PMC6718921_01
Endoscopic findings.. Type 2 tumor found in the anal canal.
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On endoscopy, a type 2 lesion was found in the anal canal (Fig. 1), and on pathology, a diagnosis of SCC in the anal canal was made.
Abdominal contrast-enhanced CT findings.. a: The mass with enhancement detected at the anal canal (white arrow).. b: An enlarged left inguinal lymph node (white arrow).
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The abdominal contrast-enhanced CT indicated that the mass was at the anal canal; swollen lymph node of left supraclavicular, left inguinal, and left external iliac lesions were also detected (Fig. 2a, b), and no evidence of liver and lung metastasis was noted.
PET findings.. a, b: PET revealed an accumulation of FDG in the anal canal mass and left inguinal lymph nodes (white arrow head) which were detected by CT.
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A Positron Emission Tomography (PET) scan revealed an accumulation of fludeoxyglucose (FDG) (11.5 F) in the anal canal and another mild accumulation of FDG (2.0 F) in the left inguinal lymph nodes (Fig. 3a, b).
Macroscopic findings.. Type 2 tumor encircling the wall found in the anal canal (white arrow).
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Macroscopically, a type 2 tumor was found all around the wall of the anal canal. (Fig. 4).
Histopathological findings.. a: The tumor nuclei of different sizes and intercellular bridge led to a diagnosis of poorly differentiated squamous cell carcinoma (Hematoxylin-eosin stain, original magnification x200).. b: Tumor cells were positive for p63 (marker of basal cells) (original magnification x200).
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An immunohistochemical staining revealed that the tumor was positive for cytokeratin 5/6 and p63 (Fig. 5a, b).
Abdominal contrast-enhanced computed CT findings 3 weeks after surgery.. a-c: Few low-density areas with irregular peripheral rim enhancement in the liver.. d: 3/4th of lumbar spine melted.. e: Multiple pulmonary nodules detected bilaterally (white arrow).
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Multiple liver abscesses were initially suspected due to fever and elevation of inflammatory marker levels; however, whole body CT revealed melting of vertebral bodies, multiple lung nodule, and enlargement of the right inguinal lymph node (Fig. 6a-e), which suggested distant metastasis from anal SCC.
a-c PET findings after surgery.. PET demonstrated an accumulation of FDG in the pelvic, lung, liver and vertebral body.
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PET-CT demonstrated an accumulation of FDG in the pelvis, lung, liver, vertebral body, and right inguinal lymph nodes (Fig. 7a-c).
The liver biopsy findings.. The liver biopsy necrosis similar to the tumor cells (Hematoxylin-eosin stain, original magnification x400).
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The cytology of liver drainage and liver biopsy revealed metastatic SCC with necrosis (Fig. 8).
Abdominal contrast-enhanced CT findings 3 months after surgery Liver and lung metastases rapidly increased in size.
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Although she underwent chemotherapy for 2 courses, abdominal contrast-enhanced CT 3 month after surgery revealed liver and lung metastasis with increasing size (Fig. 9).