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DOI: 10.1055/s-2001-14256
© Georg Thieme Verlag Stuttgart · New York
Anal Leukoplakia: An Unusual Case of Anal Stenosis
P. Katsinelos,M.D.
Dept. of Gastroenterology
Theagenion Institute of Cancer
Marathonos 14
TT 546 38 Thessaloníki
Greece
Fax: Fax:+ 30-31-257070
Email: E-mail:per_amp@yahoo.com
Publication History
Publication Date:
31 December 2001 (online)
Causes of secondary anal stenosis that have been reported include trauma, Crohn’s disease, tuberculosis, actinomycosis, lymphogranuloma, Bowen’s disease, Paget’s disease, epidermoid carcinoma, and actinic causes [1]. We report here an unusual case of anal stenosis caused by extensive anal leukoplakia, which (so far as we are aware) is the first such case to be reported.
A 64-year-old woman was first admitted to our department two years ago, with a diagnosis of anal cancer. She was having difficulty in evacuation, with a decreasing stool caliber and tenesmus. She denied any history of rectal trauma, pruritus, laxative use, perianal abscess, or fistula. The clinical examination and laboratory data were normal. A digital examination revealed anal tightness and a granular, hard sensation in the anal canal. Endoscopy showed a white and firm circumferential lesion in the anal canal, extending cephalad from the anal verge to the pectinate line (Figure [1]). The anal canal was stenotic, and could not be passed with the endoscope. A biopsy of the lesion revealed hyperkeratosis and acanthosis, with a mild inflammatory reaction (Figure [2]). No dysplastic changes were identified.
The patient declined to undergo surgery for the anal stenosis. It was decided to follow her up with serial observations and biopsies; she returned in June 2000 for evaluation of leukoplakia. Four-quadrant biopsies showed findings similar to those of the previous histological diagnosis. Dysplasia and dyskeratosis were absent.
Anal leukoplakia has previously been described rarely and in little detail. Rosser [2] cited three cases reported in the Scandinavian literature up to the 1930s, and in a 1960 report, Gabriel [3] had observed ten cases - but again, these were not well described. Bender and Lechago [4] described two cases of leukoplakia of the anal canal which were asymptomatic and were discovered by routine rectal examination. Morson and Dawson [5] describe leukoplakia in their textbook, but give no figures for the incidence. Other authoritative sources [6] [7] make no mention of anal leukoplakia.
There is little evidence that leukoplakia of the anal canal is a premalignant condition, but patients should be carefully followed up, as the natural course of this rare lesion is unknown. A review of the literature confirms our clinical experience that anal leukoplakia is a rare entity and a previously unreported cause of anal stenosis.
#References
- 1 Khubchandani I T.. Anal stenosis. Surg Clin North Am. 1994; 74 1353-1360
- 2 Rosser C. The etiology of anal cancer. Am J Surg. 1931; 11 328-333
- 3 Gabriel W B.. Discussion on squamous cell carcinoma of anus and anal canal. Proc R Soc Med. 1960; 53 403-409
- 4 Bender M D, Lechago J. Leukoplakia of the anal canal. Dig Dis. 1976; 21 867-872
- 5 Morson B C, Dawson I MP.. Morson and Dawson’s gastrointestinal pathology. Oxford; Blackwell Scientific, 1990: 621-624
- 6 Kirsner J B, Shorter R G.. Diseases of the colon, rectum, and anal canal. Baltimore; Williams and Wilkins, 1988
- 7 Feldman M, Sleisenger M H, Scharschmidt B F, Klein S (eds).. Sleisenger and Fordtran’s gastrointestinal and liver disease. Philadelphia; Saunders, 1998
P. Katsinelos,M.D.
Dept. of Gastroenterology
Theagenion Institute of Cancer
Marathonos 14
TT 546 38 Thessaloníki
Greece
Fax: Fax:+ 30-31-257070
Email: E-mail:per_amp@yahoo.com
References
- 1 Khubchandani I T.. Anal stenosis. Surg Clin North Am. 1994; 74 1353-1360
- 2 Rosser C. The etiology of anal cancer. Am J Surg. 1931; 11 328-333
- 3 Gabriel W B.. Discussion on squamous cell carcinoma of anus and anal canal. Proc R Soc Med. 1960; 53 403-409
- 4 Bender M D, Lechago J. Leukoplakia of the anal canal. Dig Dis. 1976; 21 867-872
- 5 Morson B C, Dawson I MP.. Morson and Dawson’s gastrointestinal pathology. Oxford; Blackwell Scientific, 1990: 621-624
- 6 Kirsner J B, Shorter R G.. Diseases of the colon, rectum, and anal canal. Baltimore; Williams and Wilkins, 1988
- 7 Feldman M, Sleisenger M H, Scharschmidt B F, Klein S (eds).. Sleisenger and Fordtran’s gastrointestinal and liver disease. Philadelphia; Saunders, 1998
P. Katsinelos,M.D.
Dept. of Gastroenterology
Theagenion Institute of Cancer
Marathonos 14
TT 546 38 Thessaloníki
Greece
Fax: Fax:+ 30-31-257070
Email: E-mail:per_amp@yahoo.com