대한대장항문학회

<b>Purpose:</b> Although adenocarcinoma associated with anal fistula is rare, missed diagnosis may result in progression of the tumor and poor outcome. This study is aimed to determine the clinical features of adenocarcinoma associated with anal<br>fistula. <b>Methods:</b> The medical records of 8 (0.4%) cases associated with anal fistula, out of 1978 anorectal adenocarcinoma treated at Seoul National University Hospital between 1979 and 2000, were reviewed. <b>Results:</b> The median age<br>at<br>diagnosis of cancer was 57 years (range, 39 to 62 years) and sex ratio was 7 to 1 with male predominance. The median duration of anal fistula before diagnosis of cancer was 8.5 years (range, 4 to 30 years). Major symptoms at diagnosis of cancer<br>were<br>perianal pain (38%) and discharge (38%). Perianal mass was palpable in all patients. All patients except for one case, in which palliative T-colostomy was performed due to extensive invasion despite preoperative radiation therapy, were treated<br>with<br>abdominoperineal resection: 4 in curative resection and 3 in palliative rsection. There were 4 (50%) in stage Ⅳ, 3 (38%) in stage Ⅲ, and Ⅰ (12%) in stage Ⅱ. On median follow-up of 16 months (range, 3 to 72 months), systemic recurrences of 2<br>cases at<br>lung or intraperitoneal cavity and 1 local recurrence at posterior vaginal wall were developed after curative resection. <b>Conclusions:</b> Adenocarcinoma associated with anal fistula had the history of long-standing anal fistula and perianal<br>mass<br>on<br>physical examination. These tumors were detected at advanced stage and their outcomes were poor. Therefore, in the anal fistula combined with long-standing history or perianal mass, a high index of suspicion for malignancy is necessary and a<br>generous<br>biopsy of fistulous tract should be performed to rule out concomitant adenocarcinoma.<br>