Bamba Yuta, Nakano Masato, Shimada Yoshifumi, Yamai Daisuke, Matsumoto Akio, Tajima Yosuke, Nakano Mae, Muneoka Yusuke, Ishikawa Hirosuke, Kano Yosuke, Miura Kohei, Ichikawa Hiroshi, Takizawa Kazuyasu, Sakata Jun, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1455-1457.
A woman in her 60s had been aware of perianal erosions for 1 month. Skin biopsy showed Paget's cells in the stratified squamous epithelium, and immunohistochemistry showed negative staining for CK7 and positive staining for CK20. Colonoscopy revealed well-differentiated adenocarcinoma in the anal canal. Computed tomography showed neither regional lymph node metastasis nor distant metastasis. Hence, she was diagnosed with anal canal carcinoma with pagetoid spread. We determined the extent of resection of the skin lesion preoperatively by mapping biopsy, and performed laparoscopic abdominoperineal resection. The pathological findings revealed adenocarcinoma(tub1, tub2), and the skin resection margin was negative. Immunohistochemistry for Paget's cells in the stratified squamous epithelium showed negative staining for GCDFP-15 and CK7, and positive staining for CK20. Twenty-four months after surgery, we detected right inguinal lymph node metastasis and performed right inguinal lymphadenectomy. As of 4 months after the lymphadenectomy, no local recurrence or distant metastasis has been detected during follow-up examinations.
一名60多岁的女性肛周糜烂已有1个月。皮肤活检显示复层鳞状上皮中有佩吉特细胞，免疫组化显示CK7染色阴性，CK20染色阳性。结肠镜检查显示肛管有高分化腺癌。计算机断层扫描显示无区域淋巴结转移及远处转移。因此，她被诊断为伴有派杰样扩散的肛管癌。我们通过定位活检术前确定了皮肤病变的切除范围，并进行了腹腔镜腹会阴联合切除术。病理结果显示为腺癌（tub1、tub2），皮肤切缘阴性。复层鳞状上皮中佩吉特细胞的免疫组化显示GCDFP-15和CK7染色阴性，CK20染色阳性。术后24个月，我们检测到右腹股沟淋巴结转移并进行了右腹股沟淋巴结清扫术。截至淋巴结清扫术后4个月，随访检查未发现局部复发或远处转移。
