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A 46-year-old male patient presented with complaint of painful bleeding and lumps in anal region since 3 months. He had undergone haemorrhoidectomy one year back. He didn't have any other co-morbid conditions. There was no history of smoking. Per rectal examination couldn't be done without anaesthesia since he had sphincter spasm. On evaluation under anaesthesia, the patient had a freely mobile, friable growth about 2 cm from the anal verge along posterior and the lateral wall. A biopsy was taken and the histopathological examination revealed small malignant cells with hyperchromatic nuclei and scanty cytoplasm with tumour invading the fibro-collagenous tissue with features of poorly differentiated malignancy [ Colonoscopy was done which showed lesion in the posterior and lateral wall measuring about 4cm and 2cm from anal verge. Rest of the colon appeared normal. CECT abdomen showed circumferential irregular wall thickening about 4cm proximal to anal verge with enlarged left inguinal, mesorectal and left internal iliac lymph node enlargement without perianal fat stranding [Table/ Fig-6a,b]. Chest X Ray showed no evidence pulmonary carcinoma. Bone scan was normal and tumour marker i.e., Carcinoembryonic antigen was not elevated. The patient was negative for HIV, HbsAg and HCV.Prognosis of the condition was explained to the patient along with the morbidity and mortality associated with surgery. After obtaining informed consent, Abdomino Perineal Resection (APR) was done with permanent end colostomy. Post-op he was admitted in ICU Anal canal malignancy is one of the dreadful conditions. Most of the anal canal malignancies are squamous cell carcinomas for which the treatment is well established and the prognosis is usually favourable. Small cell carcinoma of anal canal is a very rare condition and poorly understood, which can present as haemorrhoids in its early stages and has an aggressive course. We present a case of small cell carcinoma of anal canal who underwent Abdomino Perineal Resection (APR) and chemotherapy. He developed liver metastasis during the course of chemotherapy and succumbed to the condition 4 months later.