PMC6915020_01
Preoperative appearance of the mucinous adenocarcinoma.
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Physical examination showed a 3 cm plaque-like eczematous lesion, circumferentially involving the perianal skin and extending to the anal verge (Figure 1).
Pelvic MRI (T2W-TSE) showing invasion of the skin but not of the anal sphincters.
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A pelvic MRI showed that the lesion had invaded the skin tissue without involvement of perirectal structures and anal sphincters (Figure 2).
Intraoperative surgical field after resection of the lesion with the double V flap (arrows) marking drawn and the stiches placed on the margins of the anal mucosa (arrowheads).
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A double V marking was drawn, and the flaps were dissected with vascular pedicle preservation, based on random inferior gluteal perforator vessels and peripheral skin undermining (Figure 3).
(a, b) Histology of the perianal lesion showing a discontinuous spread of pagetoid cells (EE: 20x (a); 5x (b)).
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The pathological report was mucinous adenocarcinoma of the perianal skin involving the subcutaneous tissue with pagetoid spread with negative resection margins (Figure 4).
Immunohistochemistry showing positivity for CDX2, typical of secondary (intestinal) adenocarcinoma (20x).
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The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
Immunohistochemistry showing positivity for CK7 (20x).
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The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
Immunohistochemistry showing positivity for CK20 (20x).
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The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
Immunohistochemistry showing positivity for CEA (20x).
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The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
Immunohistochemistry showing negativity for GCFDP15 (20x).
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The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
View of the perianal region three months after surgery.
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After 3 months (Figure 10), random biopsies were taken in the flaps, in the skin proximal to the flaps, and in the anal canal, and the histopathological examination showed no sign of disease.