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A 40-year-old man presented to the Department of Emergency Medicine with severe pain in abdomen which was present for the past two days. He experienced three episodes of vomiting and two episodes of diarrhoea which was greenish in colour without any blood or mucus. A mass from the anal region was also noticed while defecating which was insidious in onset and gradually progressing in size since one month. Physical examination upon deep palpation revealed generalised abdominal pain but no signs of peritoneal involvement. He claimed to have lost weight during the last four months. Notably, his family history included several relatives who had intestinal polyps and colon cancer. Laboratory findings indicated 8.5 g/dL haemoglobin levels and a mean corpuscular volume of 70 fL, along with a positive faecal occult blood test. Normal serum levels of electrolytes, creatinine, glucose, haemoglobin, and pH were observed. A differential diagnosis of haemorrhoids and rectal ulcers was made.

Background: While cutaneous melanoma is common in up to 2.6% of Caucasian population, it is far less common in the African American population, up to 0.1%. Additionally, anal melanoma in particular comprises less than 1% of all melanomas and roughly 4% of anal cancers, while Spindle-cell variants are even less common, suggesting an extremely low incidence in the African American population. Definitive diagnosis can be challenging due to lack of definitive mass or pigmentation at presentation. There is a lack of good long-term studies and treatment guidelines for this malignancy with significant variation in treatment approaches and patient outcomes. Case description: Here we present a case of an 63-year old African American gentleman with no significant past medical history and unremarkable colonoscopy 3 years prior, who presented with a mass in the anal canal that was found during a scheduled screening colonoscopy. The patient was completely asymptomatic at presentation. PET/CT scan showed hypermetabolic activity in the anal canal region. Patient underwent surgical excision with pathology revealing a 2.7 cm spindle cell type of malignant melanoma and promptly treated with adjuvant immunotherapy, resulting in extended progression-free survival before recurrence in the liver. Conclusion: The early diagnosis of spindle cell melanoma can prompt more aggressive surgical and systemic management options resulting in extended survival, however, late recurrences are common and often refractory to standard therapeutic options.

The article discusses a case of Familial Adenomatous Polyposis (FAP), an uncommon autosomal genetic condition characterized by the development of more than 100 adenomatous polyps in the large bowel. The patient, a 40-year-old man, presented with abdominal pain, weight loss, and a family history of intestinal polyps and colon cancer. Diagnosis was confirmed through imaging and histopathological examination, highlighting the importance of recognizing atypical presentations of FAP for accurate diagnosis and management. The article also discusses the genetic basis of FAP, its association with colorectal cancer, and the need for lifelong monitoring and screening in affected individuals. [Extracted from the article]

Simple Summary: Fecal incontinence is a condition characterized by an inability to control defecation, due to either a failure of the large intestine to contain colorectal contents or a failure of the anal sphincter to resist the rectal propulsive forces. Surgical intervention is often necessary to treat severe cases. This study presents a modified semitendinosus muscle flap technique for anal sphincter augmentation in two canine patients with fecal incontinence: a 4-year-old mixed breed dog and a 19-year-old English Cocker Spaniel. The semitendinosus muscle was bifurcated and transposed around the anus. The resulting two muscle bundles completely encircled the anorectum, leading to a complete reconstruction of the external anal sphincter. Both dogs regained fecal continence following surgery. This new technique requires a shorter length of harvested muscle flap and is a relatively simple surgical procedure compared to conventional surgeries. So, it may be a viable surgical option for anal sphincter incontinence in dogs. A 4-year-old mixed breed dog and a 19-year-old English cocker spaniel dog were evaluated for fecal incontinence. The second dog's fecal incontinence was associated with the anal mass. In both dogs, reconstruction of the external anal sphincter was required to gain fecal continence. Especially in the dog with an anal mass, the whole musculature involved in fecal continence was removed with the affected anorectum. Conventional surgical treatments for fecal incontinence have limitations in terms of muscle flap length and complexity of the surgical procedure. A modified surgical technique using the semitendinosus muscle was devised in the present study to overcome these limitations. The distal part of the semitendinosus muscle was bifurcated to make two muscle bundles, used to completely encircle the anorectum. These muscle bundles were sutured to the surrounding rectal muscle and the pelvic diaphragm to simulate the function of the external anal sphincter. Three months after surgery, both dogs showed significantly improved fecal continence without severe complications, such as infection, dehiscence, or lameness of the limb where the semitendinosus muscle was harvested. The outcomes of the two dogs supported the acceptability of the bifurcated muscle flap for anal sphincter augmentation. In addition, this report showed the possibility of more diverse applications of semitendinosus muscle in dogs. [ABSTRACT FROM AUTHOR]

Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in response to chronic irritation or tissue damage. Lesions usually remain small and mostly present in elderly adults with local disease. Case Report: An otherwise healthy 15-year-old male presented with a giant pedunculated mass projecting out of the anal verge that enlarged over 2 years, causing discomfort. Results: Upon surgical excision and histologic examination, the mass resembled a fibroepithelial polyp with numerous dilated lymphatics. Conclusions: While literature describes the spectrum of pathology possible in such lesions, often consisting of a mixture of stromal and epithelial components, dilated lymphatics are less common. This giant anal fibroepithelial polyp characterized by edematous stroma and numerous dilated lymphatics is consistent with lymphangioma. To our knowledge, this presentation is novel in this age group with no underlying risk factors. [ABSTRACT FROM AUTHOR]

A 4-year-old mixed breed dog and a 19-year-old English cocker spaniel dog were evaluated for fecal incontinence. The second dog’s fecal incontinence was associated with the anal mass. In both dogs, reconstruction of the external anal sphincter was required to gain fecal continence. Especially in the dog with an anal mass, the whole musculature involved in fecal continence was removed with the affected anorectum. Conventional surgical treatments for fecal incontinence have limitations in terms of muscle flap length and complexity of the surgical procedure. A modified surgical technique using the semitendinosus muscle was devised in the present study to overcome these limitations. The distal part of the semitendinosus muscle was bifurcated to make two muscle bundles, used to completely encircle the anorectum. These muscle bundles were sutured to the surrounding rectal muscle and the pelvic diaphragm to simulate the function of the external anal sphincter. Three months after surgery, both dogs showed significantly improved fecal continence without severe complications, such as infection, dehiscence, or lameness of the limb where the semitendinosus muscle was harvested. The outcomes of the two dogs supported the acceptability of the bifurcated muscle flap for anal sphincter augmentation. In addition, this report showed the possibility of more diverse applications of semitendinosus muscle in dogs.

Key Clinical Message Giant condyloma acuminata are associated with malignant transformation in up to 50% of cases, high recurrence rate, and poor prognosis. Treatment strategies have included wide local excision, abdominopelvic resection, and addition of radiotherapy and adjuvant and/or neoadjuvant systemic chemotherapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass. [ABSTRACT FROM AUTHOR]