A Case of Anal Canal Adenocarcinoma associated with Perianal Pagetoid Spread Lacking Connection within the Epidermis

Yota Yamagishi, Yuji Okada, Masakazu Isikawa, Akira Mizuno and Kouichi Katano*

Department of Surgery and Department of Internal Medicine*, Inabe General Hospital

A 78-year-old woman with perianal itching not relieved by topical steroid treatment was found in physical examination to have a circular 8×9 cm elevated eroded lesion around the anus. Punch biopsy showed perianal Paget's disease. Barium enema and colonoscopy showed a 3×3 cm anorectal tumor proving on biopsy to be well-differentiated adenocarcinoma. Based on a preoperative diagnosis of anal canal adenocarcinoma associated with perianal Pagetoid spread, we conducted abdominoperineal resection of the rectum with D2 lymphadenectomy, accompanied by reconstruction of the perianal skin defect using an abdominal rectal muscle flap, maintaining a wide skin excision for an appropriate margin around the perianal lesion. Pathology showed well-differentiated adenocarcinoma, Isp, sm2, ly2, v0, n1, stage IIIa. Although Pagetoid cells were present in the epidermis and metastasizing adenocarcinoma was present within the dermal lymphatics, no connection was demonstrated between epidermal Pagetoid cells and anorectal adenocarcinoma. We hypothesized that adenocarcinoma infiltrated the lymphatics in the perianal dermis and induced a pattern of Pagetoid spread lacking connection within the epidermis. To the best of our knowledge, this is the first report of Pagetoid spread of anorectal adenocarcinoma.

Key words
anal canal cancer, perianal Pagetoid spread

Reprint requests
Yota Yamagishi Department of Surgery, Inabe General Hospital
771 Ageki, Hokusei-cho, Inabe, 511-0428 JAPAN

Accepted
September 16, 2009

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