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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(04): 688-701
DOI: 10.1055/s-0044-1781459
Review Article

Anal and Perianal Masses: The Common, the Uncommon, and the Rare

Antony Augustine
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Rijo Issac
2   Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
,
Aisha Lakhani
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Harsha Veena Kanamathareddy
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Reetu John
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Betty Simon
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Dipti Masih
2   Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
,
Anu Eapen
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Anuradha Chandramohan
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
› Author Affiliations Funding None.
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Abstract

A variety of tumors involve the anal canal because the anal canal forms the transition between the digestive system and the skin, and this anatomical region is made of a variety of different cells and tissues. Magnetic resonance imaging (MRI) is the modality of choice for diagnosis and local staging of the anal canal and perianal neoplasms. In this pictorial review, we demonstrate the MRI anatomy of the anal canal and perianal region and display the imaging spectrum of tumors in the region along with an overview of its management. Imaging appearances of many tumorlike lesions that can cause diagnostic dilemmas are also demonstrated with pointers to differentiate between them.

Keywords

anal - perianal - neoplasms - cancer - MRI

Note

A part of this article including images were presented as electronic poster with the same title during the 33rd Annual Meeting and Postgraduate Course of European Society of Gastrointestinal and Abdominal Radiology (ESGAR), 2022, and was selected as a recommended poster.




Publication History

Article published online:
23 March 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022; 72 (01) 7-33
    CrossrefPubMedGoogle Scholar
  • 2 Solan P, Davis B. Anorectal anatomy and imaging techniques. Gastroenterol Clin North Am 2013; 42 (04) 701-712
    CrossrefPubMedGoogle Scholar
  • 3 Brown G, Daniels IR, Richardson C, Revell P, Peppercorn D, Bourne M. Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol 2005; 78 (927) 245-251
    CrossrefPubMedGoogle Scholar
  • 4 Chandramohan A. et al. MRI staging of anorectal malignancy—a reporting dilemma: is it adenocarcinoma or squamous cell carcinoma?. J Gastrointestinal Abdominal Radiol 2023; 6: 136-145
    Google Scholar
  • 5 deSouza NM, Williams AD, Gilderdale DJ. High-resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal receiver coil. Eur Radiol 1999; 9 (03) 436-443
    CrossrefPubMedGoogle Scholar
  • 6 Kochhar R, Plumb AA, Carrington BM, Saunders M. Imaging of anal carcinoma. AJR Am J Roentgenol 2012; 199 (03) W335-W344
    CrossrefPubMedGoogle Scholar
  • 7 World Health Organization Classification of Tumours Editorial Board. WHO Classification of Tumours. Vol. 1: Digestive System Tumours. Lyon:: IARC; 2019
    Google Scholar
  • 8 Amin MB, Edge SB, Greene FL. et al, eds. AJCC Cancer Staging Manual. 8th ed. New York, NY:: Springer International Publishing;; 2017
    Google Scholar
  • 9 Surabhi VR, Menias CO, Amer AM. et al. Tumors and tumorlike conditions of the anal canal and perianal region: MR imaging findings. Radiographics 2016; 36 (05) 1339-1353
    CrossrefPubMedGoogle Scholar
  • 10 Kochhar R, Renehan AG, Mullan D, Chakrabarty B, Saunders MP, Carrington BM. The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer. Eur Radiol 2017; 27 (02) 607-617
    CrossrefPubMedGoogle Scholar
  • 11 Jones M, Hruby G, Solomon M, Rutherford N, Martin J. The role of FDG-PET in the initial staging and response assessment of anal cancer: a systematic review and meta-analysis. Ann Surg Oncol 2015; 22 (11) 3574-3581
    CrossrefPubMedGoogle Scholar
  • 12 Tarazi R, Nelson RL. Anal adenocarcinoma: a comprehensive review. Semin Surg Oncol 1994; 10 (03) 235-240
    CrossrefPubMedGoogle Scholar
  • 13 Benson AB, Venook AP, Al-Hawary MM. et al. Anal carcinoma, Version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2018; 16 (07) 852-871
    CrossrefPubMedGoogle Scholar
  • 14 Rao S, Guren MG, Khan K. et al; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up☆ . Ann Oncol 2021; 32 (09) 1087-1100
    CrossrefPubMedGoogle Scholar
  • 15 Hussain SM, Outwater EK, Siegelman ES. Mucinous versus nonmucinous rectal carcinomas: differentiation with MR imaging. Radiology 1999; 213 (01) 79-85
    CrossrefPubMedGoogle Scholar
  • 16 Ambrosio MR, Rocca BJ, Barone A. et al. Primary anorectal Hodgkin lymphoma: report of a case and review of the literature. Hum Pathol 2014; 45 (03) 648-652
    CrossrefPubMedGoogle Scholar
  • 17 Horvat N, Rocha CCT, Oliveira BC, Petkovska I, Gollub MJ. MRI of rectal cancer: tumor staging, imaging techniques, and management. Radiographics 2019; 39 (02) 367-387
    CrossrefPubMedGoogle Scholar
  • 18 Valadão M, Câmara ERZ, de Castro Araujo RO. et al. Low rectal cancer: current approach based on magnetic resonance imaging. BJ Oncology 2017; 13 (45) 1-5
    Google Scholar
  • 19 Santiago I, Figueiredo N, Parés O, Matos C. MRI of rectal cancer-relevant anatomy and staging key points. Insights Imaging 2020; 11 (01) 100
    CrossrefPubMedGoogle Scholar
  • 20 Park HJ, Kim HJ, Park SH. et al. Journal Club: primary anorectal melanoma: MRI findings and clinicopathologic correlations. AJR Am J Roentgenol 2018; 211 (02) W98-W108
    CrossrefPubMedGoogle Scholar
  • 21 Nassif MO, Habib RA, Almarzouki LZ, Trabulsi NH. Systematic review of anorectal leiomyosarcoma: current challenges and recent advances. World J Gastrointest Surg 2019; 11 (08) 334-341
    CrossrefPubMedGoogle Scholar
  • 22 Matsuda A, Miyashita M, Matsumoto S. et al. Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma: a systematic review. Ann Surg 2015; 261 (04) 670-677
    CrossrefPubMedGoogle Scholar
  • 23 Ueberroth BE, Liu AJ, Starr JS. et al. Neuroendocrine carcinoma of the anus and rectum: patient characteristics and treatment options. Clin Colorectal Cancer 2021; 20 (02) e139-e149
    CrossrefPubMedGoogle Scholar
  • 24 Rindi G, Mete O, Uccella S. et al. Overview of the 2022 WHO classification of neuroendocrine neoplasms. Endocr Pathol 2022; 33 (01) 115-154
    CrossrefPubMedGoogle Scholar
  • 25 Ganeshan D, Bhosale P, Yang T, Kundra V. Imaging features of carcinoid tumors of the gastrointestinal tract. AJR Am J Roentgenol 2013; 201 (04) 773-786
    CrossrefPubMedGoogle Scholar
  • 26 Juhlin CC, Falhammar H, Kjellman M, Åhlén J, Welin S, Calissendorff J. Highly proliferative anal neuroendocrine carcinoma: molecular and clinical features of a rare, recurrent case in complete remission. BMC Gastroenterol 2020; 20 (01) 290
    CrossrefPubMedGoogle Scholar
  • 27 Schwenzer NF, Pfannenberg AC. PET/CT, MR, and PET/MR in lymphoma and melanoma. Semin Nucl Med 2015; 45 (04) 322-331
    CrossrefPubMedGoogle Scholar
  • 28 Rubinstein PG, Aboulafia DM, Zloza A. Malignancies in HIV/AIDS: from epidemiology to therapeutic challenges. AIDS 2014; 28 (04) 453-465
    CrossrefPubMedGoogle Scholar
  • 29 Cuffy M, Abir F, Longo WE. Management of less common tumors of the colon, rectum, and anus. Clin Colorectal Cancer 2006; 5 (05) 327-337
    CrossrefPubMedGoogle Scholar
  • 30 Kusminsky RE, Bailey W. Leiomyomas of the rectum and anal canal: report of six cases and review of the literature. Dis Colon Rectum 1977; 20 (07) 580-599
    CrossrefPubMedGoogle Scholar
  • 31 Kim H, Kim JH, Lim JS. et al. MRI findings of rectal submucosal tumors. Korean J Radiol 2011; 12 (04) 487-498
    CrossrefPubMedGoogle Scholar
  • 32 Haliloglu N, Gulpinar B, Ozkavukcu E, Erden A. Typical MR imaging findings of perianal infections in patients with hematologic malignancies. Eur J Radiol 2017; 93: 284-288
    CrossrefPubMedGoogle Scholar
  • 33 Koch MR, Jagannathan JP, Shinagare AB. et al. Imaging features of primary anorectal gastrointestinal stromal tumors with clinical and pathologic correlation. Cancer Imaging 2013; 12 (03) 557-565
    CrossrefPubMedGoogle Scholar
  • 34 Hassan I, You YN, Shyyan R. et al. Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol 2008; 15 (01) 52-59
    CrossrefPubMedGoogle Scholar
  • 35 Kline RJ, Spencer RJ, Harrison Jr. EG. Carcinoma associated with fistula-in-ano. Arch Surg 1964; 89 (06) 989-994
    CrossrefPubMedGoogle Scholar
  • 36 Chandramohan K, Mathew AP, Muralee M, Anila KR, Ramachandran K, Ahamed I. Squamous cell carcinoma arising from long-standing perianal fistula. Int Wound J 2010; 7 (06) 515-518
    CrossrefPubMedGoogle Scholar
  • 37 Yang B-L, Shao W-J, Sun G-D, Chen Y-Q, Huang J-C. Perianal mucinous adenocarcinoma arising from chronic anorectal fistulae: a review from single institution. Int J Colorectal Dis 2009; 24 (09) 1001-1006
    CrossrefPubMedGoogle Scholar
  • 38 Faria SC, Elsherif SB, Sagebiel T. et al. Ischiorectal fossa: benign and malignant neoplasms of this “ignored” radiological anatomical space. Abdom Radiol (NY) 2019; 44 (05) 1644-1674
    CrossrefPubMedGoogle Scholar
  • 39 Hajjar R, Alharthi M, Richard C, Gougeon F, Loungnarath R. Pelvic aggressive angiomyxoma: major challenges in diagnosis and treatment. Cureus 2019; 11 (04) e4419
    Google Scholar
  • 40 Loock MT, Fornès P, Soyer P, Rousset P, Azizi L, Hoeffel C. MR imaging features of nongynaecologic cystic lesions of the pelvis. Clin Imaging 2013; 37 (02) 211-218
    CrossrefPubMedGoogle Scholar
  • 41 Jiang Y, Ajani JA. Anal margin cancer: current situation and ongoing trials. Curr Opin Oncol 2012; 24 (04) 448-453
    CrossrefPubMedGoogle Scholar
  • 42 Bambao C, Nofech-Mozes S, Shier M. Giant condyloma versus verrucous carcinoma: a case report. J Low Genit Tract Dis 2010; 14 (03) 230-233
    CrossrefPubMedGoogle Scholar
  • 43 Takezawa Y, Shimizu N, Kurokawa K, Suzuki K, Yamanaka H. Appearance on magnetic resonance imaging of Buschke-Lowenstein tumour. Br J Urol 1996; 78 (02) 308-309
    CrossrefPubMedGoogle Scholar
  • 44 Rubbini M, Ascanelli S. Classification and guidelines of hemorrhoidal disease: Present and future. World J Gastrointest Surg 2019; 11 (03) 117-121
    CrossrefPubMedGoogle Scholar
  • 45 Erden A. MRI of anal canal: common anal and perianal disorders beyond fistulas: part 2. Abdom Radiol (NY) 2018; 43 (06) 1353-1367
    CrossrefPubMedGoogle Scholar
  • 46 Erdemli S, Aris D, Çiçek B. et al. Revisiting imaging features of rectosigmoid vascular malformation with emphasis on multiparametric MRI: a case report. Egypt J Radiol Nucl Med 2022; 53: 173
    CrossrefGoogle Scholar
  • 47 Chen N, Zhu L, Lang J. et al. The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases. Hum Reprod 2012; 27 (06) 1624-1627
    CrossrefPubMedGoogle Scholar
  • 48 Lorusso F, Scioscia M, Rubini D. et al. Magnetic resonance imaging for deep infiltrating endometriosis: current concepts, imaging technique and key findings. Insights Imaging 2021; 12 (01) 105
    CrossrefPubMedGoogle Scholar
  • 49 de Vries HJC, Nori AV, Kiellberg Larsen H. et al. 2021 European guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. J Eur Acad Dermatol Venereol 2021; 35 (07) 1434-1443
    CrossrefPubMedGoogle Scholar
  • 50 Dsouza RG, Al Rasheed MRH, Low G. Perianal inflammation or something more?. J Clin Imaging Sci 2021; 11: 47
    CrossrefPubMedGoogle Scholar