Multi-institutional registration concerning the ciinicopathological characteristics, treatment and prognosis of squamous cell carcinoma (SCC) of anus and carcinoma in association with anal fistula, was performed before the 59th meeting of Japanese Society for Cancer of the Colon and Rectum (JSCCR) in 2003. The total number of anal malignancy cases was 1, 540. Adenocarcinomas or mucinous carcinomas were 1, 029 cases (66.8%). SCC were 226 cases (14.7%). The average age of SCC patients was 63.4. Male : female ratio was 1:2.25. Histologically, 50.4% of cases were moderately differentiated SCC and 24.4% were poorly differentiated SCC. Lymph node metastases were found in 47.6% of cases. Inguinal lymph node metastases were found in 25.0% of cases. Serum SCC antigen level was elevated in 52% of cases with stage II, III and IV. Treatments associated with abdominoperineal resection (APR) were performed in 68.4% of cases. The number of cases of radiotherapy or chemotherapy is increasing recently, and the five-year survival rate of SCC patients was 51.4% consequently. No significant difference was found between APR and the other treatments.
The average number of years of suffering anal fistula in anorectal carcinoma arising from anal fistula was 18.8 years. Histologically, 60.8% were mucinous adenocarcinoma. The five-year survival rate was 90.1% in stage 0 or I, 66.7% in stage II and 29.0% in stage III.

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Squamous cell carcinoma (SCC) of the anal canal is very rare. We report a case of SCC of the anal canal that was found in the pelvis by abdominal CT. The tumor was 0-IIc type SCC of the anal canal and the depth was submucosa. The pathological diagnosis was moderately differentiated SCC. We surgically resected the tumor by abdomino perineal resection (APR). The number of 251 lymph node metastasis was detected.

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We report a case of gangrenous ischemic enterocolitis associated with antihypertensive therapy for brain hemorrhage. A 65-year-old man was referred to us in April 2004 for brain hemorrhage with gait disorder. He had a history of untreated hypertension. When he visited our hospital, blood pressure was 212/107 mmHg. Antihypertensive therapy with continuous infusion of nicardipine chlorhydrate was started immediately after admission. Two days after the onset of brain hemorrhage, fever over 38°C, abdominal pain and signs of peritonitis appeared. Abdominal computed tomography showed thickening of the intestinal wall in the ileocecal region. Emergency surgery was performed. Ileocecal resection was done for the localizing necrosis in the cecum and terminal ileum. According to the macroscopic and histopathological findings of the resected specimen, the diagnosis of gangrenous ischemic enterocolitis was made. Abrupt decrease of blood pressure in the patient with arteriosclerosis might possibly promote ischemia in the intestinal wall. Therefore, attention should be paid to abdominal symptoms during antihypertensive therapy for brain hemorrhage.

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Several researchers have reported the possible association between colorectal cancer and schistosomiasis japonica. However, it remains to be determined whether this association is significant. We report a case of sigmoid colon cancer associated with schistosomiasis japonica and discuss the relationship between schistosoma japonica and the development of colorectal cancer from a review of the Japanese literature. An 82-year-old man was referred to our hospital because of bloody stool. He had worked as a fisherman for 30 years in an endemic schistosomal area. A tumor was detected in the sigmoid colon without distant metastases. Sigmoidectomy with lymph node dissection was performed. A type-1 tumor measuring 2.5 × 2 × 1.5 cm was revealed in the resected specimen. Histological findings demonstrated well differentiated adenocarcinoma with muscular invasion, moderately lymphatic vessel invasion and lymph node metastases (n1). Many calci-fied eggs of schistosomiasis japonica were also seen in the colonic wall of both the tumor and normal tissue, mainly in the submucosal layer. The eggs were more often seen in the tumor than in the normal tissue. The patient also underwent transanal local excision for rectal adenoma 16 months later and survived for 50 months after the initial operation without recurrence.

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We report a case of an 84-year-old man who underwent Hartmann's resection for rectal cancer and vis-ited our hospital with complaint of peristomal pain. The patient removed his stoma appliances frequently, thinking that the pain was caused by the pouching devices. Stomal stricture and peristomal hardness of the abdominal wall were detected by stomal digitalization. CT scan revealed a recurrence tumor of the abdominal wall. No other recurrent findings were seen at that time. Tumor resection and reconstruction of the abdominal wall and new stomal outlet with preoperative site-marking were made. The patient was alive at 24 months after the second operation with no evidence of disease and had good QOL. If peristomal pain occurs, close monitoring for para-stomal recurrence is recommended. Aggressive resection may improve the osto-mate's QOL ; furthermore, it is suggested that periodical examination for stomal estimation is very important.

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We describe a rare case of amebic colitis detected by colonoscopy without any gastrointestinal symptoms. A 62-year-old asymptomatic man who had a recent history of trips to Malaysia and China underwent a colonoscopy for further examination of the elevation of CEA levels. Colonoscopic examination demonstrated multiple shallow ulcers covered with a white layer in the cecum. The biopsied specimens revealed trophozoites of Entamoeba hystolytica and the anti Entamoeba hystolytica antibody was increased. He was treated with Metronidazole 500 mg per day orally for 14 days. The follow-up colonoscopic examination after three months revealed ulcer scars and the level of trophozoites on the biopsied specimens was negative.

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A 48-year-old man underwent incisional drainage three times at other institutions from 1996 for peri-anal abscess accompanied by a swollen right thigh. In January 1999, his right thigh became inflamed again with purulent discharge, and he was admitted to our department in April. Although an extensive fistulotomy was performed under the diagnosis of anal fistula extending to the right thigh, it recurred in March 2000. On the second admission in March 2001, two-step surgery was attempted. Firstly the anal fistula was drained with loose seton with the thigh abscess being drained and curetted on March 14. Histological examination of the resected specimen revealed actinomyces, and an antibiotic, cefazolin sodium, was administered. After the second operation on March 28, in which an anal fistulotomy was performed, no recurrence of the fistula developed.
Preoperative diagnosis of actinomycosis infection is extremely difficult because its detection rate by bacteriological culture or histological examination is not high. This infection, therefore, tends to recur because effective antibiotics combined with an appropriate surgery are rarely given. On treating a refractory anal fistula or perianal abscess as complicated as this case, actinomycosis infection should be considered as one of the possible causes.

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