Preoperative Diagnosis of Anal Canal Cancer with Pagetoid Spread and Detection of Suitable Resection Area by Mapping Biopsy—A Report of Two Cases

Abstract

We present two cases of anal canal cancer with Pagetoid spread that were preoperatively diagnosed and a suitable resection area was detected by preoperative mapping biopsy. Case one was a 72-year-old male who presented with anal pain since two years ago. He applied steroid ointments to treat anal pruritus, but with no improvement noted. Case two was a 72-year-old male with bloody stools since three years ago. For both cases we observed erosion at the perianal skin. We performed biopsy and diagnosed both cases as anal canal cancer with Pagetoid spread by immunohistochemistry. We then performed a laparoscopic abdominoperineal resection. After doing a mapping biopsy of 1 cm and 2 cm separate concentric areas around the anal erosion, we performed preoperative rapid pathological biopsies to diagnose negative margins for cancer cells, and then determined the resection area of the anal skin. The surgical margin was negative for cancer cells. We report these two cases of anal canal cancer with Pagetoid spread and review the literature.