Yamamoto Masahiro, Mizuuchi Yusuke, Tamura Koji, Sada Masafumi, Nagayoshi Kinuko, Nakata Kohei, Ohuchida Kenoki, Oda Yoshinao, Nakamura Masafumi
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Asian J Endosc Surg. 2023 Oct;16(4):747-752. doi: 10.1111/ases.13217. Epub 2023 Jun 18.
Pagetoid spread (PS) of anorectal cancer is relatively rare and associated with poor prognosis. While a primary tumorous lesion is usually obvious in most PS cases, we experienced two cases of nonmass-forming type anorectal cancer with PS. It remains challenging to decide strategies. In both cases, histological findings of a perianal skin biopsy showed proliferation of atypical cells that were positive for cytokeratin (CK) 7, CK20, and caudal type homeobox 2 and negative for Gross cystic disease fluid protein 15, suggesting PS. Abdominoperineal resection (APR) with extensive anal skin resection was performed in both patients. The pathological diagnosis in each was nonmass-forming type anorectal cancer with PS. Neither has experienced recurrence in postoperative courses. Even nonmass-forming type anorectal cancer with PS could have high malignant potentials. APR with lymph nodes dissection and wide skin excision and regular surveillance might be necessary.
肛管直肠癌的派杰样扩散（PS）相对少见且预后较差。虽然在大多数PS病例中原发性肿瘤病变通常很明显，但我们遇到了两例具有PS的非肿块形成型肛管直肠癌。制定治疗策略仍然具有挑战性。在这两例病例中，肛周皮肤活检的组织学结果显示非典型细胞增殖，细胞角蛋白（CK）7、CK20和尾型同源盒2呈阳性，而大囊性病液蛋白15呈阴性，提示为PS。两名患者均接受了腹会阴联合切除术（APR）并广泛切除肛门皮肤。每例的病理诊断均为具有PS的非肿块形成型肛管直肠癌。两名患者在术后过程中均未出现复发。即使是具有PS的非肿块形成型肛管直肠癌也可能具有较高的恶性潜能。可能有必要进行APR并清扫淋巴结、广泛切除皮肤并进行定期监测。
