Table of Contents
1
UI - 11319973
AU - Arany I; Muldrow M; Tyring SK
TI -
The endogenous interferon system in anal squamous epithelial lesions
with different grades from HIV-positive individuals.
SO - Int J STD AIDS 2001 Apr;12(4):229-33
AD - Department of Microbiology, The University of Texas Medical Branch,
Galveston, TX 77555-1070, USA. iarany@utmb.edu
Anal intraepithelial lesions (ASILs) are considered as precursors of
anal cancer. The incidence of high-grade ASIL (HSIL) and progression of
low-grade ASIL (LSIL) to HSIL are high in HIV-positive men. Endogenous
cytokines, such as interferons (IFNs) play an important role in the
regulation of proliferation and immune responses in epithelial cells,
and thus, they might control the above-mentioned progression events.
Accordingly, we determined mRNA levels of IFN-gamma and IFN-gamma
receptors, levels of IFN-gamma receptor-associated kinases (JAK1 and
TYK2) and signalling molecules (signal transducer and activator of
transcription-1 [STAT1], STAT3, interferon-responsive-factor-1 [IRF-1]
and IRF-2) as well as inhibitors of cytokine signalling (protein
inhibitor of activated STAT1 [PIAS1] and suppressor of cytokine
signalling 2 [SOCS2]) in biopsies of anal condylomas, LSILs as well as
HSILs from HIV-positive individuals by a semi-quantitative reverse
transcribed polymerase chain reaction (RT-PCR) method. We found that
HSIL significantly differs in expression of these genes from LSIL and
condylomas. Expression profile of HSIL samples showed activation of
STAT3 signalling, probably accounting for the observed high levels of
genes that support cellular proliferation (IRF-2, c-fos and c-myc).
Decreases in levels of suppressors (IFN-gamma and IRF-1) and JAK1
kinase, but increases in levels of inhibitors of cytokine signalling
(PIAS1 and SOCS2) might also contribute to the altered cytokine
signalling in HSIL biopsies. These findings might reveal important
molecular events associated with progression of LSIL to HSIL in
HIV-infected men.
2
UI - 11370496
AU - Chawla AK; Willett CG
TI -
Squamous cell carcinoma of the anal canal and anal margin.
SO - Hematol Oncol Clin North Am 2001 Apr;15(2):321-44, vi
AD - Department of Radiation Oncology, Massachusetts General Hospital,
Harvard Medical School, Boston, Massachusetts, USA.
Squamous cell carcinomas of the anal canal and margin are relatively
uncommon neoplasms of the distal gastrointestinal tract and surrounding
skin. The major risk factors for tumor development have been defined
through various epidemiologic studies. Randomized, phase III trials have
defined the standard of care for anal cancer tumors to be a combined
modality approach of radiation therapy and chemotherapy. This
nonsurgical, organ-sparing regimen results in good anal sphincter
function in the majority of patients, and treatment efficacy is
favorable when compared with historic surgical series. Anal margin
tumors are staged and treated as skin cancers, with a more favorable
prognosis.
3
UI - 11480798
AU - Kondo R; Hanamura N; Kobayashi M; Seki T; Adachi W; Ishii K
TI -
Mucoepidermoid carcinoma of the anal canal: an immunohistochemical
study.
SO - J Gastroenterol 2001 Jul;36(7):508-14
AD - Second Department of Surgery, Shinshu University School of Medicine,
Matsumoto, Japan.
We present a case of mucoepidermoid carcinoma of the anal canal, with
special reference to immunohistochemical analysis of the tumor to
clarify its histogenesis. A 36-year-old man underwent surgery for
mucoepidermoid carcinoma of the anal canal. Immunohistochemical analysis
of the resected specimen was performed. Serial sections were stained
immunohistochemically by the labeled streptavidin-biotin peroxidase
method for various antigens, including epithelial membrane antigen
(EMA); carcinoembryonic antigen (CEA); different types of cytokeratins,
including CK10 and CAM 5.2; and p53 oncoprotein. The solid component of
the tumor cells was immunohistochemically positive for EMA, CEA, and CAM
5.2, but negative for CK10. These staining patterns were different from
those of anal squamous epithelium. These results confirm that
mucoepidermoid carcinoma of the anus may arise from the anal
transitional zone, and that it is biologically different from squamous
cell carcinoma of the anus.
4
UI - 11484975
AU - Indinnimeo M; Cicchini C; Stazi A; Ghini C; Mingazzini P; Laghi A
TI -
Analysis of a follow-up program for anal canal carcinoma.
SO - J Exp Clin Cancer Res 2001 Jun;20(2):199-203
AD - Dept. of Surgery Pietro Valdoni, University of Rome La Sapienza, Italy.
The ideal follow-up program for anal canal cancer remains unclear and
controversial. We hereby describe an extensive follow-up program for
anal canal carcinoma in order to evaluate which examinations and which
diagnostic techniques really had impact on survival and management. We
evaluated 25 patients with anal canal carcinoma. Local excision (LE) was
performed in 5 patients, radiochemotherapy (RCT) in 13,
radiochemotherapy and local excision (RCTE) in 7. Mean follow-up time
was 6.3 years (range 20 months-11 years). The follow-up program included
clinical examination, serum tumor markers evaluation, transrectal
ultrasonography (TRUS), anoscopy with either mucosal or by Tru-cut
needle multiple biopsies, standard chest X-ray and hepatic-inguinal
ultrasonography, endoanal magnetic resonance imaging and in some cases
total-body skeletal scintigraphy. A large multicentered randomized and
prospective trial is surely lacking and should be undertaken as soon as
possible. Our results suggest that an effective local control, rather
than a higher survival is the reachable goal at present for anal canal
carcinomas. However, further steps should be made to achieve better
results. After this experience we propose a more semplified follow-up
protocol which consists in performing only rectal examination,
endoscopy, Tru-cut needle biopsies and TRUS for local control and
inguinal ultrasound and TC to evidence distant metastases.
5
UI - 11695329
AU - Cheonis N
TI -
Anal neoplasia: a growing concern.
SO - BETA 2001 Winter;13(4):31-41
6
UI - 11582966
AU - Guimaraes AP; Matos D; Segreto R; Forones NM
TI -
[Squamous cell carcinoma of the canal anal]
SO - Arq Gastroenterol 2001 Jan-Mar;38(1):9-13
AD - Universidade Federal de Sao Paulo, UNIFESP-EPM, Sao Paulo, SP.
BACKGROUND: Anal cancer is an uncommon malignancy accounting for only a
small (4%) percentage of intestinal cancer. The authors described the
clinical aspects and the treatment of the patients with squamous cell
carcinoma of the canal anal. PATIENTS: Eleven patients with squamous
cell carcinoma treated among 1995 and 1999, were analyzed
retrospectively. Nine were women and two were men. The mean age was 57.6
years old (range 35-82 years old). RESULTS: The most common symptoms
were rectal bleeding, local tumor and pain. Six of them had previous
anal benign disease and two had metastases at the diagnosis. All were
submitted to systemic chemotherapy with 5-fluorouracil and mitomycin and
radiotherapy with 4500 cGy. Four patients had residual disease after
chemo radiation and salvage surgery with abdominoperineal resection was
done. Three patients had recurrence and four died from the disease.
CONCLUSION: Most of our patients were women. The chemo radiation can be
a curable treatment in patients with local disease; conversely in
patients with residual disease, abdominoperineal resection must be done.
Although anal cancer is an often curable disease, four patients died
because the diagnosis was done in advanced stage.
7
UI - 11588559
AU - Thornton SC; Hirshorn SA; Bradway M; Levien D
TI -
Correct visualization of the anal ring.
SO - J Clin Gastroenterol 2001 Oct;33(4):346
8
UI - 11578724
AU - Myerson RJ; Kong F; Birnbaum EH; Fleshman JW; Kodner IJ; Picus J; Ratkin
TI -
GA; Read TE; Walz BJ
Radiation therapy for epidermoid carcinoma of the anal canal, clinical
and treatment factors associated with outcome.
SO - Radiother Oncol 2001 Oct;61(1):15-22
AD - Radiation Oncology Center, Mallinckrodt Institute of Radiology,
Washington University School of Medicine, St. Louis, MO 63110, USA.
BACKGROUND AND PURPOSE: In recent years, treatment with combined
chemotherapy and radiation has become the standard of care for
epidermoid carcinoma of the anus. However, optimal radiotherapy
techniques and doses are not well established. MATERIALS AND METHODS:
During the period 1975-1997, 106 patients with epidermoid carcinoma of
the anal canal underwent radiation therapy. Treatment policies evolved
from radiation therapy alone or with surgery, to combined chemotherapy
and radiation followed by surgery, to combined chemotherapy and
radiation. RESULTS: Overall 74% of patients were NED (no evidence of
disease) at last follow-up. The most important clinical correlate with
ultimate freedom from disease (includes the contribution of salvage
surgery) was extent of disease. The 5-year ultimate freedom from disease
was 87+/-5% for T1/T2N0, 78+/-10% for T3N0 (15% salvaged by surgery),
and 43+/-10% for either T4N0 or any N+ lesions (P<0.001, Tarone-Ware).
There was no difference between planned vs. expectant surgery (5-year
ultimate NED: 67+/-11% planned surgery vs. 73+/-5% expectant surgery).
The most important correlate with late toxicity was a history of major
pelvic surgery (surgical vs. non-surgical group: P=0.013, Fisher's exact
test, two-tailed summation). Thirty-three additional malignancies have
been seen in 26 patients. The most common additional malignancies were
gynecologic (nine cases), head and neck (six cases), and lung cancer
(five cases). CONCLUSIONS: For T1/T2N0 disease, moderate doses of
radiation combined with chemotherapy provided adequate treatment. T4N0
and N+ lesions are the most appropriate candidates for investigational
protocols evaluating dose intensification. T3N0 tumors may also be
appropriate for investigation; however, dose intensification may
ultimately prove counterproductive if the cure rate is not improved and
salvage surgery is rendered more difficult. The volume of irradiated
small bowel should be minimized for patients who have a past history of
major pelvic surgery or who (because of locally advanced tumors) may
need salvage surgery in the future. Because of the occurrence of
additional malignancy, patients with anal cancer should receive general
oncologic screening in long-term follow-up.
9
UI - 11588276
AU - Martin F; Bower M
TI -
Anal intraepithelial neoplasia in HIV positive people.
SO - Sex Transm Infect 2001 Oct;77(5):327-31
AD - Department of Oncology, Chelsea and Westminster Hospital, Fulham Road,
London SW10 9NH, UK.
OBJECTIVE: To review the current literature on HIV associated anal
intraepithelial neoplasia (AIN). METHODS: A comprehensive Medline/Pubmed
search was performed for the years 1980-2001 (January) for articles
pertaining to HIV associated anal intraepithelial neoplasia. From the
MeSH terms "anal intraepithelial neoplasia" and "anal cancer" the
following subheadings were used: HIV, homosexual men, HPV, Epidemiology,
Etiology, Mortality, Diagnosis, Screening, Drug Therapy, Surgical
Therapy, Radio Therapy, Risk factors, ASIL. The search was limited to
"human" for all searches. In the absence of enough "randomised
controlled trials" the search was extended to clinical trials, reviews,
and case reports. One analysis on cost effectiveness and two abstracts
presented at 12th World AIDS Conference and 6th Conference on Retrovirus
and Opportunistic Infections were included. The 44 publications referred
to originate from the United Kingdom (9), the United States (26), and
Denmark (5), with one each from Switzerland, Germany, Australia, and
France. The Cochrane Database of systematic reviews yielded 11 complete
reviews for "anal cancer" and none for "anal intraepithelial neoplasia."
The textbook of AIDS-related cancers and their treatment was consulted.
We also included our personal experience from the treatment of patients
at the Chelsea and Westminster Hospital, one of the largest centres for
the management of HIV disease in Europe. CONCLUSION: Routine anal
cytological screening followed by appropriate management of AIN is an
important issue for HIV infected patients. The natural history of AIN
has not been fully established and this prevents clinicians from
defining clear management protocols. There is early evidence that the
benefits of highly active antiretroviral therapy (HAART) in terms of
restoring immune function and reducing opportunistic infections and some
neoplasms may not extend to regression of AIN. Under these circumstances
it might be predicted that AIN and subsequent progression to invasive
anal cancer would rise as HAART prolongs the lives of seropositive
people. However, routine anal cytological screening will surely have to
await an effective proved intervention for AIN and this would seem to be
a pressing clinical goal.
10
UI - 11596018
AU - Hobbs CM; Lowry MA; Owen D; Sobin LH
TI -
Anal gland carcinoma.
SO - Cancer 2001 Oct 15;92(8):2045-9
AD - Department of Hepatic and Gastrointestinal Pathology, Armed Forces
Institute of Pathology, Washington, DC 20306-6000, USA.
BACKGROUND: Anal gland carcinoma is a rare entity. The authors conducted
a joint study of cases coded as definite or possible anal gland
carcinoma from the archives of the Armed Forces Institute of Pathology
and the Canadian Reference Center for Cancer Pathology. METHODS: Seven
cases of potential anal gland carcinoma were identified from the
Canadian files and 12 from the Armed Forces Institute of Pathology
archives. Of these 19 cases, 14 had adequate material to allow clinical,
histologic, and immunohistochemical analysis. RESULTS: Seven of these 14
cases met a modified World Health Organization (WHO) definition of anal
gland carcinoma. The mean age of these patients was 66 years (range,
60-72 years), with a male-to-female ratio of 6:1. The tumors were
composed of haphazardly dispersed, small glands with scant mucin
production that invaded the wall of the anorectal area with no obvious
intraluminal component observed clinically or microscopically.
Immunohistochemical studies were performed on all seven of these cases,
revealing cytokeratin (CK) 7+/CK 20- expression in six cases, and CK
7+/CK 20+ expression in one case. The remaining seven cases showed no
intraluminal component but did not meet a modified WHO definition of
anal gland carcinoma. This group included three mucinous adenocarcinomas
(two clinically arising in anal fistulas), all of which were CK 7+/CK
20+, and a rectal-type adenocarcinoma that was CK 7-/CK 20+. There was
also a tumor interpreted as probable rectal-type adenocarcinoma that was
CK 7+/CK 20+, and a tumor interpreted as probable squamous cell
carcinoma that was CK 7-/CK 20-. The seventh tumor in this group, which
could not be classified, was CK 7+/CK 20-. CONCLUSIONS: A useful and
discriminating definition of anal gland carcinoma is an anal canal tumor
composed of haphazardly dispersed, small glands with scant mucin
production invading the wall of the anorectal area without an
intraluminal component. The glands are positive for CK 7. Copyright 2001
American Cancer Society.
11
UI - 11688571
AU - Miettinen M; Furlong M; Sarlomo-Rikala M; Burke A; Sobin LH; Lasota J
TI -
Gastrointestinal stromal tumors, intramural leiomyomas, and
leiomyosarcomas in the rectum and anus: a clinicopathologic,
immunohistochemical, and molecular genetic study of 144 cases.
SO - Am J Surg Pathol 2001 Sep;25(9):1121-33
AD - Department of Soft Tissue Pathology, Armed Forces Institute of
Pathology, Washington, DC 20306-6000, USA. miettinen@afip.osd.mil
Gastrointestinal stromal tumors (GISTs), the specific KIT-positive
mesenchymal tumors of the gastrointestinal tract, have been sporadically
reported in the rectum, but there are few clinicopathologic series. In
this study we analyzed the clinicopathologic features of 133 anorectal
GISTs, 3 intramural leiomyomas (LMs), and 8 leiomyosarcomas (LMSs) from
the files of the Armed Forces Institute of Pathology and the Haartman
Institute of the University of Helsinki. Ninety-six GISTs were
documented as KIT-positive and three additional ones as CD34-positive.
Thirty-four tumors were included by their histologic similarity to KIT-
or CD34-positive cases. GIST-specific c-kit gene mutations, mostly in
exon 11, were documented in 18 of 29 cases (62%). The GISTs occurred in
adults with the age range of 17-90 years (median 60 years) with a
significant male predominance (71%). The tumors ranged from small
asymptomatic intramural nodules to large masses that bulged into pelvis
causing pain, rectal bleeding, or obstruction. They were mostly highly
cellular spindle cell tumors; four tumors had an epithelioid morphology.
The tumors coexpressed CD34 and KIT and were rarely positive for smooth
muscle actin or desmin and never for S-100 protein. Seventy percent of
patients with tumors >5 cm with more than 5 mitoses/50 high power fields
(HPF) (n = 31) died of disease, whereas only one tumor <2 cm with <5
mitoses/50 HPF (n = 21) recurred and none caused death. Long latency was
common between primary operation and recurrences and metastases; either
one occurred in 60 of 111 patients with follow-up (54%). Distant
metastases were in the liver, bones, and lungs. Three benign actin- and
desmin-positive and KIT-negative intramural LMs, similar to those seen
in the esophagus, were identified. There were eight LMSs, six of which
formed a polypoid intraluminal mass and were actin-positive and
KIT-negative. Despite high mitotic counts, only one LMS patient died of
disease. A great majority of rectal smooth muscle and stromal tumors are
GISTs, which have a spectrum from minimal indolent tumors to overt
sarcomas. Intramural LMs are exceptional, and true LMSs are rare, and
similar to colonic ones, often present as intraluminal polypoid masses
that appear to have a better prognosis than GISTs with similar mitotic
rates.
12
UI - 11706558
AU - Ishii S; Han S; Shiiba K; Mizoi T; Okabe M; Horii A; Nagura H; Matsuno
TI -
S; Sasaki I
Allelic loss of the NF1 gene in anal malignant melanoma in a patient
with neurofibromatosis type 1.
SO - Int J Clin Oncol 2001 Aug;6(4):201-4
AD - Division of Biological Regulation and Oncology, Department of Surgery,
Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku,
Sendai 980-8574, Japan. s.ishii@surg1.med.tohoku.ac.jp
A 64-year-old man with neurofibromatosis type 1 (NF1) developed a
primary malignant melanoma of the anus. Genetic analysis of the resected
tumor confirmed loss of heterozygosity (LOH) of the NF1 gene. Anorectal
malignant melanoma in NF1 is extremely rare, and genetic studies of the
NF1 gene in such patients have not been reported. The allelic loss
detected in the present patient supports the previously raised idea that
NF1 can function as a tumor suppressor gene in the development of
malignant melanoma in patients with NF1.
13
UI - 11711729
AU - Remzi FH; Church JM; Bast J; Lavery IC; Strong SA; Hull TL; Harris GJ;
TI -
Delaney CP; O'Riordain MG; McGannon EA; Fazio VW
Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with
familial adenomatous polyposis: functional outcome and neoplasia
control.
SO - Dis Colon Rectum 2001 Nov;44(11):1590-6
AD - Department of Colorectal Surgery, Cleveland Clinic Foundation,
Cleveland, Ohio 44195, USA.
PURPOSE: The tradeoff of neoplasia control for better function
represented by a stapled ileal pouch-anal anastomosis is still
controversial in patients with familial adenomatous polyposis. We
compared outcomes after mucosectomy and hand-sewn ileal pouch-anal
anastomosis with those after stapled ileal pouch-anal anastomosis in 119
patients with familial adenomatous polyposis who underwent surgery since
1983. METHODS: Age, gender, length of follow-up, complications, quality
of life, incontinence, urgency, nighttime and daytime seepage, pad
usage, necessity of ileostomy, and incidence of adenomas developing in
pouch and anal transitional zone were recorded. RESULTS: There were 42
mucosectomy and 77 stapled patients who were followed up for an average
of 5.8 and 3.6 years, respectively, with endoscopic surveillance. There
was one postoperative death in the stapled group that prohibited
long-term follow-up. Nine of 42 mucosectomy patients developed pouch
adenomas vs. 8 of 76 in the stapled group. Six of 42 patients developed
adenomas in the mucosectomized anal transitional zone in the mucosectomy
group. Twenty-one of 76 patients developed adenomas in the anal
transitional zone in the stapled group. All were managed with local
procedures or further surveillance. One of 76 patients developed cancer
in the residual low rectum; this required further resection. Patients
with stapled anastomosis had better outcomes in every category.
Differences in incontinence, daytime and nighttime seepage, pad usage,
and avoidance of ileostomy were statistically significant. All patients
with mucosectomy required ileostomy vs. only 40 of 77 patients with
stapled anastomosis. CONCLUSION: Familial adenomatous polyposis patients
with stapled ileal pouch-anal anastomosis have better functional outcome
and can avoid temporary diversion. This should be balanced against a 28
percent incidence of adenomas in the anal transitional zone.
14
UI - 11730221
AU - Winburn GB
TI -
Anal carcinoma or "just hemorrhoids"?
SO - Am Surg 2001 Nov;67(11):1048-58
AD - Department of Surgery, Medical College of Georgia Hospital and Clinics,
Augusta 30912-4004, USA.
Cancers of the anal margin and anal canal are extremely rare and often
misdiagnosed. Only one to two per cent of large bowel cancers arise in
this area. Current management of these cancers includes surgery,
50 patients were diagnosed with anal cancer at two institutions. This
retrospective review includes all available cases of anal cancer
including all histologies. Patient charts were analyzed for diagnosis,
staging, treatment, survival, and recurrence rate. The patients ranged
in age from 27 to 92 years (median age 51 years; mean age 52.8 years);
there were 22 men and 28 women. The pathologic diagnosis included 44
(88%) with squamous cell carcinoma, three (6%) with melanoma, two (4%)
with adenocarcinoma, and one (2%) with Paget's disease. At presentation
nine (18%) were classified as stage 0, five (10%) stage I, 21 (42%)
stage II, eight (16%) stage III, and seven (14%) stage IV. Mean
follow-up data were available on 100 per cent of the patients.
Chemoradiotherapy was the primary treatment modality in 25 patients
(50%). Ten patients (20%) underwent abdominoperineal resection (APR) in
the study. Three patients (6%) received an APR as primary treatment,
three (6%) in combination with chemoradiation, and four (8%) for salvage
therapy. Fourteen patients (28%) underwent wide local excision (WLE) as
the primary treatment. Two patients (4%) underwent WLE plus
chemoradiation therapy. One patient (2%) underwent WLE and chemotherapy.
There were 18 deaths (36%) in this series. Thirteen patients (26%) died
of anal cancer; the average time to death from diagnosis was 13.2
months. Three of these deaths were in patients with melanoma who
presented with stage IV disease. Thirty-two patients (64%) are alive,
and 30 (60%) of these patients are free of disease (mean time since
diagnosis 32.5 months, range 2-151 months). Six patients (12%) had
recurrence after treatment (mean time to recurrence 12.6 months; range
3-26 months). Anal cancers continue to present at an advanced stage,
with a high mortality rate. Anal melanoma in particular is an aggressive
and highly fatal cancer. APR remains the recommended salvage therapy for
advanced anal carcinomas that fail primary treatment. In our series only
one of four patients has had a disease-free survival of 4 months. Early
recognition and detection of primary and recurrent disease is necessary
for improved outcome.
15
UI - 11764880
AU - Kotlarewsky M; Freeman JB; Cameron W; Grimard LJ
TI -
Anal intraepithelial dysplasia and squamous carcinoma in
immunosuppressed patients.
SO - Can J Surg 2001 Dec;44(6):450-4
AD - Division of General Surgery, The Ottawa Hospital, Ont.
OBJECTIVE: To describe a treatment and follow-up protocol for HIV
patients with anal dysplasia or warts, which are at risk of malignant
change. DESIGN: An ongoing study of highly selected patients referred to
a single surgeon. SETTING: The Colorectal and HIV/AIDS Clinics,
University of Ottawa, General Campus. PATIENTS: Ninteen young men who
presented with suspicious anal lesions and were referred to the
Colorectal Clinic by the HIV/AIDS Clinic, which sees approximately 800
patients per year. OUTCOME MEASURE: Significance of dysplasia or
carcinoma. RESULTS: Of the 19 patients, 14 had dysplasia,
carcinoma-in-situ or invasive carcinoma. All were treated with multiple
mapped cold biopsies and local or wide excision as indicated. Two
patients with invasive carcinoma received radiotherapy or chemotherapy,
or both. CONCLUSIONS: The incidence of dysplasia or the sequence by
which dysplasia progresses to invasive carcinoma is unknown.
Surveillance of HIV patients, especially those with nodules or warts, by
flexible sigmoidoscopy and Papanicolaou smears every 3 to 12 months is
recommended, depending on the severity of the anal lesion.
16
UI - 11722509
AU - Levine TS; Rolfe KJ; Crow J; Styles S; Perrett CW; Maclean AB; Reid WM
TI -
The use of cytospin monolayer technique in the cytological diagnosis of
vulval and anal disease.
SO - Cytopathology 2001 Oct;12(5):297-305
AD - Department of Histopathology and Cytopathology, The Royal Free Hospital
NHS Trust, London, UK. Tanya.Levine@rfh.nthames.nhs.uk
This pilot study investigated the use of the non-invasive cytospin
monolayer technique in the diagnosis and screening of neoplastic and
non-neoplastic vulval disease. Twenty-three patients (age range 34-86
years) attending a vulval disease clinic had brush cytology performed.
The samples were prepared with a cytospin monolayer technique and the
slides Papanicolaou-stained. Subsequent cytological interpretation and
diagnosis were performed without knowledge of the clinical history and
correlated with follow-up biopsy histopathology from each patient.
Twenty-eight cytospin samples were analysed in total, of which 11 (39%)
contained dyskaryotic cells which were assessed and a predicted VIN/AIN
grade given. Ten of 11 samples (91%) reported as dyskaryotic had VIN/AIN
on biopsy histology. One of 11 samples (9%) was reported as containing
occasional squamous cells with borderline nuclear features and, although
the corresponding biopsy did not show VIN, basal atypia was reported.
One patient had features suggesting invasive carcinoma on cytology which
was verified on subsequent biopsy. The 15 cases in which no dyskaryotic
cells were identified did not show VIN or AIN on subsequent histology.
Two cases were acellular and considered inadequate for cytological
interpretation. The cytospin monolayer technique allows the diagnosis of
neoplastic from non-neoplastic vulval disease. It is a quick,
inexpensive and non-invasive method that may have a role in diagnosis,
screening and surveillance of patients.
17
UI - 11745194
AU - Damascelli B; Cantu G; Mattavelli F; Tamplenizza P; Bidoli P; Leo E;
TI -
Dosio F; Cerrotta AM; Di Tolla G; Frigerio LF; Garbagnati F; Lanocita R;
Marchiano A; Patelli G; Spreafico C; Ticha V; Vespro V; Zunino F
Intraarterial chemotherapy with polyoxyethylated castor oil free
paclitaxel, incorporated in albumin nanoparticles (ABI-007): Phase II
study of patients with squamous cell carcinoma of the head and neck and
anal canal: preliminary evidence of clinical activity.
SO - Cancer 2001 Nov 15;92(10):2592-602
AD - Department of Radiology, Istituto Nazionale Tumori, Milano, Italy.
damascelli@istitutotumori.mi.it
BACKGROUND: This study was designed to determine the feasibility,
maximum tolerated dose, and toxicities of intraarterial administration
of paclitaxel-albumin nanoparticles in patients with advanced head and
neck and recurrent anal canal squamous cell carcinoma. Antitumor
activity also was assessed. METHODS: Forty-three patients (31 with
advanced head and neck and 12 with recurrent anal canal squamous cell
carcinoma) were treated intraarterially with ABI-007 every 4 weeks for 3
cycles. In total, 120 treatment cycles were completed, 86 in patients
with head and neck carcinoma (median, 3 cycles; range, 1-4) and 34 in
patients with anal canal carcinoma (median, 3 cycles; range, 1-4).
ABI-007 was compared preliminarily with Taxol for in vitro cytostatic
activity. Increasing dose levels from 120 to 300 mg/m2 were studied in
18 patients. Pharmacokinetic profiles after intraarterial administration
were obtained in a restricted number of patients. RESULTS: The
dose-limiting toxicity of ABI-007 was myelosuppression consisting of
Grade 4 neutropenia in 3 patients. Nonhematologic toxicities included
total alopecia (30 patients), gastrointestinal toxicity (3 patients,
Grade 2), skin toxicity (5 patients, Grade 2), neurologic toxicity (4
patients, Grade 2) ocular toxicity (1 patient, Grade 2), flu-like
syndrome (7 patients, Grade 2; 1 patient, Grade 3). In total, 120
transfemoral, percutaneous catheterization procedure-related
complications occurred only during catheterization of the neck vessels
in 3 patients (2 TIA, 1 hemiparesis) and resolved spontaneously.
CONCLUSIONS: Intraarterial administration of ABI-007 by percutaneous
catheterization does not require premedication, is easy and
reproducible, and has acceptable toxicity. The maximum tolerated dose in
a single administration was 270 mg/m2. Most dose levels showed
considerable antitumor activity (42 assessable patients with 80.9%
complete response and partial response). The recommended Phase II dose
is 230 mg/m2 every 3 weeks. Copyright 2001 American Cancer Society.
18
UI - 9069302
AU - Peiffert D; Bey P; Pernot M; Guillemin F; Luporsi E; Hoffstetter S;
TI -
Aletti P; Boissel P; Bigard MA; Dartois D; Baylac F
Conservative treatment by irradiation of epidermoid cancers of the anal
canal: prognostic factors of tumoral control and complications.
SO - Int J Radiat Oncol Biol Phys 1997 Jan 15;37(2):313-24
AD - Radiotherapy Department, Centre Alexis Vautrin, Nancy, France.
We analyzed in a retrospective series of patients treated by
conservative irradiation for an epidermoid cancer of the anal canal
(ECAC) the prognostic factors of locoregional control (LRC), survival,
late severe complications (LSC), and sphincter conservation (SC).
METHODS AND MATERIALS: From 1976 until 1994, 118 patients presenting
with an ECAC were conservatively treated (mean age, 65 years). According
to the 1987 International Union Against Cancer (TNM) classification,
they were: 19 T1, 70 T2, 22 T3, 7 T4, 94 N0, and 24 N1-3. The treatment
started with external beam irradiation (EBI) (36 Gy in 3 weeks or 45 Gy
in 5 weeks). Concomitant chemotherapy (5-fluorouracil and mitomycin C)
was delivered to 31 patients. Two months later, a boost of 20 Gy was
delivered by interstitial 192Ir brachytherapy to 101 patients and EBI in
5. Twelve other patients had an abdominoperineal resection (APR). The
mean follow-up was 6 years. RESULTS: At 5 years the overall survival was
60%, and specific survival (SS) was 75%; it was 94% for T1, 79% for T2,
53% for T3, and 19% for T4. In multivariate analysis, tumor size (> or =
4 cm), node involvement, and no response to the EBI were factors of poor
prognosis for SS. Thirty-two locoregional recurrences occurred of which
21 were local recurrences in the 106 patients treated by a conservative
schedule. Only tumor size and response to the EBI were prognostic
factors on multivariate analysis for local and LRC. A total of 17
patients presented with LSC (Grade 3, 16 patients; and Grade 4, 1
patient), which was treated by APR in 4 patients and colostomy in 11 (of
which 7 were definitive). The only significant prognostic factor for LSC
in the multivariate analysis was the total extrapolated response dose of
irradiation. The definitive rate of SC after conservative treatment in
cured patients was 100% for T1, 82% for T2, 58% for T3, and 100% for T4.
Since 1989, improvements of the technique have allowed reduction of the
LSC in maintaining the same local control. CONCLUSION: The results of
this series are similar to those of the literature. The confirmation of
pretherapeutic prognostic factors related to response to the treatment
should allow us to adapt the therapeutic intensity for each case to
obtain better tumor control, with as few sequelae as possible, to yield
a better rate of SC.
19
UI - 10613313
AU - Joon DL; Chao MW; Ngan SY; Joon ML; Guiney MJ
TI -
Primary adenocarcinoma of the anus: a retrospective analysis.
SO - Int J Radiat Oncol Biol Phys 1999 Dec 1;45(5):1199-205
AD - Department of Radiation Oncology, Peter MacCallum Cancer Institute,
Melbourne, Victoria, Australia. dlimj@petermac.unimelb.edu.au
PURPOSE: To report the clinical features and outcome of patients with
primary adenocarcinoma of the anus following radiotherapy with or
without chemotherapy. METHODS AND MATERIALS: A retrospective analysis
was performed on 15 patients referred to Peter MacCallum Cancer
Institute between 1981 to 1998 with primary adenocarcinoma of the anus.
The median follow-up was 7.5 years. Six patients underwent treatment
with curative intent-either chemoradiation or radiotherapy alone.
Surgery was mainly limited to either incisional or excisional biopsy.
The remaining nine patients were treated with palliative intent because
of advanced age, advanced disease, or poor medical status. The
biological equivalent doses were calculated for all patients and
correlated with time to progression. RESULTS: None of the curative group
had relapsed after a median follow-up of 6.6 years. All except one were
alive and well. No patient developed any serious long-term toxicity and
all patients avoided colostomy. All patients managed with palliative
intent died with persistent locoregional disease with a median survival
of 0.8 year. CONCLUSION: Primary adenocarcinoma of the anus is a very
rare disease that precludes a rigorous analysis. This study demonstrates
that radiation and in particular chemoradiation are effective therapies
consistent with other recent series and analogous to squamous cell
carcinomas of the anus. It also emphasizes the poor prognosis of
patients treated with palliative intent.
20
UI - 11293433
AU - Wolff P; Peiffert D
TI -
In regard to Joon et al. IJROBP 1999;45:1199-1205.
SO - Int J Radiat Oncol Biol Phys 2001 Apr 1;49(5):1517
21
UI - 11523931
AU - Jaworski RC; Biankin SA; Baird PJ
TI -
Squamous cell carcinoma in situ arising in inflammatory cloacogenic
polyps: report of two cases with PCR analysis for HPV DNA.
SO - Pathology 2001 Aug;33(3):312-4
AD - Department of Tissue Pathology, Institute of Clinical Pathology and
Medical Research, Westmead Hospital, New South Wales, Australia.
Inflammatory cloacogenic polyp (ICP) is regarded as part of the spectrum
of pathological changes encountered in mucosal prolapse syndrome
(MPS)/solitary rectal ulcer. We present the clinicopathological features
of two females with squamous cell carcinoma in situ arising in their
ICPs. Human papillomavirus (HPV) type 16 was demonstrated in the areas
of squamous carcinoma in situ in both polyps by polymerase chain
reaction. These cases highlight the need for close scrutiny of the
squamous components of these lesions.
22
UI - 11669560
AU - Grifaichi F; Padovani A; Romeo F; Trinca C; Moscetti L; Cortesi E
TI -
Response of metastatic epidermoid anal cancer to single agent
irinotecan: a case report.
SO - Tumori 2001 Jan-Feb;87(1):58-9
AD - Department of Experimental Medicine, University La Sapienza, Policlinico
Umberto I, Rome, Italy.
We report a case of a patient affected by epidermoid anal cancer who had
hepatic progression after standard therapy with the Nigro regimen
(fluorouracil and mitomycin C plus radiotherapy). This is an uncommon
neoplasm against which only few chemotherapeutic agents have been
tested. In our patient salvage treatment with low dose irinotecan
resulted in a partial response.
23
UI - 11787851
AU - Behrendt GC; Hansmann ML
TI -
Carcinomas of the anal canal and anal margin differ in their expression
of cadherin, cytokeratins and p53.
SO - Virchows Arch 2001 Dec;439(6):782-6
AD - Department of Histopathology, University College London, UK.
Gabriele@behrendt.fsnet.co.uk
Carcinomas of the anus are subdivided into those of the anal canal and
those of the anal margin. It has been postulated that the various types
of tumours of the anal canal represent a spectrum of differentiation
rather than tumours of a separate origin. We compared the expression of
Pan-cadherin, cytokeratins (CKs) 5/6, 7, 13, 18 and 19, p53 and MIB-1 in
17 cases of carcinoma of the anal canal and 5 cases of carcinoma of the
anal margin. Expression of Pan-cadherin was decreased in 70% of
carcinomas of the anal canal but preserved in all five carcinomas of the
anal margin. Most of the carcinomas of the anal canal expressed all of
the CKs studied. Carcinomas of the anal margin showed expression of CK
5/6 and CK 13, whereas CK7, CK18 and CK19 were rarely expressed. Loss of
expression of CK 18 and 19, but not CK 7, is a marker of
dedifferentiation in anal canal carcinoma. Of the carcinomas of the anal
canal and anal margin, 46% and 80%, respectively, expressed p53. The
immunhistochemical findings support the opinion that the various
subtypes of carcinoma of the anal canal represent variants in
differentiation of squamous cell carcinomas of the anal canal. They
confirm the separate histogenetic origin of tumours from the anal canal
and anal margin.
24
UI - 11526690
AU - Peroni M; Visci P
TI -
[Colposcopy in human papilloma virus infections of the distal
uro-ano-genital tract]
SO - Minerva Ginecol 2000 Dec;52(12 Suppl 1):59-67
AD - Unita Operativa Malattie a Trasmissione Sessuale della Sfera Genitale
Femminile, Istituto di Ricovero e Cura a Carattere-Scientifico "L.
Spallanzani", Roma.
HPV infections fall within the STDs and certain high-risk types have a
significant role in the cancer genesis of the distal genital tract. The
infection results can be clinically evident or be subclinical and in
this latter case they are revealed by a highly-sensitive colposcopic
examination after acetic acid application at 3% followed by Schiller's
test with Lugol solution in weak iodine concentration. Indeed, the
distal districts of male and female uroano-genital tracts takes
advantage of the colposcopic diagnostics although complementary analysis
like histology or DNA tests for HPV typing have sometimes to be
performed to confirm the results or to evaluate the prognosis. HPV
subclinical lesions, above all at cervical and vaginal level, are those
mostly involved with the cancer genesis: the bright-white acidophilia
often combined with irregular surface, atypical vascularization and
discrete iodine caption represents a colposcopic indication to
complementary diagnostic analysis aiming at choosing the most suitable
therapy for which colposcopy can show the lesion topography and its
frequent plurilocalizations.
25
UI - 11817122
AU - Chapet O; Corcelle-Requin A; Padovani L; Bizollon MH; Merieux C;
TI -
Trillet-Lenoir V; Gerard JP
[Anorectal neuroendocrine carcinoma and small cell carcinoma. Report of
two cases]
SO - Rev Med Interne 2001 Nov;22(11):1109-15
AD - Service de radiotherapie-oncologie, centre hospitalier Lyon-Sud, 69495
Pierre-Benite, France.
INTRODUCTION: Anorectal neuroendocrine small cell carcinomas are rare
and frequently difficult to treat. EXEGESIS: Two women presented with a
fungating tumor located on the upper part of the anal canal. Histology
displayed neuron-specific enolase and chromogranin A immunoreactive
small cell tumors. A plasmatic neuron-specific enolase secretion was
noticed in one case. Tumors were poorly reactive to chemotherapy and
irradiation, less than in usual epidermoid anal canal cancer. Evolution
was quickly leading to hepatic and pulmonary metastases in both cases.
CONCLUSION: Anorectal neuroendocrine small cell carcinomas are rare but
need to be individualized from epidermoid anal canal tumors owing to
their poor prognosis with a frequent occurrence of hepatic and pulmonary
metastasis.
26
UI - 11744829
AU - Palefsky JM; Holly EA; Ralston ML; Da Costa M; Bonner H; Jay N; Berry
TI -
JM; Darragh TM
Effect of highly active antiretroviral therapy on the natural history of
anal squamous intraepithelial lesions and anal human papillomavirus
infection.
SO - J Acquir Immune Defic Syndr 2001 Dec 15;28(5):422-8
AD - Department of Laboratory Medicine, University of California, San
Francisco, San Francisco, California 94143, USA. joelp@medicine.ucsf.edu
The effect of highly active antiretroviral therapy (HAART) on the
natural history of anal squamous intraepithelial lesions (ASIL)-the
likely anal cancer precursor-and anal human papillomavirus (HPV)
infection is unknown. ASIL severity and level of anal HPV DNA were
evaluated among HIV-positive men who have sex with men (MSM) for at
least 6 months before initiation of HAART. The results were compared
with those from a 6-month period after initiation of HAART. Anal swabs
for cytology and HPV studies were obtained, followed by high-resolution
anoscopy and biopsy. Among men whose most severe pre-HAART diagnosis was
atypical squamous cells of undetermined significance or low-grade ASIL,
18% (confidence interval [CI], 6-31%, 7 of 38) progressed and 21% (CI,
8-34%, 8 of 38) regressed 6 months after starting HAART. Seventeen
percent (CI, 0-38%, 2 of 12) of study subjects who began with a normal
diagnosis developed ASIL. Only 4% (CI, 0-10%, 1 of 28) of study subjects
with high-grade ASIL regressed to normal. There was no reduction in the
proportion of study subjects who tested positive for HPV DNA or HPV DNA
levels after HAART initiation. The ASIL and HPV data were similar to
those of the pre-HAART comparison period. These results indicate that
HAART has little effect on either ASIL or HPV in the first 6 months
after HAART initiation.
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