10^th International Conference on Clinical and Medical Case Reports September 16-17, 2019 Amsterdam, Netherlands

"Park Plaza Amsterdam Airport"

Manasa. A has completed her MBBS from Rajiv Gandhi University of Health Sciences, Karnataka, India and is currently in her final year of General Surgery residency in the prestigious Madras Medical College, Chennai, India, which is the third oldest medical college in India. She has been awarded the best paper award by the Association of Surgeons of India, Chennai city chapter. She actively participates in local surgical society meets, clinical audits, poster presentations and other academic presentations. She is known for her keen interest in medical research activities.

Anal canal melanoma, a rare tumor, constituting 0.5-2% of all the anorectal malignancies and less than 2% of all melanomas. We present a case of a 38 year old male, who presented with mass descending per-rectum for a duration of 3 months, with occasional bleeding Per-rectum while straining for stools. He consulted in various hospitals, who diagnosed him to have hemorrhoids and advised for conservative management. On examination, he had a 4x4 centimeters bluish black mass descending per rectum which became prominent on bearing down, with no active bleeding and no lymphadenopathy. Computed tomography (CT) abdomen revealed anal canal thickening, extending to the distal rectum with peritoneal deposits. Colonoscopy revealed a growth arising from the anal verge, extending 10 centimeters upwards. Guided biopsy confirmed it to be mucosal melanoma, following the application of S-100 and HMB 45 stains. Considering the advance nature of the condition, he received chemotherapy (dacarbazine and cisplatin).Anal canal melanomas are the third most common, following cutaneous and ocular varieties. They frequently present with non-specific symptoms: rectal bleeding, tenesmus, anorectal mass, change in bowel habits and hemorrhoids. It most commonly metastasizes to inguinal lymph nodes, mesenteric lymph nodes, hypogastric lymph nodes, para –aortic lymph nodes, liver, lung, skin and brain. Surgery (WLE/APR) may be an option when presented early without distal organ involvement. Palliative chemo/radiotherapy for advanced diseases. High index of clinical suspicion, especially when the symptoms are incongruent with clinical findings is of utmost importance in diagnosing and managing aggressive conditions like this.

Manasa. A has completed her MBBS from Rajiv Gandhi University of Health Sciences, Karnataka, India and is currently in her final year of General Surgery residency in the prestigious Madras Medical College, Chennai, India, which is the third oldest medical college in India. She has been awarded the best paper award by the Association of Surgeons of India, Chennai city chapter. She actively participates in local surgical society meets, clinical audits, poster presentations and other academic presentations. She is known for her keen interest in medical research activities.

Fistula in ano, one of the common conditions, which usually arises as a complication of incompletely drained perianal abscess. Our first case is a 73 year old male with complaints of purulent discharge in the perianal region for a duration of 5 years. Operated twice for fistula in ano 5 and 3 years ago but symptoms failed to resolve. On examination, external openings noted at 6, 8 and 10 ‘o’ clock position, indurated with overhanging granulation tissue. Rectal examination revealed a growth arising from anorectal junction, extending for 5 centimeters upwards, confirmed by computed tomography abdomen. Colonoscopy guided biopsy revealed infiltrating adenocarcinoma which was congruent with the wedge biopsy taken from the fistulous tract. Our second case is a 60 year old male patient with complaints of purulent discharge from the perianal region since 7 years, with history of surgery for perianal abscess 7 years ago. Examination revealed external openings at 1, 2, 3 and 5’o’ clock position with overhanging granulation tissue with mucous discharge. Rectal and colonoscopic examinations was normal. Wedge biopsy revealed it to be mucinous adenocarcinoma. Following tumour board consensus, both of them were sent for neoadjuvant chemotherapy. Systemic conditions like tuberculosis and Crohn’s disease are commonly associated with fistula in ano .Malignancy with implantation in a fistula and a primary malignancy arising in a fistula are extremely rare presentations, with less than 50 cases being reported. With a high index of suspicion, mandatory colonoscopies and guided biopsies for patients with chronic fistulae is of utmost importance.