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Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 47-50

Adenocarcinoma arising in a chronic fistula-in-ano and presenting as a gluteal mass

1 Department of Surgery, Federal Medical Centre, Nguru, Yobe State, Nigeria
2 Department of Pathology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Correspondence Address:
Dr. Ibrahim E Suleiman
Department of Surgery, Federal Medical Centre, Nguru, Yobe State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-9596.187197

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The occurrence of adenocarcinoma within a fistula-in-ano is a rare phenomenon, more so when it arises within the fistula. A 54-year-old man presented with a slow-growing, painless, left gluteal mass of 5 years' duration. There was history suggestive of chronic fistula-in-ano, for which he never had orthodox treatment. On examination, he looked well-preserved. The left gluteal mass measured about 20 × 18 × 10 cm with multiple sinuses discharging mucus and pus. There were tracts connecting the mass with sinuses in the anus. The gluteal mass was excised; histology revealed well-differentiated adenocarcinoma, probably from the rectum. He had abdominoperineal excision of the rectum 3 months later, and a fasciocutaneous flap was raised from the right thigh to cover the gluteal defect. Histological examination did not reveal any malignant lesion in the excised rectum. Malignant transformation does occur within a chronic fistula-in-ano. A high index of suspicion is essential to diagnose such cases; histological examination is therefore, very essential for all tissues resected at surgery for fistula-in-ano. Prompt and adequate treatment will save the patient from a protracted and debilitating course of the disease.

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