Abstract
Colonoscopy examination revealed a polypoid lesion, about 1 cm in diameter, in the anal canal of a 70-year-old man who had made no complaints. Gross findings showed benign lesion but the biopsy suggested adenocarcinoma, though it was not conclusive. He was refered to our hospital and we resected this polypoid lesion with near by skin and rectal mucosa. The histopathological examination revealed that the cancer cells were positive in part of the surgical skin margin. We examined in detail and concluded that this lesion emerged from proctal gland and showed intraepidermal extension in a pagetoid spread. In a short period during other examinations necessary to rule out a possibility of metastasis, the periproctal eczema rapidly spread surrounding the skin. According to the mapping biopsy, carcinoma was detected even in the rectal mucosa above the dentate line and we finally performed an abdominoperineal resection. We could not find a case report of proctal early cancer with such a rapid pagetoid spread and this report may give a helpful suggestion about the progression of the proctal gland cancer.
