Troicki Filip, Pappas Alexandros, Noone Robert, Denittis Albert
Department of Radiation Oncology, Lankenau Hospital, 100 Lancaster Avenue, Wynnewood, PA, USA.
J Med Case Rep. 2010 Feb 24;4:67. doi: 10.1186/1752-1947-4-67.
High-grade anal intraepithelial neoplasia, also referred to as anal squamous carcinoma in-situ, or Bowen's disease of the anus, make up less than 1% of all digestive system cancers in the United States. The treatment of choice is surgical resection with anal mapping. However, this disease often recurs or persists, requiring additional surgery for these patients. This can compromise the anal sphincter leading to leakage. In this case report, we discuss the efficacy of radiation therapy as a modality to treat post-excisional recurrent Bowen's disease, which may prevent sphincter compromise, leading to improved quality of life.
An 84-year-old Caucasian woman presented with post-excisional persistent/recurrent squamous cell carcinoma in-situ. The initial lesion measured 3 cm in diameter on the right lateral side of the anal margin. A standard surgery consisting of wide local excision with anal mapping was performed. The margins were clear and our patient was followed up. Our patient recurred with a 1.2 x 0.8 cm lesion on the left anal verge extending to the anal canal. A biopsy along with mapping was done, and 2 of the 17 mapping specimens were positive for carcinoma in-situ, one in the anal canal. Due to the location of the positive anal mapping, and in order to prevent sphincter compromise on re-excision, our patient was offered definitive radiation therapy. Two years after radiation therapy, our patient showed no signs of recurrent disease and had good sphincter control.
Although the main treatment modality for treating persistent/recurrent Bowen's disease is surgery, an alternative approach using external beam radiation for CIS may be enough to provide a cure for some patients with recurrent disease.
高级别肛管上皮内瘤变，也称为肛管原位鳞状癌或肛门鲍恩病，在美国所有消化系统癌症中占比不到1%。首选治疗方法是手术切除并进行肛门定位。然而，这种疾病经常复发或持续存在，这些患者需要额外的手术治疗。这可能会损害肛门括约肌导致失禁。在本病例报告中，我们讨论放射治疗作为治疗切除术后复发性鲍恩病的一种方式的疗效，这可能会防止括约肌受损，从而提高生活质量。
一名84岁的白人女性出现切除术后持续性/复发性原位鳞状细胞癌。最初的病变位于肛门边缘右侧，直径为3厘米。进行了包括广泛局部切除并肛门定位的标准手术。切缘清晰，对患者进行了随访。患者在左肛缘出现一个1.2×0.8厘米的病变并延伸至肛管，复发。进行了活检及定位检查，17个定位标本中有2个原位癌阳性，其中一个在肛管。由于阳性肛门定位的位置，为防止再次切除时括约肌受损，为患者提供了根治性放射治疗。放射治疗两年后，患者没有复发迹象，括约肌控制良好。
虽然治疗持续性/复发性鲍恩病的主要治疗方式是手术，但对于原位癌，使用外照射的替代方法可能足以治愈一些复发性疾病患者。
