Local Excision
23 results
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Malignancy- A 75-year-old woman underwent a transanal excision of a cT1N0M0 rectal cancer. The final pathology was T1 with negative margins and no aggressive features. What is the appropriate endoscopic surveillance regimen?
- A 64-year-old woman with a history of cervical intraepithelial neoplasia presents with a firm 3-cm mass protruding at the anal verge. Anoscopy shows a fixed mass just distal to the dentate line. A biopsy of the lesion is performed, which has the findings shown in the Figure. Colonoscopy findings are unremarkable and computed tomography of the chest, abdomen, and pelvis reveals no evidence of distant disease. Magnetic resonance imaging reveals no locoregional nodal or sphincter involvement. The next best step in management for this patient is:
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 72-year-old patient with severe systolic congestive heart failure and oxygen-dependent chronic obstructive pulmonary disease completes chemoradiation for a locally advanced rectal adenocarcinoma 5-cm proximal to the anal verge. Reexamination of the rectum 8 weeks after chemoradiation reveals normal, intact mucosa, and magnetic resonance imaging of the pelvis reveals no visible cancer or suspicious mesorectal nodes. What is the most appropriate therapy for this patient?
- A 62-year-old man was found to have 1-cm posterior rectal lesion that is 3 cm from the anal verge. Histopathologic findings are consistent with a well-differentiated adenocarcinoma without lymphovascular or perineural invasion. Magnetic resonance imaging shows that the tumor is limited to the submucosa and there are no suspicious mesorectal lymph nodes. Metastatic workup uncovers no findings. What is the most appropriate management?
- A 63-year-old woman is diagnosed with a 1.5-cm, well-differentiated perianal squamous cell cancer that is 3.5 cm from the anal verge, with no involvement of the anal sphincter mechanism. There is no radiographic evidence of inguinal nodal or metastatic disease. The best treatment option for this patient is:
- A 50-year-old woman is found to have a 7-mm submucosal yellow lesion in the distal rectum on screening colonoscopy. There is no pillow sign. What is the most likely diagnosis?
- A 57-year-old man is found to have a submucosal mass in the distal rectum on colonoscopy. Biopsy reveals spindle cells which stain positive for CD117 on immunohistochemistry. The lesion is posterior and 5 cm from the anal verge on rigid proctoscopy. Magnetic resonance imaging measures the size of the lesion as 1.3 cm with extension into the muscularis propria. What is the appropriate treatment?
- A 49-year-old woman was seen in the clinic for hemorrhoids. On examination, a hard nodular area is palpable in the right lateral anal canal wall. You examine the patient under anesthesia and perform a biopsy. The pathology report reveals anal squamous cell carcinoma. Staging imaging reveals a T2N0 lesion with no evidence of metastasis. What is the next step in management?
- A 40-year-old woman presents to your office with constipation and vague lower back pain. On digital rectal examination, you palpate a smooth mass posteriorly at the tip of your finger. Colonoscopy findings were normal, save for posterior bulging with smooth mucosa in the rectum. Magnetic resonance imaging (MRI) shows a solid mass in the rectorectal space with bony destruction of the sacrum. What is the next best management step for this patient?
- A 65-year-old man was diagnosed with a 1.5-cm lesion at the anal verge. Biopsies were positive for S100 and HMB-45. Computed tomography of the chest, abdomen, and pelvis showed no metastases. Which is the next best step in this patient’s treatment?
- A 53-year-old man is diagnosed with rectal adenocarcinoma 7 cm from the anal verge. Preoperative pelvic magnetic resonance imaging (MRI) demonstrates a threatened circumferential radial margin. After total neoadjuvant chemoradiation, a repeat MRI demonstrates a persistently threatened radial margin. Which of the following adjuncts should be considered in operative planning for this patient?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- Anorectal Disease
- A 43-year-old woman underwent a ligation of intersphincteric fistula tract (LIFT) 7 weeks ago to close her posterior transsphincteric anal fistula. She has had persistent discharge from her intersphincteric wound. On clinical examination, she was found to have a persistent internal opening and the external opening has healed. What would be the most appropriate procedure to perform next to resolve her drainage?
- A 27-year-old man presents to the clinic with chronic seropurulent drainage from the superior gluteal cleft for 3 months. Examination reveals a 1.5-cm pilonidal cyst with a chronic midline sinus. Rectal examination findings are normal. What is the best next step in management?
- A 45-year-old woman presents with induration and chronic draining sinuses in the perineum, axilla, and groin. She underwent a screening colonoscopy 2 years ago, the result of which was normal. What is the best long-term management strategy to prevent recurrence?
- A 53-year-old woman presents with a 3×2–cm pruritic, well-circumscribed, eczematous, tender lesion that does not involve the anal verge. A punch biopsy notes intradermal infiltration of cells with large, round, eccentric nuclei, with pale vacuolated cytoplasm, which stain positive for cytokeratin 7. Workup is negative for malignancy. What is the best step in management?
- A 56-year-old HIV positive man with anal condyloma acuminata undergoes excision and fulguration of these lesions under general anesthesia. The pathology shows foci of high-grade dysplasia related to human papillomavirus. What is the next step in the management?
- A 25-year-old HIV-positive man underwent high-resolution anoscopy (HRA) and was found to have 3 small, flat, plaquelike lesions at the anal verge and in the anal canal. Biopsies indicated high-grade dysplasia. Which is the next step in management?
- A 55-year-old man presents with multiple perianal and anal canal condylomas. The patient undergoes an examination under anesthesia and excision. Which of the following techniques is most appropriate?
- Benign Disease
- Pelvic Floor
- Perioperative