Primary anorectal melanoma: a case report

Anorectal melanoma is a rare but highly lethal malignancy. Clinical symptoms are non-specific and treatment is still debated. The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma. A 66-year-old man was admitted in our surgical unit with a 3-month history of pain and rectal bleeding. Rectal examination revealed a tender mass arising from the 5 o'clock position of the anal canal that bled on touch. A provisional diagnosis of rectal polyp was made and it was removed by local excision under general anaesthesia. Histopathologic examination reported it as an anorectal malignant melanoma. The postoperative course was uneventful. Extension staging showed a 15 mm nodule on the left lung. The patient underwent a metastasectomy of the left lung. No adjuvant therapy was given. He died one year later. With this case we want to illustrate that malignant melanoma can be difficult to diagnose, as patients have non-specific symptoms and histology may be misleading. Surgery remains the mainstay of treatment. Wide local excision combined with adjuvant loco-regional radiotherapy should be preferred when technically feasible. Abdominoperineal resection has to be done only in the case of large tumors or when the anal sphincter is involved. Overall 5-year survival is less than 20%. It's correlated to extension of disease regardless of initial surgical therapy

Adenocarcinome sur poche ileo-anale compliquant une maladie de Crohn. a propos d'un cas

We reported a case of patient born in 1967 who has been operated on in 1987 on three years after the beginning of ulcerative colitis which became severe and resistant to the medical treatment. A total colectomy with an ileo-rectal anastomosis had been performed. The pathological diagnosis carried of the specimen was Ulcerative colitis. Then a proctectomy. followed by ileo-anal anastomosis, was performed in 1993. After several episodes of pochitis and the appearance of intestinal lesions upstream the ileal pocket, the retained diagnosis was Crohns colitis. Eight years after the ileo-anal anastomosis, the patient developed an adenocarcinoma in the ileal pocket. He has been operated on in 2002 and he had abdominoperineal resection, radiotherapy and chemotherapy. He died in January 2003. The death was related to the recurrence of malignancy. Endoscopic controls with biopsies are mandatory doing to follow up dysplasia predictive of degeneration