Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2021; 13(1): 87-91
Published online Jan 15, 2021. doi: 10.4251/wjgo.v13.i1.87
Internal hemorrhoid harboring adenocarcinoma: A case report
Michael L Caparelli, Jason C Batey, Anisha Tailor, Timothy Braverman, Cory Barrat
Michael L Caparelli, Jason C Batey, Anisha Tailor, Cory Barrat, Department of Surgery, The Jewish Hospital, Cincinnati, OH 45236, United States
Timothy Braverman, Department of Pathology, The Jewish Hospital, Cincinnati, OH 45236, United States
Author contributions: Caparelli ML, Batey JC, Tailor A, Braverman T and Barrat C equally contributed to the conceptualization, methodology, data curation, writing, reviewing and editing of this manuscript.
Informed consent statement: The patient involved in this study gave his written consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: The authors have no conflicts of interest and nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jason C Batey, MD, Doctor, Department of Surgery, The Jewish Hospital, 4777 E Galbraith Rd, Cincinnati, OH 45236, United States. jbatey@mercy.com
Received: June 16, 2020
Peer-review started: June 16, 2020
First decision: August 9, 2020
Revised: September 1, 2020
Accepted: October 11, 2020
Article in press: October 11, 2020
Published online: January 15, 2021
Abstract
BACKGROUND

The incidence of carcinoma found within an internal hemorrhoid specimen is exceptionally rare. Further, the presence of primary anal canal adenocarcinoma within internal hemorrhoids is even more infrequent. We describe a case in which anal canal adenocarcinoma was found within an internal hemorrhoidectomy specimen and perform a review of the current literature.

CASE SUMMARY

The patient was a 79-year-old male who presented with rectal bleeding and was found to have large thrombosed internal hemorrhoids during screening colonoscopy. The patient subsequently underwent a three-column hemorrhoi-dectomy. Pathologic analysis revealed one of three specimens containing a 1.5 cm moderate-to-poorly differentiated adenocarcinoma of anal origin with superficial submucosal invasion. At three-month follow up, he was taken to the operating theatre for biopsy and re-excision of his non-healing wound, which showed no recurrence. His wound has since healed and he was cancer free at ten-month follow up.

CONCLUSION

When faced with primary anal canal adenocarcinoma an interdisciplinary approach to treatment should be considered. Routine pathological analysis of hemorrhoidectomy specimens may be beneficial due to the severity of anal canal carcinomas if left undiagnosed and untreated in a timely manner.

Keywords: Hemorrhoidectomy, Adenocarcinoma, Colorectal, Anal canal, Oncology, Hematochezia, Case report

Core Tip: The presence of primary anal canal adenocarcinoma within internal hemorrhoids is extremely rare and can be easily missed if hemorrhoidectomy specimens are not sent for routine pathology. When faced with primary anal canal adenocarcinoma an interdisciplinary approach to treatment should be considered. Routine pathological analysis of hemorrhoidectomy specimens may be beneficial due to the severity of anal canal carcinomas if left undiagnosed and untreated in a timely manner.