A Case of Early Anorectal Carcinoma Associated with Pagetoid Spread that Recurred to the Liver and the Inguinal Lymph Node

Satoshi Hayama¹⁾²⁾, Takayuki Morita¹⁾, Miyoshi Fujita¹⁾, Naoto Senmaru¹⁾, Yuji Miyasaka¹⁾and Hiroyuki Kato²⁾

Department of Surgery, Hokkaido Gastroenterology Hospital¹⁾ Second Department of Surgery, Hokkaido University School of Medicine²⁾

A 67-year-old man came to our hospital complaining of anal pain and bleeding on defecation. An anorectal tumor was detected, and transanal excision was performed. The histological findings indicated that further operation was needed, and abdominoperinineal resection of the rectum was performed. Histologically, the tumor was poorly differentiated adenocarcinoma associated with pagetoid spread and had infiltrated into the submucosal layer. The CEA values continuously increased beginning 1 year after the operation, and 6 months later, bilateral swelling of the inguinal lymph nodes and a tumor shadow in S7 of the liver were detected by CT. Partial resection of the liver and dissection of the inguinal lymph nodes were performed.
Histological analysis revealed that the tumors had metastasized from the anorectal carcinoma. No signs of recurrence have been detected during the 1 year and 6 months since the second operation.

Key words
early anorectal carcinoma, pagetoid spread, distant metastasis

Reprint requests
Satoshi Hayama Second Department of Surgery, Hokkaido University School of Medicine Kita 14-jo Nishi 5-chome, Kita-ku, Sapporo 060-8638 JAPAN

Accepted
July 25, 2000

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