Tumeurs et pseudotumeurs du canal anal et de l'anus
ABSTRACT Les tumeurs malignes anales sont rares. Par contre, les lésions tumorales anales en relation avec lePapilloma Virus telles que le condylome acuminé (géant) sont des lésions nettement plus fréquentes. Pour comprendre les cancers qui surviennent
dans cette zone, il est nécessaire de connaître l'aspect histologique du canal anal et de l'anus.
En ce qui concerne les tumeurs malignes, une revue de notre série personnelle comme de la littérature montre clairement que
l'adénocarcinome du bas rectum, et non celui des glandes anales, est le carcinome le plus fréquent de cette région. Vient
ensuite mais son incidence augmente, le carcinome squameux du canal anal qui est parfois en relation avec l'HPV. Dans les
carcinomes squameux, il est recommandé de tenir compte des aspects de la différenciation basaloïde, kératinisante ou en microkystes
mucineux, ou de la notion de cancer intra-épithélial. Ces entités doivent être reconnues étant donné leurs pronostics biologiques
La tumeur de Buschke-Löwenstein, localement infiltrante ou condylome géant ou le carcinome verruqueux, peut être porteuse
d'HPV 6/11. Le carcinome basocellulaire peut se rencontrer dans la région anale; il doit être différencié du carcinome squameux:
son traitement étant purement local. La maladie de Paget primaire tend à récidiver fréquemment et à devenir invasive. Elle
devrait être différenciée de la forme de maladie de Paget associée à un carcinome colorectal synchrone (cytokératine 20 positive).
Les rares cas de mélanomes malins se développent le plus souvent chez des patients de race blanche et montrent des aspects
jonctionnels similaires au mélanome cutané. Chez les patients porteurs du SIDA, des lymphomes B à grandes cellules ont été
En ce qui concerne les néoplasies intra-épithéliales, la néoplasie intra-épithéliale anale de la zone squameuse ou de transition,
la dysplasie squameuse de la marge anale ou la maladie de Bowen ou encore les papuloses bowenoïdes sont reconnues.
Les lésions bénignes incluent des naevus naevocellulaires, des papillomes squameux, des hidradénomes papillaires des glandes
apocrines péri-anales, d'occasionnelles tumeurs mésenchymales ou nerveuses, l'hyperplasie fibro-épithéliale, les marisques
ou encore le polype cloaco-génique inflammatoire associés à un prolapsus muqueux ou des hémorroïdes.
Malignant anal tumours are rare but, in contrast, HumanPapilloma Virus (HPV)-related tumour-like conditions, including (giant) condyloma acuminatum, of the anus are more common diseases. To understand
the neoplasms that arise in this area it is necessary to be familiar with the histological features of the anal canal and
With regard to the malignant tumours, a review of our personal series as well as literature data indicate that adenocarcinoma
from the lower rectum, not from the anal glands, is the most common carcinoma in that region. It is not distinguishable from
the classical colorectal adenocarcinoma. Second in frequency but rising in incidence is the group of squamous cell carcinomas
(SCC) of the anal canal, which are often related with HPV infection. In the SCC it is advised to include statements on the
presence of basaloid features or mucinous microcysts, keratinisation and intraepithelial neoplasia. Entities that should be
recognized because of a different biological behaviour are SCC with mucinous microcysts and the small cell anaplastic (not
neuroendocrine) carcinoma. The locally invasive Buschke-Löwenstein tumour or giant (malignant) condyloma or verrucous carcinoma
may contain HPV 6/11. Basal cell carcinoma, the skin cancer, can be seen in the anal region and it should be distinguished
from SCC as it can be treated by local excision alone. Primary Paget's disease tends to recur frequently and to become invasive
and should be distinguished from Paget's disease associated with a synchronous or a metachronous colorectal carcinoma (cytokeratin
20 positive). The rare malignant melanoma occurs mainly in white patients and shows features like junctional activity similar
to these of cutaneous melanoma. In AIDS patients large B-cell malignant lymphomas can be seen.
Amongst the intraepithelial neoplasia, and intraepithelial neoplasia (AIN) in the transition and squamous zone, squamous dysplasia
at the anal margin or Bowen's disease and Bowenoid papulosis are recognised.
Benign lesions include naevocellular naevi, squamous cell papilloma, papillary hidradenoma of the perianal apocrine glands,
occasional reports of various mesenchymal or neurogenic tumours, the fibroepithelial hyperplasia or anal tag and the inflammatory
cloacogenic polyp associated with rectal mucosal prolapse and/or haemorrhoids.
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ABSTRACT: Clinical, pathological and flow cytometric parameters have been analysed by univariate and multivariate analysis to define those parameters of important prognostic influence in 235 cases of surgically treated squamous carcinoma of the anus and perianal skin. Patients had been treated by anorectal excision (166 patients) or by local excision (69). Analyses were carried out on five data sets--the two surgical subgroups, two groups distinguished by site of tumour and on all 235 patients. Univariate analysis showed many parameters to be of prognostic influence, although histological typing of tumours into the more common histological subtypes was of no prognostic value. Parameters of independent prognostic significance in multivariate analysis were those indicating depth of spread, inguinal lymph node involvement and DNA-ploidy. In this study the subdivision of the rarer types of anal canal tumour, such as mucoepidermoid carcinoma, microcystic squamous carcinoma and small cell anaplastic carcinoma, was relevant confirming that these tumours have a poor prognosis. It is now felt that surgery should not be employed as primary treatment in most cases of anal cancer and the results of this study have to be interpreted with caution when applied to patients treated with radiotherapy with or without chemotherapy. Nevertheless, our findings suggest that the most useful prognostic information can be gleaned from accurate clinical staging and an assessment of DNA-ploidy status.Histopathology 07/1990; 16(6):545-55. DOI:10.1111/j.1365-2559.1990.tb01159.x · 3.30 Impact Factor
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ABSTRACT: The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based case-control study in Denmark and Sweden. We conducted telephone interviews with 324 women and 93 men in whom invasive or in situ anal cancer was diagnosed between 1991 and 1994, 534 controls with adenocarcinoma of the rectum, and 554 population controls. The interviews covered a wide spectrum of possible risk factors for anal cancer. Odds ratios were calculated by logistic regression. Specimens of anal-cancer tissue and samples of rectal adenocarcinomas were tested for human papillomavirus (HPV) DNA with the polymerase chain reaction. Multivariate analysis revealed consistent and statistically significant associations between measures of sexual promiscuity and the risk of anal cancer in both men and women. There was a significant trend toward an association between higher numbers of partners of the opposite sex in women (P<0.001) and men (P<0.05) and strong associations with a variety of venereal diseases. In women, receptive anal intercourse, particularly before the age of 30 years, and venereal infections in the partner were also associated with an increased risk (odds ratios, 3.4 and 2.4, respectively). Fifteen percent of the men with anal cancer reported having had homosexual contact, as compared with none of the controls (P<0.001). High-risk types of HPV, notably HPV-16, were detected in 84 percent of the anal-cancer specimens examined, whereas all rectal-adenocarcinoma specimens tested were negative for HPV. Our study provides strong evidence that a sexually transmitted infection causes anal cancer. The presence of high-risk types of HPV, notably HPV-16 (which is known to cause cancer of the cervix), in the majority of anal-cancer tissue specimens suggests that most anal cancers are potentially preventable.New England Journal of Medicine 12/1997; 337(19):1350-8. DOI:10.1056/NEJM199711063371904 · 54.42 Impact Factor
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ABSTRACT: This report describes the clinical and pathologic features of eight cases of an unusual inflammatory polyp arising from the transitional zone of the anus. This lesion has been designated as the inflammatory cloacogenic polyp. Rectal bleeding is the most common presenting clinical symptom. The polyp is usually located on the anterior wall of the anal canal. Morphologically, it is characterized by a tubulovillous pattern of growth, superficial ulceration, displaced groups of crypts into submucosa, and extension of chronically inflamed fibromuscular stroma into the lamina propria. Clinical and morphologic similarities with the solitary rectal ulcer syndrome suggests that prolapse of transitional zone mucosa may be important in its pathogenesis. Simple surgical resection appears to be the treatment of choice.American Journal of Surgical Pathology 01/1982; 5(8):761-6. · 4.59 Impact Factor