A case report of perianal paget's disease successfully treated with transanal sleeve resection and v-y flap reconstruction

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 69; no. 12; pp. 3223 - 3227
• Main Authors: INOUE, Yasuhiro, MORIMOTO, Yuki, MIKI, Chikao, KUSUNOKI, Masato, SENBA, Yuko, ITO, Yoshiyuki
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2008
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.69.3223

A 77-year-old man was admitted to our hospital because of perianal erythemia and anal pain. Despite Pagetoid cells with positive immunostaining for cytokeratin 20 (CK20) and negative immunostaining for gross cystic disease fluid protein 15 (GCDFP15), no rectal of anal tumors were detected. An occult malignancy was strongly suggested. So we performed wide local excision with transanal sleeve resection and reconstruction using a V-Y skin flap. The final histopathological diagnosis was primary rectal cancer with tub1, pM, ly0 and v0. Thus, the surgery resulted in anus-preserving curative operation. Perianal Paget's disease with CK20+/GCDFP15-phenotype generally suggests the presence of anorectal cancer. Transanal sleeve resection seems to be the appropriate treatment of choice, when perianal Paget's disease shows the CK20+/GCDFP15-phenotype without demonstrable evidence of rectal cancer preoperatively, like in our case.