Pagetoid Spread with Anal Canal Poorly differentiated Adenocarcinoma: A Case Report

Fumie Ikezawa, Koh Miura, Chikashi Shibata, Hitoshi Ogawa, Kazuyuki Ishida*, Toshinori Ando, Atsushi Oyama, Kohei Fukushima and Iwao Sasaki

Department of Surgery, Division of GI and Colorectal Surgery and Department of Pathology*, Tohoku University hospital

A 53-year-old man whose pruritus ani was diagnosed by a dermatologist as Paget's disease and referred for further confirmation was found in total colonoscopy to have a tumor of the anal canal. Biopsies of the erythematous perianal skin lesion and the anal canal tumor showed anal canal adenocarcinoma with pagetoid spread, necessitating abdominoperineal resection with wide excision of the perianal skin. Pathology results showed that poorly differentiated and signet-ring cell adenocarcinoma in the anal canal invaded the muscularis propria and Paget cells occupied the perianal epidermis. Immunohistochemical staining was positive for cytokeratin (CK) 20, but negative for CK7 and gross cystic disease fluid protein 15 (GCDFP-15). The definitive diagnosis was anal canal adenocarcinoma with pagetoid spread. Although 42 cases, including ours, of rectal and anal adenocarcinoma with pagetoid spread have been reported, the prognosis remains unknown, making it essential to closely observe perianal skin changes and to biopsy skin lesions.

Key words
pagetoid spread, anal canal cancer

Reprint requests
Fumie Ikezawa Department of Surgery, Division of GI and Colorectal Surgery, Tohoku University Hospital
1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
September 16, 2009

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