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Anorectal smear in the diagnosis of anorectal adenocarcinoma.

Demirel D, Ramzy I - J Cytol (2013)

Bottom Line: He was diagnosed as having hemorrhoids and a hemorrhoidectomy was performed.The tumor was resected laparoscopically and was reported as an adenocarcinoma.A definitive diagnosis of adenocarcinoma was rendered based on cytologic and histologic examination of the material.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Uskudar, Istanbul, Turkey.

ABSTRACT
The purpose of this case report is to point out the diagnostic value of cytologic smears in patients presenting with anorectal complaints, such as bleeding, pain or discomfort, which may suggest a neoplastic lesion. We present a case of a 64-year-old man with a 3 months' history of anal bleeding and pain during defecation. He was diagnosed as having hemorrhoids and a hemorrhoidectomy was performed. The patient developed an anal stricture postoperatively that required operative dilation. He continued to complain about anorectal pain for 2 months and a subsequent rectoscopy revealed the presence of tumor 5 to 7 cm above the dentate line. The tumor was resected laparoscopically and was reported as an adenocarcinoma. Rectal bleeding recurred 18 months postoperatively and a smear was procured from the anorectal mucosal surface for cytologic evaluation. A definitive diagnosis of adenocarcinoma was rendered based on cytologic and histologic examination of the material. To the best of our knowledge, this is the first case report of anorectal adenocarcinoma diagnosed by cytologic smear in the English literature.

No MeSH data available.


Related in: MedlinePlus

(a) A malignant tumor cell cluster (Pap, ×400); (b) The cell group in the left bottom shows nuclear pseudostratified strip reminiscent of short “bird tail like” arrangement (Pap, ×400); (c) Spindle shaped tumor cells (Pap, ×400); (d) Adenocarcinoma in submucosa (H and E, ×100)
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Figure 1: (a) A malignant tumor cell cluster (Pap, ×400); (b) The cell group in the left bottom shows nuclear pseudostratified strip reminiscent of short “bird tail like” arrangement (Pap, ×400); (c) Spindle shaped tumor cells (Pap, ×400); (d) Adenocarcinoma in submucosa (H and E, ×100)

Mentions: Rectal bleeding recurred 18 months after the operation and the patient returned to the clinic. At this time, an anorectal smear was procured as the initial procedure, using an endocervical brush. The smears were fixed in 95% ethanol and stained with Papanicolaou stain. Cytologic examination of the smears revealed a mucinous and necrotic background in which numerous neutrophils, squamous, and glandular cells were identified. Many of the glandular cells were in the form of sheets of reactive columnar cells with thin cytoplasm and uniform oval to round nuclei. In addition, there were several atypical glandular cells with large hyperchromatic nuclei and thick cytoplasm [Figure 1a]. These cells were either single or in the form of three dimensional clusters, straps, and glands. Cellular strips with nuclear pseudostratification, reminiscent of short “bird tail like” arrangements were also seen [Figure 1b].[1] Some tumor cells were spindle shaped similar to a high-grade anal intraepithelial neoplasia or squamous cell carcinoma [Figure 1c]. These cytologic findings were interpreted as diagnostic of adenocarcinoma.


Anorectal smear in the diagnosis of anorectal adenocarcinoma.

Demirel D, Ramzy I - J Cytol (2013)

(a) A malignant tumor cell cluster (Pap, ×400); (b) The cell group in the left bottom shows nuclear pseudostratified strip reminiscent of short “bird tail like” arrangement (Pap, ×400); (c) Spindle shaped tumor cells (Pap, ×400); (d) Adenocarcinoma in submucosa (H and E, ×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643364&req=5

Figure 1: (a) A malignant tumor cell cluster (Pap, ×400); (b) The cell group in the left bottom shows nuclear pseudostratified strip reminiscent of short “bird tail like” arrangement (Pap, ×400); (c) Spindle shaped tumor cells (Pap, ×400); (d) Adenocarcinoma in submucosa (H and E, ×100)
Mentions: Rectal bleeding recurred 18 months after the operation and the patient returned to the clinic. At this time, an anorectal smear was procured as the initial procedure, using an endocervical brush. The smears were fixed in 95% ethanol and stained with Papanicolaou stain. Cytologic examination of the smears revealed a mucinous and necrotic background in which numerous neutrophils, squamous, and glandular cells were identified. Many of the glandular cells were in the form of sheets of reactive columnar cells with thin cytoplasm and uniform oval to round nuclei. In addition, there were several atypical glandular cells with large hyperchromatic nuclei and thick cytoplasm [Figure 1a]. These cells were either single or in the form of three dimensional clusters, straps, and glands. Cellular strips with nuclear pseudostratification, reminiscent of short “bird tail like” arrangements were also seen [Figure 1b].[1] Some tumor cells were spindle shaped similar to a high-grade anal intraepithelial neoplasia or squamous cell carcinoma [Figure 1c]. These cytologic findings were interpreted as diagnostic of adenocarcinoma.

Bottom Line: He was diagnosed as having hemorrhoids and a hemorrhoidectomy was performed.The tumor was resected laparoscopically and was reported as an adenocarcinoma.A definitive diagnosis of adenocarcinoma was rendered based on cytologic and histologic examination of the material.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Uskudar, Istanbul, Turkey.

ABSTRACT
The purpose of this case report is to point out the diagnostic value of cytologic smears in patients presenting with anorectal complaints, such as bleeding, pain or discomfort, which may suggest a neoplastic lesion. We present a case of a 64-year-old man with a 3 months' history of anal bleeding and pain during defecation. He was diagnosed as having hemorrhoids and a hemorrhoidectomy was performed. The patient developed an anal stricture postoperatively that required operative dilation. He continued to complain about anorectal pain for 2 months and a subsequent rectoscopy revealed the presence of tumor 5 to 7 cm above the dentate line. The tumor was resected laparoscopically and was reported as an adenocarcinoma. Rectal bleeding recurred 18 months postoperatively and a smear was procured from the anorectal mucosal surface for cytologic evaluation. A definitive diagnosis of adenocarcinoma was rendered based on cytologic and histologic examination of the material. To the best of our knowledge, this is the first case report of anorectal adenocarcinoma diagnosed by cytologic smear in the English literature.

No MeSH data available.


Related in: MedlinePlus