Neoplastic Conditions

Anal margin/perianal skin lesions such as condyloma, Bowen's disease or carcinoma are handled as for skin specimens.

Vertically bisect down through the surface opening

Multiple transverse sections of the fistula

Transverse section the fistula limit

Figure 7.3. Fistula-in-ano.

Vertically bisect down through the surface opening

Multiple transverse sections of the fistula

Transverse section the fistula limit

Figure 7.3. Fistula-in-ano.

Anal canal carcinoma if resected will either be because of recurrent or extensive disease in the context of abdominoperineal resection or pelvic exenteration specimens where the tumour spread may be partially masked by fibrotic radio-/chemotherapy changes. For general comments see Gastrointestinal Specimens - Colorectum (Chapter 5) and Pelvic Exenterations Specimens (Chapter 34).

Specific points of note in abdominoperineal resection for anal canal carcinoma are:

• open the canal longitudinally with blunt-ended scissors on the opposite side of the tumour having previously painted the external CRM.

• the tumour is frequently submucosal ± overlying mucosal ulceration. Pale and variably fleshy to scirrhous in character, pigmentation and rubbery/fleshy qualities should raise the possibility of malignant melanoma or leiomyosarcoma, respectively. Mucinous carcinoma may occur in a fistula while anal gland carcinoma is also submucosal and sclerotic.

• the relationships and distances (mm) to the anal margin/perianal skin and anorectal dentate line.

• upward or downward spread to the lower rectum and perianal skin, respectively.

• the extent of mucosal/mural/extramural spread and distances (mm) to the nearest longitudinal and radial margins (perianal skin, site-orientated apsect of the CRM). Note that the CRM comprises a tube of perianal levator musculature which also forms a tight neck or constriction at its junction with the lower edge of the mesorectum.

• serially section the tumour transversely at 3-4 mm intervals. Sample a minimum of four blocks of tumour and wall to show the deepest point of invasion in relation to the painted

CRM. Sample a longitudinal block of tumour and proximal/distal limit if close (< 0.5-1 cm) to it.

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