The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Lucian Sorin Andrei

Lucian Sorin Andrei

Late Malignancy after 26 Years of Evolution on an Untreated Perianal Fistula

Squamous cell carcinoma and basal cell carcinoma are two types of neoplasms that rarely affect the perianal region, and their etiology is still a matter for debate. We present the case of a 75 year old patient with a 26 year history of perianal fistula, who presents with purulent and fecal perianal discharge and swelling at this level. Physical examination and anoscopy detected low transsphincteric fistula. The biopsy revealed the diagnosis of squamous cell carcinoma, for which a local excision was performed followed by adjuvant radiotherapy. Two years after this event, the patient presented with another perianal lession, which according to the histopathological

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Double Perforation after Colorectal Cancer Surgery During Bevacizumab Treatment

Bevacizumab is a monoclonal antibody which has shown promising results in the treatment of varied malignant pathology, including metastasized colorectal cancer. It acts by inhibiting VEGF (vascular endothelial growth factor), and one of its most cited complications is intestinal perforation, by mechanisms which are not yet fully understood. We present the case of a 68 year old patient, operated for metastasized colorectal cancer, which underwent chemotherapy with Bevacizumab, and shortly after initiating therapy developed fistula of low colorectal anastomosis, followed by ischemic perforation of the small intestine.

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Adenocarcinoma Developing at the Level of a Chronic Perianal Fistula by Cell Implantation from a Proximal Rectal Cancer

Anorectal adenocarcinoma is a very rare complication which can occur during the long-lasting evolution of perianal fistulas (PAF), chronic inflammation being the main predisposing factor incriminated for malignant evolution. Moreover, in rare cases (only 28 being published until now), adenocarcinoma developing at the level of a perianal fistula may occur by migration of tumoral cells originating from a rectal cancer into the granulation tissue of the fistula. We present the case of a patient with a rectal adenocarcinoma that has metastasized to a perianal fistula, in evolution for 7 years. Clinical suspicion of malignant seeding at the site of the fistula has been confirmed by immunohistochemical studies.

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Rare Case of Perianal Endometriosis Complicated with Perianal Fistula: Case Report

Perianal endometriosis is a rare pathology which occurs mainly in patients with history of vaginal birth associated with an episiotomy scar. We present the case of a 42 year old patient with history of multiple interventions for right perianal fistula, accusing pain, purulent secretions and bleeding at the site of the interventions. Biopsies collected were specific for endometriosis. In the context of the sphincter involvement, which brings a high risk of incontinence, and the hormone-dependent evolution of this pathology, which tends to regress once menopause is reached, a fistulotomy was made, with subsequent remission of the purulent secretions, but with the persistence of the bleeding from the region during the menstrual cycle.

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