Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Early-stage Squamous Cell Carcinoma of the Anal Canal Diagnosed by Endoscopic Mucosal Resection

내시경 점막절제술로 진단한 조기 항문관 편평세포암 1예

  • Kim, Soo-Woong (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Cha, Jae-Myung (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Lee, Joung-Il (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Joo, Kwang-Ro (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Jung, Sung-Won (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Shin, Hyun-Phil (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Suh, Yu-Jin (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University) ;
  • Lim, Jun-Uk (Department of Internal Medicine, East-West Neo Medical Center, College of Medicine, Kyung Hee University)
  • 김수웅 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 차재명 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 이정일 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 주광로 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 정성원 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 신현필 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 서유진 (경희대학교 의과대학 동서신의학병원 소화기내과학교실) ;
  • 임준욱 (경희대학교 의과대학 동서신의학병원 소화기내과학교실)
  • Received : 2009.11.13
  • Accepted : 2010.04.07
  • Published : 2010.05.30
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Abstract

In the past, abdominoperineal resection was routinely performed for anal canal cancer, yet it is now known that squamous cell carcinoma of the anal canal has a favorable prognosis and it rarely requires radical surgery. Furthermore, T1 anal cancer, which represents about 10% of all anal canal cancers, has an excellent prognosis. Endoscopic mucosal resection (EMR), which has been used for removal of early-stage adenocarcinoma of the rectum, has not been reported as a treatment option for squamous cell carcinoma of the anal canal because making the endoscopic diagnosis of early-stage anal canal cancer is very difficult. We have experienced a case of early-stage squamous cell carcinoma of the anal canal that was identified without symptoms during routine screening colonoscopy and it was removed by EMR. As far as we know, it is the first case of early-stage anal canal cancer that was diagnosed and treated by endoscopic mucosal resection.

과거에는 항문관암에 대해 복회음절제술이 주로 시행되었지만, 현재는 항문관 편평세포암은 예후가 양호하며 광범위 수술을 거의 필요로 하지 않는다. 더욱이, 전체 항문관암의 약 10%를 차지하고 있는 T1 병기의 항문관암은 예후가 매우 우수하다. 조기 항문관암을 내시경으로 진단하는 것이 매우 어렵기 때문에, 조기 직장암의 치료에 사용되어 온 내시경 점막절제술이 항문관 편평세포암의 치료 방법으로 보고된 바는 없었다. 저자들은 특별한 증상 없이 대장내시경 선별 검사 도중 발견하고 내시경 점막절제술로 절제한 항문관의 조기 편평세포암 증례를 경험하여 이를 보고한다. 저자들이 아는 바, 이번 증례는 내시경 점막절제술로 진단하고 치료한 최초의 조기 항문관 편평세포암 증례이다.

Keywords

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249. https://doi.org/10.3322/caac.20006
  2. Pintor MP, Northover JM, Nicholls RJ. Squamous cell carcinoma of the anus at one hospital from 1948 to 1984. Br J Surg 1989;76:806-810. https://doi.org/10.1002/bjs.1800760814
  3. Greenall MJ, Quan SH, Stearns MW, Urmacher C, DeCosse JJ. Epidermoid cancer of the anal margin. Pathologic features, treatment, and clinical results. Am J Surg 1985;149:95-101. https://doi.org/10.1016/S0002-9610(85)80016-7
  4. Ortholan C, Ramaioli A, Peiffert D, et al. Anal canal carcinoma: early-stage tumors ＜ or =10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys 2005;62:479-485. https://doi.org/10.1016/j.ijrobp.2004.09.060
  5. Williams GT, Blackshaw AJ, Morson BC. Squamous carcinoma of the colorectum and its genesis. J Pathol 1979;129:139-147. https://doi.org/10.1002/path.1711290306
  6. Dyson T, Draganov PV. Squamous cell cancer of the rectum. World J Gastroenterol 2009;15:4380-4386. https://doi.org/10.3748/wjg.15.4380
  7. Nahas CS, Shia J, Joseph R, et al. Squamous-cell carcinoma of the rectum: a rare but curable tumor. Dis Colon Rectum 2007;50:1393-1400. https://doi.org/10.1007/s10350-007-0256-z
  8. Petrelli NJ, Shaw N, Bhargava A, et al. Squamous cell carcinoma antigen as a marker for squamous cell carcinoma of the anal canal. J Clin Oncol 1988;6:782-785.
  9. Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum-report of six patients and literature review. Colorectal Dis 2009;11:191-197. https://doi.org/10.1111/j.1463-1318.2008.01560.x
  10. Wade DS, Herrera L, Castillo NB, Petrelli NJ. Metastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique. Surg Gynecol Obstet 1989;169:238-242.
  11. Cotter SE, Grigsby PW, Siegel BA, et al. FDG-PET/CT in the evaluation of anal carcinoma. Int J Radiat Oncol Biol Phys 2006;65:720-725. https://doi.org/10.1016/j.ijrobp.2006.01.009
  12. Winton E, Heriot AG, Ng M, et al. The impact of 18-fluorodeoxyglucose positron emission tomography on the staging, management and outcome of anal cancer. Br J Gancer 2009;100:693-700. https://doi.org/10.1038/sj.bjc.6604897
  13. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology available at http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed February 28, 2010).
  14. Chou YP, Saito Y, Matsuda T, et al. Novel diagnostic methods for early-stage squamous cell carcinoma of the anal canal successfully resected by endoscopic submucosal dissection. Endoscopy 2009;41(suppl 2):E283-E285.