Larghero G C, Scarpettini S, Pavero R, Costanzo A, Cariati A, Berti S, Maritato F, Zoli S
Istituto di Patologia Chirurgica, Università degli Studi, Genova.
Minerva Chir. 1996 Jul-Aug;51(7-8):573-6.
Adenocarcinoma of the anal glands is a rare slow-growing tumor with a more favorable prognosis compared with colorectal adenocarcinoma, especially if an early diagnosis is established. Clinical symptoms of this disease, often associated with a fistula in ano as in the reported case, include: perianal pain, rectal bleeding and presence of perianal mass. Also perianal Paget's disease may be a not rare association with adenocarcinoma of the anal glands. We believe, therefore, that a histological examination of the resected fistulas in ano should be performed, in searching for the presence of mucinous granules. In addition, it's very important to carry out a careful examination of those patients presenting pruritus ani or eczematous lesions of the anal region. In fact adenocarcinoma of the anal glands may be due to a chronic irritation of the epithelium over a period of years. Radiation therapy and chemotherapy have proved not to provide survival benefit in the treatment of this disease; the same result is obtained with a local excision of the lesion. The only chance for cure, therefore, is early diagnosis followed by radical operation. Miles abdominoperineal resection represents the approach of choice we have adopted for our patient. A radical groin dissection should be carried out only if there are metastases to the inguinal nodes. If necessary, abdomino-perineal resection may be folowed by adjuvant irradiation.
肛门腺腺癌是一种罕见的生长缓慢的肿瘤，与结直肠腺癌相比，预后较好，尤其是在早期诊断的情况下。这种疾病的临床症状，如报道的病例中常与肛瘘相关，包括：肛周疼痛、直肠出血和肛周肿块。肛周佩吉特病也可能与肛门腺腺癌有不罕见的关联。因此，我们认为，应对切除的肛瘘进行组织学检查，以寻找黏液颗粒的存在。此外，对那些出现肛门瘙痒或肛门区域湿疹样病变的患者进行仔细检查非常重要。事实上，肛门腺腺癌可能是由于多年来上皮的慢性刺激所致。放射治疗和化疗已被证明对这种疾病的治疗没有生存益处；局部切除病变也会得到相同的结果。因此，治愈的唯一机会是早期诊断并随后进行根治性手术。腹会阴联合切除术（Miles手术）是我们为患者采用的首选方法。只有在腹股沟淋巴结有转移时才应进行根治性腹股沟清扫术。如有必要，腹会阴联合切除术后可进行辅助放疗。
