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Neuroendocrine tumors of the colon and rectum
are also called hindgut carcinoids. They are slow growing and usually become symptomatic late in the course of the disease. Current incidence is about one per 100,000. Tumors are graded into three levels based on tumor cell proliferation. Appendiceal carcinoids are usually found incidentally on pathology following an appendectomy. Colonic NETs present late, as large tumors, often with extensive metastatic disease when the diagnosis is made. Rectal NETs can be found incidentally when patients are undergoing a colonoscopy but can present with hematochezia or anorectal symptoms like tenesmus. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Rupen Shah, Surya P.M. Nalamati Source Type: research

Neuroendocrine Tumors of the Colon & Rectum
are also called hindgut carcinoids. They are slow growing and usually become symptomatic late in the course of the disease. Current incidence is about 1 per 100000.Tumors are graded into three levels based on tumor cell proliferation. Appendiceal carcinoids are usually found incidentally on pathology following an appendectomy. Colonic NETs present late, as large tumors, often with extensive metastatic disease when the diagnosis is made. Rectal NETs can be found incidentally when patients are undergoing a colonoscopy, but can present with hematochezia or anorectal symptoms like tenesmus. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Rupen Shah, Surya P.M. Nalamati Source Type: research

Colorectal Lymphoma
Lymphoma of the colon and rectum is rare clinical entity that comprises only 0.2% of large intestinal malignancies. The gastrointestinal tract is the most common site of extranodal lymphoma involvement. Among colorectal lymphoma, over 70% are found proximal to the hepatic flexure. The most common presenting symptoms are abdominal pain and weight loss, which are non-specific findings. Lower GI bleeding and perforation are rare. Diffuse large B-cell lymphoma is the most common histologic subtype followed by mucosa-associated lymphoid tissue (MALT ) lymphoma. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Benjamin Green, Shankar Raman Source Type: research

Epidermoid Cancers of the anal canal
Squamous cell cancer of the anal canal continues to be a rare cancer. Recently, the incidence has been slowly rising in part due to longer term HIV survivors and in part due to high prevalence of HPV. Early detection and treatment in these high risk groups is imperative to increasing the survival of the disease. Chemoradiation remains the standard of care for primary therapy reserving surgical resection for salvage. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Shawn Webb Source Type: research

Retrorectal Tumors
Tumors that arise in the retrorectal, (presacral), space are uncommon lesions. Diagnosis and management remain difficult. These tumors present with nonspecific signs and symptoms thereby leading to a difficulty in diagnoses. For complete evaluation of the lesion cross sectional imaging, most importantly MRI is required, for diagnostic purposes, and can determine between benign and malignant lesions, as well as the extent of resection. MRI is also utilized to determine the most appropriate surgical approach. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Jeffrey A. Neale Source Type: research

Premalignant Neoplasms of the Anus and Perianal Skin
Squamous cell carcinoma of the anal canal is preceded by a spectrum of premalignant lesions known as anal intraepithelial neoplasia (AIN). AIN is caused by infection with the human papilloma virus (HPV), and the pathogenesis mimics that of cervical cancer. It is most commonly associated with HIV infection and high risk sexual behavior. Symptoms of AIN may mimic benign processes. Multiple screening approaches exist for detecting HPV and dysplasia, but so far this is no standard algorithm. Several treatment options for AIN exist, although recurrence remains high. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Andrew Raissis, Juan Lucas Poggio Source Type: research

Squamous cell carcinoma of the anal margin
 is a rare disease. Accurate clinical staging with physical exam and imaging is important and determines the treatment.  Evidence based management is challenging because there is a paucity of randomized controlled trials and existing literature seldom distinguishes between anal canal and margin tumors. In this article, we review the anatomy, presentation, classification, and clinical management of squamous cell carcinoma of the anal margin. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Melissa Times Source Type: research

Colonic Lipomas and Liposarcomas
Gastro-intestinal lipomas are benign rare adipose tissue tumors, most frequently seen in the submucosal layer of the colon. They are often small and asymptomatic although larger tumors may become symptomatic and pose a diagnostic challenge. Colonoscopy is reliable for the diagnosis of a typical lipoma, but the endoscopic appearances may be worrisome especially when the lesion is atypical, ulcerated or bleeding. CT and MRI Imaging may reveal the signal and uptake of adipose tissue but a confident diagnosis may not be possible. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 27, 2015 Category: Gastroenterology Authors: Nasrin Ghalyaie, Eric J. Szilagy Source Type: research

Introduction
My first duty is to thank Dr. David Schoetz for the invitation to edit this edition of Seminars in Colon and Rectal Surgery, I sincerely appreciate the opportunity. This edition will review most of the least common tumors challenging physicians treating tumors of the colon, rectum, and anus; we specifically avoid discussion of colon and rectal adenocarcinoma. Several of these tumors are extremely rare and their management is very challenging, with limited evidence for both surgical and non-surgical treatments. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 24, 2015 Category: Gastroenterology Authors: Craig A. Reickert Source Type: research

Anorectal melanoma
is a rare and often aggressive malignancy of the anal canal that can be challenging to diagnose. After diagnosis, the main treatment is surgical resection. The current recommendations are to offer patients wide local excision whenever possible. However, there are situations where abdominoperineal resection is more appropriate. Other treatment options such as sentinel lymph node biopsy and adjuvant chemotherapy or radiation are also sometimes advised, but there is not substantial data to support this. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - January 24, 2015 Category: Gastroenterology Authors: Amalia J. Stefanou Source Type: research

Transanal excision of benign rectal polyps: Indications, technique, and outcomes
Due to screening programs, rectal polyps are increasingly observed nowadays. Mostly, these are adenomas, which can contain or develop into invasive rectal carcinoma. All rectal adenomas should therefore be completely removed. Transanal endoscopic microsurgery is currently the treatment of choice for large rectal adenomas. This review will discuss the current literature regarding the pre-operative workup and staging of rectal adenomas considered for transanal excision, technical considerations, surgical outcomes as well as alternative approaches. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 22, 2014 Category: Gastroenterology Authors: Mark Gerrit van Vledder, Pascal Gabriël Doornebosch, Eelco Jan Rade de Graaf Source Type: research

Introduction
In the nearly 10 years since Seminars in Colon and Rectal Surgery last covered the topic of local excision, there has been an explosion of new interest in transanal surgery. There are many factors driving this including widespread adoption of minimally invasive, laparoscopic skills, suboptimal oncologic results following standard transanal resection, increased utilization of transanal endoscopic surgery, greater interest in organ sparing surgeries, increased recognition of quality of life measures following transanal and radical surgeries, and incorporating multimodality therapies such as neoadjuvant chemoradiotherapy to e...
Source: Seminars in Colon and Rectal Surgery - October 22, 2014 Category: Gastroenterology Authors: Mark H. Whiteford Source Type: research

Conventional Transanal Excision: Current Status and Role in the Era of Transanal Endoscopic Surgery
Conventional transanal excision as originally described by Parks has been used for the local excision of both benign and malignant lesions of the rectum. Radical resections for rectal lesions are associated with higher perioperative morbidity and mortality including sexual and urinary dysfunction. Despite references to transanal resection of lesions up to 12cm from the dentate line, transanal endoscopic techniques originally developed by Buess in the 1980s afford much better visualization of the upper and middle rectum. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 22, 2014 Category: Gastroenterology Authors: Negar M. Salehomoum, Juan J. Nogueras Source Type: research

Transanal excision of benign rectal polyps Indications, technique and outcomes
Due to screening programs rectal polyps are increasingly observed nowadays. Mostly, these are adenomas, which can contain or develop into invasive rectal carcinoma. All rectal adenomas should therefore be completely removed. Transanal endoscopic microsurgery is currently the treatment of choice for large rectal adenomas. This review will discuss the current literature regarding the pre-operative work-up and staging of rectal adenomas considered for transanal excision, technical considerations, surgical outcomes as well as alternative approaches. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 22, 2014 Category: Gastroenterology Authors: M.G. van Vledder, P.G. Doornebosch, E.J.R. de Graaf Source Type: research

Predicting the Risk of Lymph Node Metastasis in Early Rectal Cancer
As surgery for rectal cancer progresses to less invasive approaches there is increasing interest in local excision techniques. Paired with this is the progress of surgical techniques to achieve local excision. From traditional transanal excision techniques we have progressed to Transanal Endoscopic Microsurgery (TEM), Transanal Minimally Invasive Surgery (TAMIS) and potentially transanal radical resection. The Achilles’ heel of local excision for rectal cancer is the inability to assess lymph node status in the mesorectum. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - October 22, 2014 Category: Gastroenterology Authors: Joseph L. Frenkel, John H. Marks Source Type: research