PMC4949808_01
Perineal Chronic Suppurative Hidradenitis, and scars from previous surgical resections. Patient in lithotomy position.
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Physical examination showed multiple deformities of the perianal region, scars, the presence of perineal skin ulcers near the posterior anal canal, mucinous discharge from fistulas, and a bulge in the perineal region (Fig. 1).
Magnetic Resonance Imaging shows hyper signal in T2, suggesting mucinous adenocarcinoma. (a) Transverse section (b) Sagittal section.
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Pelvic MRI revealed a multiloculated cystic lesion in the left side wall of the distal rectum, measuring 5.2 x 8.5 x 6.2 cm (Fig. 2).
Abdominoperineal resection: (a) Surgical aspect after tumor removal (b) Surgical specimen (c) Perineal reconstruction with bilateral pedicled anterolateral thigh flaps.
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The surgical aspects are shown in Fig. 3.
Histological analysis: (a) Intact rectal mucosa, and presence of mucinous adenocarcinoma (arrows) in the submucosa, suggesting extra-rectal mucosa origin (b) Perineal fistula tract in CSH area (arrow), showing mucinous adenocarcinoma near the fistula and extensive area of necrosis (c) Mucinous adenocarcinoma (arrows) near the perineal skin (squamous epithelium*) (d)Tumor area with mucinous production (arrows).
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Histopathological sections confirmed a large mucinous adenocarcinoma with lymphatic and perineural invasion with clear margins and the absence of lymph node metastases (Fig. 4).