study (IHC) was not performed. 1. Background *e patient was negative for human immunodeficiency Anal cancers are rare. *ey represent 1.5 to 2.5% of digestive virus (HIV). She is anemic. Computed tomography (CT) tract cancers [1, 2] and 6% of anorectal cancers [2, 3]. Most are showed anal and rectocanal thickening with inguinal and squamous cell carcinomas, accounting for less than 10% of all iliac lymph node involvement (Figures 3(a) and 3(b)); there anal cancers [4]. Anal adenocarcinoma is considered more was no extra pelvic metastasis. aggressive than squamous cell carcinoma (SCC) [4]. More For our 12-year-old girl who presents an ADK of the than two-thirds occur after age 65. Anal adenocarcinoma anus classified cT4N3M0, we realized a colostomy in gun occurrence in children is very rare. In this study, we discuss barrel. Anemia was corrected after transfusion of globular one case of anal adenocarcinoma in a 12-year-old girl. concentrate. Chemotherapy could not be administered be- cause of lack of financial resources. Evolution without an- ticancer treatment was a locoregional tumor progression. 2. Case Presentation *e patient is under tramadol to calm the sometimes intense A 12-year-old girl, whose parents are separated, was sent to perineal pain. us in May 2017 for painful swelling and pruritus of the anal margin. Eight months before the first signs, a notion of 3. Discussion multiple anal intercourses is reported. Because of the notion of anal intercourses, she was examined in several hospital Anal adenocarcinoma occurrence in a 12-year-old child is and social departments without successful outcomes. extremely rare. *e average age is 65 years or older [5, 6]. To She presented a large circumferential tumor, budding, our knowledge, our patient could be the youngest patient ulcerated, and painful tumor of the anal margin, with perineal worldwide. Anal adenocarcinoma can be separated into three and vulvar permeation nodules and bilateral fixed inguinal main categories: tumors arising from the mucosal surface, and iliac lymph nodes (Figure 1). anal glands, or along fistulous tracts [1, 4]. *e origin is the Histology showed anal adenocarcinoma with muco- anal mucosa and rarely as in our patient, perianal. *is patient secreting component and independent cells (Figure 2). has no family history of cancer. Anal intercourse could be 2 Case Reports in Oncological Medicine (a) Figure 1: Anal margin tumor with perineal and vulvar permeation nodules and bilateral inguinal lymph nodes. (a) (b) Figure 3: Anal and rectocanal thickening with inguinal and iliac lymph node involvement on CT scan. perianal gland type, while CK7 will be positive in perianal type and variably positive in rectal type [8, 11, 12]. But clinical (b) history allows us to retain the anus as a primitive site in our patient. She was seen in stage III of her disease, while more than 61% of Chang et al.’s [10] patients were diagnosed with stages I and II. *e advanced stage is due to the precarious social context and several detours in the hospital services without better multidisciplinary approach. Current adeno- carcinoma management is controversial, and experience with this disease remains largely anecdotal or based on very small series. *e goal standard of anal adenocarcinoma treatment is surgery framed by radiochemotherapy or chemotherapy [4, 5, 10, 13, 14]. Surgical treatment depends on tumor size, stage, and physical performance. Wide excision is reserved for tumors smaller than or equal to 2 cm, and then abdomi- Figure 2: Anal adenocarcinoma with mucosecreting component noperineal amputation is indicated for tumors greater than and independent cells. 2 cm [10]. In our patient who had a large tumor of the anus, infiltrating the perineum, the vulva, the anal canal, and the the risk factor. *is notion of sexual intercourse should have lower rectum, we performed a colostomy. *is palliative surgery made it possible to reduce the anal pain while waiting the human papillomavirus DNA detected on the tumor tissue whose role is reported by some authors [7]. Other risk factors for the chemotherapy, which was never carried out because of the financial problems. In this context of privileged palliative (tobacco, HIV, Cronh’s disease, and chronic fistula) [8, 9] are not found in our patient. *e clinical signs are the same as care, radiotherapy and/or surgical treatment are only dis- those of SCC of the anus. Mass, anal pain, and pruritus were cussed according to the outcomes of neoadjuvant chemo- the signs of onset in our patient. But other signs such as therapy. We think that radiotherapy would be poorly hemorrhage anal discharge may be associated [10]. It is indicated because of the growth cartilages in this 12-year-old difficult to differentiate anal cancer from the lower rectal girl. If chemotherapy was available, we would have admin- cancer with invasion of the anus in this 12-year-old patient. istered the FOLFOX4 protocol and, depending on the clinical We did not perform immunohistochemistry, but the cyto- response, performed a posterior pelvectomy and bilateral keratin (CK20) is positive for rectal type and negative for inguinoiliac lymph node dissection. Case Reports in Oncological Medicine 3 4. Conclusion *is exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. *e precarious social context and the age of onset make it difficult to manage. Conflicts of Interest *e authors declare that they have no conflicts of interest. References [1] N. N. Mahmoud and R. D. Madoff, “Investigation and management of malignant anal-canal tumours,” in Progress in Colorectal Surgery, J. Beynon and D. Nicholas, Eds., pp. 115–134, 2005. [2] R. Siegel, D. Naishadham, and A. Jemal, “Cancer statistics, 2013,” CA: A Cancer Journal for Clinicians, vol. 63, no. 1, pp. 11–30, 2013. [3] R. Glynne-Jones, P. J. Nilsson, C. Aschele et al., “Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for di- agnosis, treatment and follow-up,” Annals of Oncology, vol. 25, no. 3, pp. iii10–iii20, 2014. [4] S. Anwar, H. Welbourn, J. Hill, and D. Sebag-Montefiore, “Adenocarcinoma of the anal canal-a systematic review,” Colorectal Disease, vol. 15, no. 12, pp. 1481–1488, 2013. [5] M. F. Marquez, ´ F. J. V. Albendea, R. B. Lozano et al., “Ad- enocarcinoma of the anal canal,” Narrative Review Cirug´ıa Española, vol. 91, no. 5, pp. 281–286, 2013. [6] J. Shia, “An update on tumors of the anal canal,” Archives of Pathology & Laboratory Medicine, vol. 134, pp. 1601–1611, [7] D. Leonard, D. Beddy, and E. Dozois, “Neoplasms of anal canal and perianal skin,” Clinics in Colon and Rectal Surgery, vol. 24, no. 1, pp. 54–63, 2011. [8] R. Tarazi and R. L. Nelson, “Anal adenocarcinoma: a com- prehensive review,” Seminars in Surgical Oncology, vol. 10, no. 3, pp. 235–240, 1994. [9] M. P. Kulkarni, Y. A. Momin, A. B. Pandav, and K. R. Sulhyan, “Adenocarcinoma of the anal canal: a report of two cases with review of literature,” Indian Journal of Pathology and Mi- crobiology, vol. 59, no. 3, pp. 404–406, 2016. [10] G. J. Chang, R. J. Gonzalez, J. M. Skibber et al., “A twenty-year experience with adenocarcinoma of the anal canal,” Diseases of the Colon & Rectum, vol. 52, no. 8, pp. 1375–1380, 2009. [11] N. A. Wong, T. Shirazi, D. W. Hamer-Hodges, A. P. Corfield, and A. M. Lessells, “Adenocarcinoma arising within a Crohn’s-related anorectal fistula: a form of anal gland carcinoma?,” Histopathology, vol. 40, no. 3, pp. 302–304, 2002. [12] M. Lisovsky, K. Patel, K. Cymes, D. Chase, T. Bhuiya, and N. Morgenstern, “Immunophenotypic characterization of anus gland carcinoma: loss of p63 and cytokeratin 5/6,” Ar- chives of Pathology & Laboratory Medicine, vol. 131, no. 8, pp. 1304–1311, 2007. [13] S. A. Salati and A. Al Kadi, “Anal cancer - a review,” International Journal of Health Sciences, vol. 6, no. 2, pp. 206–230, 2012. [14] N. Bertelson, J. Blumetti, J. Cintron et al., “Anal adenocar- cinoma: outcomes in an uncommon malignancy,” American Journal of Surgery, vol. 81, no. 11, pp. 1114–1117, 2015. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Case Reports in Oncological Medicine – Hindawi Publishing Corporation

Published: Apr 1, 2018

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