Wu Sheng-Wei, Rong Yao, Chen Gui-Jin, Cao Xu-Song, Xie Zheng-Yong, Wu Bei, Huang Hao-Chun, Wang Zhi-Wei, Wu Xiao-Xiang
Department of General Surgery, General Hospital of Southern Theater Command, Guangzhou 510000, Guangdong Province, China.
World J Gastrointest Surg. 2025 Aug 27;17(8):108963. doi: 10.4240/wjgs.v17.i8.108963.
Anal canal adenocarcinoma with secondary perianal Paget's disease (PPD) is clinically rare and exhibits atypical symptoms, often misdiagnosed as benign conditions such as hemorrhoids or perianal eczema, leading to delayed treatment. Further summarization of diagnostic and therapeutic key points, as well as reasons for misdiagnosis, is necessary to enhance clinical awareness.
A retrospective analysis was conducted on a 72-year-old female patient with a 2-year history of perianal moisture, pruritus, and hematochezia, who was repeatedly misdiagnosed with mixed hemorrhoids. The diagnosis of anal canal adenocarcinoma with secondary PPD was confirmed through colonoscopy, perianal skin biopsy, and immunohistochemical staining (CK7, CK20, ). The patient underwent 3D laparoscopic-assisted abdominoperineal resection (APR) with extended perianal skin excision, achieving negative margins and primary wound healing. No recurrence or metastasis was observed during the 12-month follow-up.
Secondary PPD has a high misdiagnosis rate. Clinicians should maintain a high index of suspicion for elderly patients with prolonged perianal symptoms (, pruritus, hematochezia > 6 months) and promptly perform colonoscopy and immunohistochemical testing for definitive diagnosis. APR combined with extended perianal resection is an effective treatment, and standardized long-term follow-up is crucial for prognosis.
肛管腺癌伴继发性肛周佩吉特病（PPD）临床罕见，症状不典型，常被误诊为痔疮或肛周湿疹等良性疾病，导致治疗延误。进一步总结诊断和治疗要点以及误诊原因，对于提高临床认识很有必要。
对一名72岁女性患者进行回顾性分析，该患者有2年肛周潮湿、瘙痒和便血病史，多次被误诊为混合痔。通过结肠镜检查、肛周皮肤活检及免疫组化染色（CK7、CK20）确诊为肛管腺癌伴继发性PPD。患者接受了3D腹腔镜辅助腹会阴联合切除术（APR）并扩大切除肛周皮肤，切缘阴性，原发伤口愈合。随访12个月期间未观察到复发或转移。
继发性PPD误诊率高。临床医生应对有长期肛周症状（如瘙痒、便血>6个月）的老年患者保持高度怀疑，并及时进行结肠镜检查和免疫组化检测以明确诊断。APR联合扩大肛周切除术是一种有效的治疗方法，规范的长期随访对预后至关重要。
