Mucoepidermoid carcinoma of the anal canal: A case report and review of the literature.

Mucoepidermoid carcinoma of the anal canal is a rare tumor. We herein report the case of a 74-year-old male patient with a high-grade mucoepidermoid carcinoma of the anal canal who was treated by local surgical resection and subsequent irradiation. However, the patient succumbed to liver and lung metastases 2 years after the procedure. The characteristic findings of mucoepidermoid carcinoma of the anus remain unclear to date due to rarity of this tumor. Since 1954, when this type of tumor was first described, only 58 cases of patients diagnosed with mucoepidermoid carcinoma of the anus have been reported to date. In this context, a review of the existing English literature on this rare tumor was also performed.

Anal Canal Duplication Associated with Presacral Cyst in an Adult.

Anal canal duplication (ACD) is a rare congenital malformation, usually detected early in life. We report a case of a 67-year-old female with symptomatic ACD associated with a presacral cyst. Physical examination revealed an accessory opening located in the midline, posterior to the true anus. Imaging examinations, including fistulography, endoanal ultrasonography, and magnetic resonance imaging, revealed a blind-ending fistulous tract without connecting with the rectum and a presacral cyst posterior to the rectum. Complete surgical excision of the tract with cyst was performed through a posterior sagittal approach. Histologic examination revealed squamous epithelium lining and smooth muscle bundles, thereby confirming ACD. The postoperative course was uneventful, and the patient was doing well; no recurrence was observed 4 years after surgery. ACD can present for the first time in infants, children, and adults. Imaging examinations are useful for the diagnosis and preoperative assessment of ACD. Therefore, ACD should be considered in the differential diagnosis, even in adults, when a posterior perineal orifice is encountered, particularly in female patients. Once ACD is suspected, intense imaging inspection is recommended to visualize the ACD and associated anomalies, and surgical removal is warranted to prevent inflammatory complications or malignant changes.

Endoanal Ultrasonography of Mucinous Adenocarcinoma Arising from Chronic Fistula-in-ano: Three Case Reports.

Mucinous adenocarcinoma arising in chronic fistula-in-ano is rare, and diagnosing it at an early stage is difficult. The role of endoanal ultrasonography in diagnosing the condition has not been discussed in the study. Herein, we report three cases of mucinous adenocarcinoma arising from anal fistulas in which endosonography played an important role in diagnosing malignant change. Three male patients with a 5- to 20-year history of anal fistula were referred to our hospital due to perianal induration, progressive anal pain, or mucopurulent secretion. In all three patients, endosonography revealed a multiloculated complex echoic mass with isoechoic solid components communicating with a trans-sphincteric fistula and sonography-guided biopsy under anesthesia revealed mucinous adenocarcinoma. All patients underwent abdominoperineal resection with lymph node dissection. One patient with a local recurrence died 3 years after surgery and two have remained disease-free for >6 years. These observations suggest that endosonography may be a reliable technique for the diagnosis of mucinous adenocarcinoma arising from chronic fistula-in-ano. Sonography-guided biopsy is useful for the definitive diagnosis of malignancy. Therefore, periodic endosonography assessment should be recommended for patients with persistent anal fistula, especially those with progressive clinical symptoms. Once malignancy is suspected, aggressive sonography-guided biopsy under anesthesia should be performed, which may enable an early diagnosis, curative treatment, and favorable long-term results.

Elucidation of the mechanism of reaction between S2O8(2-), Selenite and Mn2+ in aqueous solution and limestone-gypsum FGD liquor.

The mechanism of reaction between peroxodisulfate ion (S2O8(2-)), selenite (Se(IV)O3(2-)) and Mn(2+) as an inhibitor of selenite oxidation was studied using aqueous solutions composed of commercial reagents, as well as limestone-gypsum flue gas desulfurization (FGD) liquors sampled from coal fired power plants. The oxidation of selenite to selenate (Se(VI)O4(2-)) is promoted by the sulfate ion radical (SO4(-)) which results from decomposition of S2O8(2-). In the presence of Mn(2+), selenite oxidation was prevented due to the difference in rates of reaction with SO4(-). The ratio of the oxidation rate constants of selenite and Mn(2+) with SO4(-) was determined over a temperature range of 40-60 °C, and was found to be little influenced by the various coexisting components in FGD liquors.

A case of neonatal mature teratoma transformed to malignancy in the neck extending to the mouth floor.

A case with neonatal teratoma originating from the cervicofacial region which transformed to be malignant during treatment is reported. The case is a full-term baby girl with swallowing difficulty and has a mass at the floor of her mouth with the right neck swelling. The mass was revealed to be multi-cystic and extending deep into the sublingual space and protruding outside. Puncture and marsupialisation of the cyst could not relieve her symptom and the tumor was resected in three occasions and was diagnosed as mature teratoma without malignant component. However, three months after the last resection, the solid right neck mass enlarged rapidly and the serum alpha-fetoprotein level was elevated. Biopsied specimen demonstrated the mass to be germ cell tumor with embryonal carcinoma and yolk sac tumor component. Eight courses of JEB regimen with recurrent mass resection successfully lead to complete regression without compromising patient growth as well as cosmetics. Head and neck teratomas in children are mostly benign amenable to curative excision but its rarity and site and size of the tumor make its treatment challenging. It is important to have multi-disciplinary management for the disease from neonatal period until growth has finished. There exists a relationship between the age at diagnosis and outcome of a patient with teratoma and head and neck teratomas in neonate are mostly benign but should be removed completely as soon as the patient condition is stabilized to reduce the risk of malignant change.

New technique for enterostomy of extremely low-birth-weight infants--intestinal anchoring with gauze.

BACKGROUND: In enterostomy for extremely low-birth-weight infants (<1000 g), the technique of anchoring the intestine for a stoma to the abdominal wall is very difficult because of the small size and fragile nature of the intestine. Here we describe a novel technique for intestinal anchoring in such infants. METHODS: In our approach to enterostomy, the intestine is anchored only by a strip of gauze packed into the subcutaneous space. No suturing is performed. The efficacy of this technique was evaluated in 21 infants with less than 1000 g of body weight who have intestinal perforation or obstruction. RESULTS: Two patients (9.5%) had complications that were related to the enterostomy. The complications were parastomal and intrastomal intestinal prolapse, both of which were treated successfully by reoperation. Eighteen patients (86%) survived to closure of the enterostoma. CONCLUSIONS: Intestinal anchoring with gauze is an easy and effective technique for enterostomy in extremely low-birth-weight infants and can be applied in selected cases.

Synchronous adenocarcinoma and gastrointestinal stromal tumors of the stomach treated laparoscopically.

Gastric adenocarcinomas account for approximately 95% of primary gastric tumors, and gastrointestinal stromal tumor (GIST) is the most common gastrointestinal mesenchymal tumor, accounting for 1%-3% of primary gastric tumors. However, the synchronous occurrence of GIST and gastric epithelial tumor is rare. We herein report a case of synchronous occurrence of gastric adenocarcinoma and two GISTs of the stomach. All lesions were resected laparoscopically. We discuss this case and review the literature.

Life-threatening airway obstruction caused by mediastinal germinoma in a 9-year-old girl.

The authors report a case of a 9-year-old girl with a mediastinal germinoma that required emergent surgical extirpation because of tracheal compression and asphyxia. The tumor was successfully debulked under general anesthesia with the capability of extracorporeal circulation immediately available. Postoperatively, the tumor responded to adjuvant chemotherapy and irradiation and the patient survived without evidence of recurrence.

Cardiac lymphangioma: case report and review of the literature.

Cardiac lymphangioma is uncommon and constitutes one of the rare forms of cardiac diseases. A 6-year-old girl had an abnormal electrocardiogram in a screening test on admission to an elementary school. Echocardiogram, computed tomogram, and magnetic resonance imaging showed a mediastinal multicystic mass that was adjacent to the left ventricle of the heart. The tumor was found to be originated in myocardium by left thoracotomy and pericadiotomy. A partial resection of tumor and a pericardial window were done. This case, to the authors' knowledge, represents the sixth reported case of cardiac lymphangioma.