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UNASSIGNED: The ingestion of jujube pits by children is a rare cause of perianal infection.This article aimed to report two cases of perianal infection in children resulting from the ingestion of jujube pits.
UNASSIGNED: We reviewed the clinical records of perianal infection caused by jujube pits at our hospital. Details of the patients\' presentation, imaging studies, complications and treatment were recorded.
UNASSIGNED: Both pediatric patients presented with perianal swelling and pain. The caregivers of both patients denied a history of jujube consumption. Magnetic resonance imaging (MRI) indicated the presence of jujube pits, which were subsequently removed during surgery. Postoperatively, both patients recovered well, and follow-up showed no recurrence or the formation of anal fistulas.
UNASSIGNED: The ingestion of jujube pits leading to perianal infection is rare and inconspicuous. Early diagnosis and treatment are beneficial in preventing the occurrence of serious complications.

UNASSIGNED: Gastrointestinal stromal tumor (GIST) is rare because of its variable clinical incidence reported (from 0.4 to 2/100,000 per year) in the literature, mainly occurs primarily in the stomach and small intestine. GISTs in the perianal and perineal regions have been reported in a few pieces of literature. GIST located in the perianal and perineal regions may be misdiagnosed and missed due to atypical symptoms. We report two cases of GIST in rare sites and hope to reduce the occurrence of such events through a review of the relevant literature.
METHODS: We reported two cases of GIST located in the perianal and perineal regions with different symptoms. One case underwent an emergency procedure to stop bleeding and resect the mass, and the other case was discovered during the physical examination and slowly grew in the follow-up. Following the completion of the relevant examination, the patient underwent surgical resection. Both cases were finally diagnosed as GIST by immunohistochemistry.
UNASSIGNED: Due to atypical clinical symptoms of perianal and perineal GIST, definitive diagnosis depends on pathology and immunohistochemistry, which can lead to misdiagnosis and missed diagnosis. Surgical resection is the preferred option for localized masses. Surgical resection of GIST located in the perianal and perineal regions requires an appropriate surgical approach based on the patients\' actual condition, taking into account the protection of anal function and complete resection of the mass. Masses located in perianal and perineal region should be taken seriously by clinicians.

Perianal skin Paget disease (PPD) is an unusual subtype of extramammary Paget disease, which is usually caused by a primary intraepithelial adnexal tumor and secondary spread from colorectal adenocarcinoma. The reports of secondary PPD associated with non-invasive colorectal adenoma are rare. We report a rare case of non-invasive colorectal-adenoma-associated PPD. In this case, the intraepithelial Paget cells of perianal skin manifested with colorectal phenotype by immunohistochemistry, and adjacent adenomas had high-grade intraepithelial neoplasia but not invasion. Although this is a rare manifestation of PPD, understanding this phenomenon is important to prevent overdiagnosis and invasive overtreatment. Clinical management is variable and, therefore, close follow-up examination is necessary.

BACKGROUND: Recent studies have confirmed that combined surgery and anti-TNF therapy could improve outcomes in patients with perianal fistulising Crohn\'s disease (PFCD). However, the optimal timing for infliximab infusion after surgical intervention is uncertain. We aimed to determine the long-term efficacy of early initiation of infliximab following surgery among PFCD patients.
METHODS: We performed a retrospective cohort study of PFCD patients who received combined infliximab and surgical treatment between 2010 and 2018 at a tertiary referral hospital. Patients were grouped according to the time interval between surgery and infliximab infusion, with < 6 weeks into early infliximab induction group and > 6 weeks into delayed infliximab induction group. The primary outcome was to compare surgical re-intervention between early and delayed infliximab induction groups. The secondary outcomes were fistula healing and predictors associated with these outcomes of early infliximab induction approach.
RESULTS: One hundred and seventeen patients were included (73 in early infliximab induction, 44 in delayed infliximab induction). The median interval between surgery and infliximab initiation was 9.0 (IQR 5.5-17.0) days in early infliximab induction group and 188.0 (IQR 102.25-455.75) days in delayed infliximab induction group. After followed-up for a median of 36 months, 61.6% of patients in early infliximab induction group and 65.9% in delayed infliximab induction group attained fistula healing (p = 0.643). The cumulative re-intervention rate was 23%, 32%, 34% in early infliximab induction group and 16%, 25%, 25% in delayed infliximab induction group, at 1, 2, and 3 years respectively (p = 0.235). Presence of abscess at baseline (HR = 5.283; 95% CI, 1.61-17.335; p = 0.006) and infliximab maintenance therapy > 3 infusions (HR = 3.691; 95% CI, 1.233-11.051; p = 0.02) were associated with re-intervention in early infliximab induction group. Presence of abscess at baseline also negatively influenced fistula healing (HR = 3.429, 95% CI, 1.216-9.668; p = 0.02).
CONCLUSIONS: Although no clear benefit was shown compared with delayed infliximab induction group, early initiation of infliximab after surgery could achieve promising results for PFCD patients. Before infliximab infusion, durable drainage is required for patients with concomitant abscess or prolonged infliximab maintenance therapy.

BACKGROUND: Superficial CD34-positive fibroblast tumors (SCPFTs) are newly recognized fibroblast and myofibroblast tumors representing intermediate tumors. To the best of our knowledge, fewer than 50 cases have been reported. Perianal SCPFT has not been previously reported.
METHODS: A 55-year-old man was hospitalized upon discovering a painless perianal lump 10 d prior. Physical examination showed a lump of approximately 3 cm × 4 cm in the 7 to 8 o\'clock direction in the perianal area. Perianal abscess was considered the primary diagnosis. Lump removal surgery was performed under epidural anesthesia. Postoperative pathology showed a well-circumscribed, soft tissue-derived, spindle-cell tumor with strong CD34 positivity by immunohistochemistry. The final diagnosis was perianal SCPFT. There were no complications, and the patient was followed for more than 8 mo without recurrence or metastasis.
CONCLUSIONS: We report a case of perianal superficial CD34-positive fibroblast tumor. This rare mesenchymal neoplasm has distinctive histomorphology, which is important for diagnosis. Comprehensive consideration of clinical information, imaging, histology, and immunohistochemistry is important for diagnosis.

BACKGROUND: Perianal/perineal rhabdomyosarcomas (PRMS) are easily misdiagnosed soft tissue tumours with a poor prognosis. This study was designed to analyze the clinical, diagnostic, pathological and prognostic features of PRMS, and to explore currently available therapeutic modalities.
METHODS: Clinical data of PRMS patients admitted to the Sixth Affiliated Hospital and the Cancer Center of Sun Yat-sen University and from related Chinese literature published from 1987 to 2018 were collected and analyzed. The Chi-square test was used to evaluate the differences between each group. The Kaplan-Meier methods were applied to estimate and compare survival rates.
RESULTS: A total of 35 patients were included in this study; 20 identified within related Chinese literatures and 15 from our center admitted during the period of 1997-2019. Out of these cases, 34 presented with perianal masses and the remaining one manifested as an inguinal mass. Moreover, 20 patients complained of pain and 16 of them were misdiagnosed as perianal abscesses, in which the presence of pain contributed to the misdiagnosis (p < 0.05). The average time interval between symptom onset and pathological diagnosis was 3.1 months. Next, 13 cases were classified into IRS group III/IV and 20 cases into stages 3/4. Additionally, 14 and 9 cases received the pathological diagnoses of embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma, respectively. Regarding the patients\' survival rates, five patients survived for more than 2 years, and three of them survived for more than 5 years. The overall 2 years and 5 years survival rates were 32% and 24%, respectively. The symptom of pain and misdiagnosis both contributed to the poor prognosis in these patients (p < 0.05). MRI showed that the PRMS were closely related to external anal sphincter in 10 cases.
CONCLUSIONS: PRMS are easily misdiagnosed lesions, which often leads to an unfavourable outcome in affected patients. Patients with painful perianal masses should be evaluated to exclude PRMS. MRI revealed that PRMS are closely related to the external anal sphincter. Multidisciplinary management is recommended in the treatment of PRMS.

BACKGROUND: Epidermoid cysts can be found at any location in the human body. However, perianal epidermoid cysts are extremely rare and only a few cases have been reported. As far as we know, there is no special literature on the value of contrast-enhanced computed tomography (CT) for the diagnosis of perianal epidermoid cysts.
METHODS: A 60-year-old male patient presented to the department of general surgery of PLA Strategic Support Force Characteristic Medical Center with the chief complaint of a mass in the perianal region gradually expanding for more than 30 years and perianal discomfort upon sitting for a preceding period of 2 mo. Physical examination revealed a painless mass in the left perianal region. Contrast-enhanced CT was used for preoperative diagnosis. The patient was treated by total mass excision under epidural anesthesia. Postoperative pathological examination revealed the presence of a perianal epidermoid cyst. The patient showed a satisfactory recovery during the 6-month follow-up period.
CONCLUSIONS: Contrast-enhanced CT may be a beneficial, useful, and convenient approach for assistance for preoperative diagnosis and surgical decision-making for patients with perianal epidermoid cysts.

Granular cell tumor (GCT) is a rare soft tissue neoplasm. At present, there is limited information available on the incidence, diagnosis, and treatment of GCTs. Therefore, we perform magnetic resonance imaging (MRI) of a perianal GCT case and review the literature of other reported cases to obtain a more comprehensive understanding of the disease. Here, we describe a rare case of perianal GCT in a 53-year-old female who presented with recurrent abdominal pain. Contrast-enhanced MRI demonstrated a well-defined perianal GCT mass, and the diagnosis was confirmed by immunostaining after mass excision. During a 10-month follow-up, there had been no evidence of recurrence. In addition, we discussed the findings of other perianal GCT cases, with regard to their age, gender, MRI analysis results, pathologic features, and treatment outcomes.

Ten patients with perianal necrotizing fasciitis were admitted to our department from June to December 2016. There were 8 men and 2 women among the patients, aged 42 to 69 years. Early and complete debridement surgery and comprehensive supportive treatment during perioperative period were carried out to quickly stabilize the patient\'s overall condition, and wounds were sutured directly or repaired with autologous scalps and or adjacent local random flaps. After debridement, wound areas ranged from 10 cm×8 cm to 54 cm×21 cm, and area of the flap was about 8 cm×5 cm. The donor site of flap was sutured directly. After the operation, all skin grafts and the flap survived, and wounds of all patients healed. During follow-up of six months to one year, there was no recurrence of perianal necrotizing fasciitis, and functions of the involved lower extremities didn\'t be influenced.
2016年6—12月，笔者科室收治10例肛周坏死性筋膜炎患者，其中男8例、女2例，年龄42～69岁，采取早期彻底清创及围手术期综合支持治疗迅速稳定患者全身状况，直接缝合或采用自体头皮和/或邻近局部随意皮瓣转移封闭创面。清创后创面面积10 cm×8 cm～54 cm×21 cm，皮瓣面积约8 cm×5 cm，供瓣区直接拉拢缝合。术后所有患者移植皮片、皮瓣均成活，创面完全愈合。随访6个月～1年，肛周坏死性筋膜炎均无复发，受累下肢功能不受影响。.