Video Endoscopic Sequence 1 of 6..

Extensive Anal and Buttocks Cancer

This is a 55 year-old, lady with extensive anal and buttocks carcinoma. Biopsies display ulcerated epidermoid carcinoma.
At digital examination as well as colonoscopy shows that Infiltrates the pectineal line.
The computed tomography shows metastasis to both pulmonary bases and conglomerate of inguinal
lymph nodes.

.

Video Endoscopic Sequence 2 of 6..

Extensive Anal and Buttocks Cancer

To enlarge the image, click on it.

Video Endoscopic Sequence 3 of 6..

Extensive Anal and Buttocks Cancer

To enlarge the image, click on it.

Video Endoscopic Sequence 4 of 6..

Extensive Anal and Buttocks Cancer

To enlarge the image, click on it.

Video Endoscopic Sequence 5 of 6..

Extensive Anal and Buttocks Cancer

To enlarge the image, click on it.

Video Endoscopic Sequence 6 of 6..

Extensive Anal and Buttocks Cancer

This image contains a video; double-click it.

Video Endoscopic Sequence 1 of 11.

Anal Cancer

This is A 69 year old, Female, for 6 months had suffered from an external lesion in the anus and in that period 5 different general practitioners had misdiagnosed hemorrhoids.

Squamous cell carcinoma. This is the most common type of cancer of the anus. It begins in the cells that line the anal canal and grow into the deeper tissue.

All the endoscopic images contained in this Atlas contain a video clip.

Video Endoscopic Sequence 2 of 11.

A colonoscopy shows extensive infiltration of the first centimeters of the rectum

Primary Cancer of the anus is a very rare tumor.

The term anal cancer usually refers to anal squamous cell carcinoma. Previous histopathological terms for squamous cell carcinoma, including cloacogenic, large-cell keratinizing/nonkeratinizing, and basaloid carcinoma, have been removed from the most recent two World Health Organization (WHO) classification schemes.

Video Endoscopic Sequence 3 of 11.

Retroflexed view The infiltration of the neoplasm in the area of rectum as welll as of the pectinate line (dentate line) is displayed.

Anal squamous cell carcinoma is a distinct disease entity that, like cervical cancer, is primarily linked to human papillomavirus (HPV) infection. In both diseases, HPV-related inflammation leads to dysplasia and progression to cancer. Interesting differences between those two disease processes, new indications for human papillomavirus (HPV) vaccines, and a marked increase in the diagnosis of anal cancer have brought more attention to this relatively uncommon disease entity.

Video Endoscopic Sequence 4 of 11.

Anal squamous cell carcinoma develops at the anal squamocolumnar junction and arises from a precancerous lesion called high-grade anal intraepithelial neoplasia (AIN-II, AIN-III). The presence of AIN in high-risk groups, especially HIV-positive patients, is an indication for ongoing surveillance by means of high-resolution anoscopy, close followup, topical medications, or other methods.

Video Endoscopic Sequence 5 of 11.

Part of the anus and part of the rectum is dispayed, the contrast of anal tissue and tissue infiltrated by the neoplasm in the first centimeters of the rectum.

Patients with anal cancer often delay seeking medical care. In addition, anal cancer is often misdiagnosed, or the diagnosis is significantly delayed, during which time the patient receives treatment for other benign anorectal disease (eg, hemorrhoids). To avoid diagnostic delay

Video Endoscopic Sequence 6 of 11.

The anal and cervical canal share embryologic, histologic, and pathologic characteristics. Both develop from the embryonic cloacal membrane, and are sites of fusions of endodermal and ectodermal tissue to form a squamocolumnar epithelial junction. Both areas may display normal metaplastic change and abnormal dysplastic change related to infection with human papillomavirus (HPV).

The rates of anal cancer are increasing in the general population and are particularly high in HIV-infected men who have sex with men (MSM). The use of antiretroviral therapy (ART) has not altered the prevalence of anal squamous intraepithelial lesions (SIL), and may be associated with an increased incidence of progression to anal cancer due to the longer life expectancy of HIV infected individuals.

The biologic consequences of anal SIL are considered analogous to those of cervical SIL. Anal high-grade SIL (HSIL) has been demonstrated to progress to invasive anal cancer in limited series, providing the rationale for active treatment.

Video Endoscopic Sequence 7 of 11.

Anal cancer comprises 2.5 percent of all digestive system malignancies in the United States; 8600 new cases are diagnosed annually. The incidence of anal cancer in the general population has increased over the last 30 years. A higher incidence has been associated with female gender, infection with human papillomavirus (HPV), lifetime number of sexual partners, genital warts, cigarette smoking, receptive anal intercourse, and infection with HIV. From an etiologic standpoint, anal cancer is more similar to genital malignancies than it is to other gastrointestinal tract cancers. Substantial progress has been made in understanding the pathophysiology and the management of anal cancer As a result of carefully conducted epidemiologic and clinical studies, it is now known that anal cancer is closely associated with HPV infection and that cure is possible in the majority of patients with preservation of the anal sphincter.

Video Endoscopic Sequence 8 of 11.

The anal canal begins where the rectum enters the puborectalis sling at the apex of the anal sphincter complex (palpable as the anorectal ring on digital rectal examination and approximately 1 to 2 cm proximal to the dentate line) and ends where the squamous mucosa blends with the perianal skin, which roughly coincides with the palpable intersphincteric groove or the outermost boundary of the internal sphincter muscle.

Video Endoscopic Sequence 9 of 11.

Photograph of the neoplasia, pressing on the image to enlarge it

Video Endoscopic Sequence 10 of 11.

Photograph of the neoplasia, pressing on the image to enlarge it

Video Endoscopic Sequence 11 of 11.

Photograph of the neoplasia, pressing on the image to enlarge it