Wu SW, Rong Y, Chen GJ, Cao XS, Xie ZY, Wu B, Huang HC, Wang ZW, Wu XX. Anal adenocarcinoma with perianal Paget's disease: A case report. World J Gastrointest Surg 2025; 17(8): 108963 [DOI: 10.4240/wjgs.v17.i8.108963]
Corresponding Author of This Article
Xiao-Xiang Wu, Chief Physician, Professor, Department of General Surgery, General Hospital of Southern Theater Command, No. 111 Liuhua Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China. 786486617@qq.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2025; 17(8): 108963 Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.108963
Anal adenocarcinoma with perianal Paget's disease: A case report
Sheng-Wei Wu, Yao Rong, Gui-Jin Chen, Xu-Song Cao, Zheng-Yong Xie, Bei Wu, Hao-Chun Huang, Zhi-Wei Wang, Xiao-Xiang Wu
Sheng-Wei Wu, Yao Rong, Gui-Jin Chen, Xu-Song Cao, Zheng-Yong Xie, Bei Wu, Hao-Chun Huang, Zhi-Wei Wang, Xiao-Xiang Wu, Department of General Surgery, General Hospital of Southern Theater Command, Guangzhou 510000, Guangdong Province, China
Co-first authors: Sheng-Wei Wu and Yao Rong.
Co-corresponding authors: Zhi-Wei Wang and Xiao-Xiang Wu.
Author contributions: Wu SW and Rong Y contribute equally to this study as co-first authors; Wang ZW and Wu XX contribute equally to this study as co-corresponding authors; Wu SW and Rong Y contributed to manuscript writing and editing; Chen GJ, Cao XS and Xie ZY contribute to the collection of data; Wu B and Huang HC contributed to the production of figures and table; Wang ZW and Wu XX contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Supported by Guangdong Provincial Medical Research Fund General Program, No. B2025209.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Xiang Wu, Chief Physician, Professor, Department of General Surgery, General Hospital of Southern Theater Command, No. 111 Liuhua Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China. 786486617@qq.com
Received: April 27, 2025 Revised: June 5, 2025 Accepted: July 7, 2025 Published online: August 27, 2025 Processing time: 121 Days and 1.4 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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, etc.). 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.
CONCLUSION
Secondary PPD has a high misdiagnosis rate. Clinicians should maintain a high index of suspicion for elderly patients with prolonged perianal symptoms (e.g., 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.
Core Tip: Perianal Paget's disease (PPD), particularly secondary PPD associated with anal adenocarcinoma, is frequently misdiagnosed due to nonspecific symptoms resembling hemorrhoids or eczema. This case highlights a 72-year-old female with a 2-year misdiagnosis history, ultimately confirmed via colonoscopy, biopsy, and immunohistochemistry [IHC; CK7(+)/CK20(+)/CDX2(+)/CEA(+)]. Successful treatment with 3D laparoscopic abdominoperineal resection and extended perianal excision underscores the importance of early IHC testing in refractory perianal symptoms. Key takeaways: (1) Secondary PPD requires high clinical suspicion in elderly patients with chronic perianal lesions; (2) Multimodal diagnostics (endoscopy, biopsy, IHC) are critical to differentiate primary/secondary PPD; and (3) Radical resection ensures oncologic safety, while structured follow-up prevents recurrence.
