Anal Cancer with Pagetoid Spread—A Case Report

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 84; no. 7; pp. 1070 - 1075
• Main Authors: KOMATSU, Shigeki, IMAIZUMI, Ken, SATO, Aya, YAMANA, Daisuke, KASAJIMA, Hiroyuki, MUNAKATA, Satoru, SHIMOYAMA, Norihiko, NAKANISHI, Kazuaki
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2023
• Subjects: adenocarcinoma; anal cancer; pagetoid spread
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.84.1070

A 77-year-old male visited our department with an anal mass. Digital examination revealed a protuberant tumor in the anal canal, and biopsy provided a diagnosis of mucinous adenocarcinoma. No obvious gross changes were observed on the perianal skin. The preoperative assessment was Stage I (T2N0M0). Laparoscopic abdominoperineal resection with D3 lymph node dissection was performed. As the tumor was a mucinous adenocarcinoma, the perianal skin was resected with a margin of approximately 3 cm from the anal verge. Pathological examination revealed the infiltration of Paget-like cells into the epidermis surrounding the tumor. Immunostaining revealed CK7- and CK20-positivity, and was negative for GCDFP-15 ; therefore, the patient was diagnosed with anal adenocarcinoma with pagetoid spread. The size of the pagetoid lesion that had spread to the anal side was 2 cm. No tumor cells were observed in the distal resection margins. The pathological assessment was stage IIIc (T3N2bM0). Postoperative adjuvant chemotherapy was administered, and the patient survived without recurrence. The possibility of pagetoid spread must be considered when treating cancers of the anal canal. It is important to secure sufficient resection margins, even if a preoperative diagnosis of pagetoid spread cannot be made due to poor perianal skin findings.