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Case Reports
. 2021 May;64(5):511-515.
doi: 10.1097/DCR.0000000000002000.

Perianal Paget's Disease

Hannah M Thompson  1 , Jin K Kim
Affiliations
Case Reports

Perianal Paget's Disease

Hannah M Thompson et al. Dis Colon Rectum. 2021 May.

Abstract

A 78-year-old woman with a complaint of fecal incontinence was noted to have a perianal rash. Despite improvement of the incontinence with medical management, the rash persisted. She had no symptoms related to the rash, but due to its persistence after two years, she saw a dermatologist who performed a punch biopsy of the area. The biopsy revealed extramammary Paget’s disease that was positive for CAM5.2, CK7, and CDX2 and equivocal for CK20. On physical examination, she had a 2×3cm raised and erythematous lesion on the right buttock extending to the anal margin without anal canal involvement (see Figure 1). Subsequent work-up including upper endoscopy, colonoscopy, CT of the chest and abdomen and pelvis, and small bowel follow through was negative. This patient’s case was discussed at the multi-disciplinary conference, and wide local excision was recommended. The patient underwent wide local excision with healing via secondary intention. Closure was foregone due to the small size of the wound and the patient’s medical comorbidities. Pathological examination confirmed negative margins.

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Figures

Figure 1:
Figure 1:. This is an example of perianal Paget's disease.
Figure 2:
Figure 2:. These are other examples of perianal Paget's disease.
On the left, this is a patient that had circumferential disease extending to the anal orifice. On the right, the patient had disease extending anteriorly to the scrotum.
Figure 3:
Figure 3:. This is an example of a wide local excision for perianal Paget's disease.
On the top, this is the lesion with surgical markings. In the middle, the picture shows the defect after wide local excision. On the bottom, the defect was closed with a VY advancement flap. (Images courtesy of Daniel Herzig, MD, all rights reserved).
Figure 3:
Figure 3:. This is an example of a wide local excision for perianal Paget's disease.
On the top, this is the lesion with surgical markings. In the middle, the picture shows the defect after wide local excision. On the bottom, the defect was closed with a VY advancement flap. (Images courtesy of Daniel Herzig, MD, all rights reserved).
None
EVALUATION AND TREATMENT ALGORITHM
See this image and copyright information in PMC

Comment in

References

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