Perianal Paget's disease treated with wide excision and gluteal skin flap reconstruction: report of a case and review of the literature

Abstract

Background: Paget's disease of the anus is a rare perianal disorder. The condition is often associated with underlying invasive carcinoma and the prognosis is poor when underlying adenocarcinoma is present.

Methods: We report the case of a 72-year-old woman suffering from a two-year history of perianal itching, bleeding, and irritation. Perianal Paget's disease was confirmed by histopathologic demonstration of Paget's cells from a biopsy. Synchronous malignancy and metastasis were excluded.

Results: A first-stage operation consisted of a wide excisional biopsy with frozen section margin assessment. Permanent sections confirmed absence of invasive carcinoma and clear margins. Four days after wide excision, bilateral gluteal skin flap reconstruction was performed with a temporary diverting colostomy. No adjuvant therapy was necessary, and after one-year follow-up, the patient remains disease free.

Conclusion: Perianal Paget's disease continues to pose problems in diagnosis and treatment. Our case report of perianal Paget's disease shows one method of management for advanced non invasive disease.