PMC5910508_01
Colonoscopy revealed a pigmented neoplasm arising at dentate line.
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She underwent a colonoscopy, which revealed a pigmented neoplasm arising at dentate line (Fig. 1).
A biopsy of the mass demonstrated malignant melanoma with positive stains in immunohistochemistry for melan A, HMB-45 and protein S-100.
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A biopsy of the mass demonstrated malignant melanoma with positive stains in immunohistochemistry for melan A, HMB-45 and protein S-100 (Fig. 2).
A computed tomography of the pelvis demonstrated the mass at the anorectal junction, with no evidence of lymph nodes or distant metastases. (Yellow arrow).
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A computed tomography (CT) of chest, abdomen and pelvis demonstrated the mass at the anorectal junction, with no evidence of lymph nodes or distant metastases (Fig. 3).
The procedure started with the laparoscopic transabdominal part. After lymph node dissection was performed, mobilizing the rectum to the level of levator ani muscle laparoscopically (a). Then a skin incision was made around the tightly closed anus, and a multiport deivice was placed (b). Transperineal dissection was achieved in the down-to-up direction under endoscopic visualization(c). Finally permanent colostomy creation was performed laparoscopically (d).
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Finally permanent colostomy creation was performed laparoscopically (Fig. 4).
The resected specimen showed the tumor invaded through the perirectal tissue at anorectal junction.
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But there was no tumor invasion of resected margin (Fig. 5).