Zen Yumi, Kojima Masatsugu, Miyake Toru, Tani Soichiro, Iida Hiroya, Kaida Sachiko, Takebayashi Katsushi, Maehira Hiromitsu, Yamaguchi Tsuyoshi, Onoda Shiori, Kushima Ryoji, Shimizu Tomoharu, Tani Masaji
Dept. of Surgery, Shiga University of Medical Science.
Gan To Kagaku Ryoho. 2023 Apr;50(4):487-489.
A man in his 80s was referred to our hospital with the chief complaint of perianal erosion. Colonoscopy revealed a peripheral flat lesion in the anal canal. Since immunohistological examination showed positive for CK20 and negative for GCDFP15, we made a preoperative diagnosis of anal canal cancer with Pagetoid spread. It was diagnosed as cT1bN0M0, cStage Ⅰ by TNM classification, and laparoscopic abdominoperineal resection with TpTME was performed. Negative biopsy of the perianal skin was confirmed both preoperation and during the operation. The postoperative course was uneventful, and no urinary dysfunction was observed. The patient was discharged 15 days after the operation. The histopathological diagnosis was negative margin. The patient is alive without recurrence 1 year after the operation. Adenocarcinoma of anal canal with Pagetoid spread is rare, and differentiation from Paget's disease is important for determining treatment policy. By conducting a detailed examination of the extent of tumor progression and using TpTME together, it was possible to perform surgery that both secured the CRM and preserved urinary function.
一名80多岁的男性因肛周糜烂为主诉被转诊至我院。结肠镜检查发现肛管有一外周扁平病变。由于免疫组织学检查显示细胞角蛋白20（CK20）阳性，乳腺珠蛋白15（GCDFP15）阴性，我们术前诊断为伴有派杰样扩散的肛管癌。根据TNM分类，诊断为cT1bN0M0，cⅠ期，并行腹腔镜腹会阴联合切除术及全直肠系膜切除术（TpTME）。术前及术中均证实肛周皮肤活检阴性。术后病程顺利，未观察到排尿功能障碍。患者术后15天出院。组织病理学诊断切缘阴性。术后1年患者存活且无复发。伴有派杰样扩散的肛管腺癌罕见，与佩吉特病相鉴别对于确定治疗策略很重要。通过详细检查肿瘤进展范围并联合使用TpTME，有可能实施既确保环周切缘阴性又保留排尿功能的手术。
