Synchronous squamous cell carcinoma of rectum and anal canal- a rare entity

Abstract

Rectal squamous cell carcinoma (SCC) is a rare entity whereas anal SCC is the most common malignancy of the anal canal. We discuss a case of 78 year old man who presented to us with 2-month history of altered bowel habits and anorexia. On evaluation, by digital rectal examination there were two growths one at 2 cms and another at 8 cms from anal verge. Multiple biopsies were negative for malignancy. He underwent PET/CT scan which confirmed one mid-rectal and another anal canal growth with high SUV uptake, suspicious of malignancy. He underwent a laparoscopic abdomino-perineal resection and the final histopathology showed synchronous rectal and anal SCC. This is only the second case of synchronous rectal and anal SCC reported in English literature. We discuss the challenges faced in the diagnosis and management of this case.

Case report of unusual synchronous anal and rectal squamous cell carcinoma: clinical and therapeutic lesson

“…The insurgence of SCC in the lower gastrointestinal tract is rare, with most of the tumors originating from the squamous epithelium of the anal canal ( 2 ). Primary SCC from the colon and rectum are rare, representing less than 1% of colorectal malignancies ( 1 – 5 ). So far, while different theories have been proposed, the etiology of rectal SCC is still debated ( 1 , 2 ).…”

“…In a large population of 142 patients diagnosed between 1946 and 2015, the median age was 63, with a predominance in women and in diagnosis in the early stage compared with advanced disease. The presence of synchronous rectal and anal SCC is an uncommon condition, and to date, only two cases were described in the literature ( 4 , 5 ). The first one was a 48-year-old man with an anal and a rectosigmoid SCC with type 2 diabetes as the only comorbidity; no history of smoking or alcohol consumption was described ( 4 ).…”

“…The second case was a 78-year-old man with a concurrent anal canal SCC and a rectal SCC ( 5 ). The patients had an anamnesis of heavy smoking, alcohol drinking, and opium consumption.…”

“…Thus, identification of the optimal treatment in this unusual presentation is challenging and has to be defined case by case. To date, only two cases of synchronous SCC of the rectum and anus are reported, and both were treated with up-front surgery ( 4 , 5 ). Here, we report the first case in the literature of a patient with synchronous SCC of the rectum and anus treated with definitive chemo-radiotherapy (CRT) without subjecting her to radical surgery.…”