Anal Canal Carcinoma with Pagetoid Spread: Report of a Case

Abstract

A 70-year-old man with a history of colon polyps was found to have a semipedunculated polyp in the anal canal. The patient was asymptomatic. The lesion was 14 mm in diameter and located 5 mm from the dentate line. Histological examination of biopsy specimens revealed well-differentiated adenocarcinoma of the anal canal. During transanal local excision of the tumor, an abnormality of the perianal skin was recognized. Although intraoperative frozen section of the perianal skin did not show malignancy, permanent sections of the perineal skin revealed Paget's cells in the epidermis. Pathological examination of the anal canal carcinoma revealed submucosally invasive well-differentiated adenocarcinoma with a positive distal surgical margin. Thus, we performed additional wide local excision of the perianal skin including the distal margin of the previous local excision. Pathological examination revealed continuance within the epidermis between the anal canal adenocarcinoma and Paget's cells in the perianal skin lesion. Scattered Paget's cells also formed some glandular structures. Thus, we concluded that the perianal skin lesion was Pagetoid spread of anal canal adenocarcinoma. This report shows that the perianal skin should be examined carefully in patients with anal canal carcinoma.

Stop routine screening for associated malignancies in cutaneous noninvasive vulvar Paget disease?

“…Therefore, some consider primary noninvasive VPD to be the only 'true' VPD, and secondary VPD a 'pagetoid phenomenon'. [6][7][8][9] In the late 19th century, skin lesions like the nipple ulceration associated with breast cancer became known as extramammary Paget disease (EMPD). [10][11][12] The histological characteristics of EMPD resemble those of mammary Paget disease, raising the suspicion of a comparable pathogenesis.…”

“…Some consider VPD secondary to intestinal or urological malignancies a pagetoid spread rather than a separate entity. Therefore, some consider primary noninvasive VPD to be the only ‘true’ VPD, and secondary VPD a ‘pagetoid phenomenon’ …”

Recurrence with pagetoid spread arising 17 years after surgery for intramucosal rectal cancer: a case report

“…Such spread, therefore, is referred to as pagetoid spread [ 11 ]. Some case reports describe anorectal carcinoma with pagetoid spread [ 12 , 13 ]; however, most of those cases were synchronous primary anorectal cancer. To the best of our knowledge, metachronous recurrence rectal cancer with pagetoid spread has never been reported previously.…”

Double anal canal cancers associated with a long history of perianal Paget’s disease: report of a case

“…Shutze and Gleysteer [16] proposed a staging classification for perianal Paget's disease with a description of each stage and the recommended therapy (Table 1). Treatment is essentially surgical, with wide local excision the preferred approach for noninvasive, locally confined disease [13,[17][18][19][20][21][22].…”