case_images: PMC6915020_01
case_images: Preoperative appearance of the mucinous adenocarcinoma.
case_images: CRIS2019-9073982.001.jpg
case_images: PMC6915020_01_CRIS2019-9073982.001.jpg
case_images: fig1
case_images: Physical examination showed a 3 cm plaque-like eczematous lesion, circumferentially involving the perianal skin and extending to the anal verge (Figure 1).
case_images: Pelvic MRI (T2W-TSE) showing invasion of the skin but not of the anal sphincters.
case_images: CRIS2019-9073982.002.jpg
case_images: PMC6915020_01_CRIS2019-9073982.002.jpg
case_images: fig2
case_images: A pelvic MRI showed that the lesion had invaded the skin tissue without involvement of perirectal structures and anal sphincters (Figure 2).
case_images: Intraoperative surgical field after resection of the lesion with the double V flap (arrows) marking drawn and the stiches placed on the margins of the anal mucosa (arrowheads).
case_images: CRIS2019-9073982.003.jpg
case_images: PMC6915020_01_CRIS2019-9073982.003.jpg
case_images: fig3
case_images: A double V marking was drawn, and the flaps were dissected with vascular pedicle preservation, based on random inferior gluteal perforator vessels and peripheral skin undermining (Figure 3).
case_images: (a, b) Histology of the perianal lesion showing a discontinuous spread of pagetoid cells (EE: 20x (a); 5x (b)).
case_images: CRIS2019-9073982.004.jpg
case_images: PMC6915020_01_CRIS2019-9073982.004.jpg
case_images: fig4
case_images: The pathological report was mucinous adenocarcinoma of the perianal skin involving the subcutaneous tissue with pagetoid spread with negative resection margins (Figure 4).
case_images: Immunohistochemistry showing positivity for CDX2, typical of secondary (intestinal) adenocarcinoma (20x).
case_images: CRIS2019-9073982.005.jpg
case_images: PMC6915020_01_CRIS2019-9073982.005.jpg
case_images: fig5
case_images: The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
case_images: Immunohistochemistry showing positivity for CK7 (20x).
case_images: CRIS2019-9073982.006.jpg
case_images: PMC6915020_01_CRIS2019-9073982.006.jpg
case_images: fig6
case_images: The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
case_images: Immunohistochemistry showing positivity for CK20 (20x).
case_images: CRIS2019-9073982.007.jpg
case_images: PMC6915020_01_CRIS2019-9073982.007.jpg
case_images: fig7
case_images: The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
case_images: Immunohistochemistry showing positivity for CEA (20x).
case_images: CRIS2019-9073982.008.jpg
case_images: PMC6915020_01_CRIS2019-9073982.008.jpg
case_images: fig8
case_images: The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
case_images: Immunohistochemistry showing negativity for GCFDP15 (20x).
case_images: CRIS2019-9073982.009.jpg
case_images: PMC6915020_01_CRIS2019-9073982.009.jpg
case_images: fig9
case_images: The lesion presented the following immunohistochemical pattern: CK7+, CK20+, CDX2+, CEA+, and GCFDP15-, suggestive of secondary Paget's disease (Figures 5-9).
case_images: View of the perianal region three months after surgery.
case_images: CRIS2019-9073982.010.jpg
case_images: PMC6915020_01_CRIS2019-9073982.010.jpg
case_images: fig10
case_images: After 3 months (Figure 10), random biopsies were taken in the flaps, in the skin proximal to the flaps, and in the anal canal, and the histopathological examination showed no sign of disease.