case_images: PMC10755467_01
case_images: The overview of procedures during the treatment. All procedures marked in green were presented in the order of timelines, all contents marked in orange were supplementary explanation of each procedure. PPD, Perianal Paget disease; EMPD, Extramammary Paget disease; MRI, Magnetic resonance imaging; MDT, Multi-disciplinary treatment; CR, Complete response.
case_images: fonc-13-1327173-g001.jpg
case_images: PMC10755467_02_fonc-13-1327173-g001.jpg
case_images: f1
case_images: The treatment course was well-tolerated without any notable discomfort (Figure 1).
case_images: Physical examination. The scope of lesions were marked in yellow dotted line, the most typical lesion was marked in yellow arrow. (A) The overall outlook of perianal disease, an obvious mass protruding out of anal canal before nCRT; (B) The massive scope of vulva lesions, and the lesion skin before nCRT; (C) The overall outlook of perianal region after nCRT; (D) the lesions of vulvar region with no macroscopic lesions after nCRT; (E) Anterior view of the excised specimen; (F) The image of the dissected specimen; (G) Images after surgery; (H) Perineal incision on postoperative day 9. nCRT, neoadjuvant chemoradiotherapy.
case_images: fonc-13-1327173-g002.jpg
case_images: PMC10755467_03_fonc-13-1327173-g002.jpg
case_images: f2
case_images: The patient was subsequently scheduled for laparoscopic abdominoperineal resection combined with vulvar lesion resection on February 3, 2023, the resected specimens of anal tumor along with perianal lesions were displayed in Figures 2E, F. The surgery was successful, and the patient was discharged from the hospital on postoperative day 10 (Figures 2G, H).
case_images: The results of colonoscopy and pathology. (A) Anus lesion, protrusion and nodular lesions at anal canal and perianal mucosa, the most typical lesion was marked in yellow arrow; (B) The lesions at perianal region; (C) The proximal mucosa was normal; (D) Pathology of biopsied perianal skin before nCRT, Paget's like tumor cells could be found, marked in yellow arrow. (E) Pathologic result of anal adenocarcinoma; (F) Pathologic result of resected perianal and vulva lesions. nCRT, neoadjuvant chemoradiotherapy.
case_images: fonc-13-1327173-g003.jpg
case_images: PMC10755467_03_fonc-13-1327173-g003.jpg
case_images: f3
case_images: Pathological review of the resected specimens revealed that the anal mass was a moderately differentiated adenocarcinoma staged as ypT2N0, and the tumor regression grade was reaching CAP 2 (Figure 3E), there was no evidence of tumor cells in the resected perianal and vulvar lesions (Figure 3F), Immunohistochemistry indicated positivity for CK20 (+), CDX-2 (+), MUC2 (+), GCDFP-15 (+), and negative CK-7.
case_images: The typical images of anal adenocarcinoma before and after nCRT in three dimensions. The lesions were marked in yellow arrow. (A) The axial images before nCRT, the irregular mass protruding into the intestinal cavity; (B) The sagittal images before nCRT; (C) Lesions presented by DWI before nCRT; (D) The axial images after nCRT; (E, F) represent the sagittal and DWI lesions after nCRT. nCRT, neoadjuvant chemoradiotherapy; DWI, Diffusion weighted imaging; TRG, Tumor regression grade.
case_images: fonc-13-1327173-g004.jpg
case_images: PMC10755467_02_fonc-13-1327173-g004.jpg
case_images: f4
case_images: The application of nCRT effectively reduced both the volume and diameter of the tumor mass to an extremely diminished status, with MRI indicating a tumor regression grade reaching TRG 3 (Figures 4D-F).
case_images: PMC10755467_02
case_images: The overview of procedures during the treatment. All procedures marked in green were presented in the order of timelines, all contents marked in orange were supplementary explanation of each procedure. PPD, Perianal Paget disease; EMPD, Extramammary Paget disease; MRI, Magnetic resonance imaging; MDT, Multi-disciplinary treatment; CR, Complete response.
case_images: fonc-13-1327173-g001.jpg
case_images: PMC10755467_02_fonc-13-1327173-g001.jpg
case_images: f1
case_images: The treatment course was well-tolerated without any notable discomfort (Figure 1).
case_images: Physical examination. The scope of lesions were marked in yellow dotted line, the most typical lesion was marked in yellow arrow. (A) The overall outlook of perianal disease, an obvious mass protruding out of anal canal before nCRT; (B) The massive scope of vulva lesions, and the lesion skin before nCRT; (C) The overall outlook of perianal region after nCRT; (D) the lesions of vulvar region with no macroscopic lesions after nCRT; (E) Anterior view of the excised specimen; (F) The image of the dissected specimen; (G) Images after surgery; (H) Perineal incision on postoperative day 9. nCRT, neoadjuvant chemoradiotherapy.
case_images: fonc-13-1327173-g002.jpg
case_images: PMC10755467_03_fonc-13-1327173-g002.jpg
case_images: f2
case_images: The patient was subsequently scheduled for laparoscopic abdominoperineal resection combined with vulvar lesion resection on February 3, 2023, the resected specimens of anal tumor along with perianal lesions were displayed in Figures 2E, F. The surgery was successful, and the patient was discharged from the hospital on postoperative day 10 (Figures 2G, H).
case_images: The typical images of anal adenocarcinoma before and after nCRT in three dimensions. The lesions were marked in yellow arrow. (A) The axial images before nCRT, the irregular mass protruding into the intestinal cavity; (B) The sagittal images before nCRT; (C) Lesions presented by DWI before nCRT; (D) The axial images after nCRT; (E, F) represent the sagittal and DWI lesions after nCRT. nCRT, neoadjuvant chemoradiotherapy; DWI, Diffusion weighted imaging; TRG, Tumor regression grade.
case_images: fonc-13-1327173-g004.jpg
case_images: PMC10755467_02_fonc-13-1327173-g004.jpg
case_images: f4
case_images: The application of nCRT effectively reduced both the volume and diameter of the tumor mass to an extremely diminished status, with MRI indicating a tumor regression grade reaching TRG 3 (Figures 4D-F).
case_images: PMC10755467_03
case_images: Physical examination. The scope of lesions were marked in yellow dotted line, the most typical lesion was marked in yellow arrow. (A) The overall outlook of perianal disease, an obvious mass protruding out of anal canal before nCRT; (B) The massive scope of vulva lesions, and the lesion skin before nCRT; (C) The overall outlook of perianal region after nCRT; (D) the lesions of vulvar region with no macroscopic lesions after nCRT; (E) Anterior view of the excised specimen; (F) The image of the dissected specimen; (G) Images after surgery; (H) Perineal incision on postoperative day 9. nCRT, neoadjuvant chemoradiotherapy.
case_images: fonc-13-1327173-g002.jpg
case_images: PMC10755467_03_fonc-13-1327173-g002.jpg
case_images: f2
case_images: The patient was subsequently scheduled for laparoscopic abdominoperineal resection combined with vulvar lesion resection on February 3, 2023, the resected specimens of anal tumor along with perianal lesions were displayed in Figures 2E, F. The surgery was successful, and the patient was discharged from the hospital on postoperative day 10 (Figures 2G, H).
case_images: The results of colonoscopy and pathology. (A) Anus lesion, protrusion and nodular lesions at anal canal and perianal mucosa, the most typical lesion was marked in yellow arrow; (B) The lesions at perianal region; (C) The proximal mucosa was normal; (D) Pathology of biopsied perianal skin before nCRT, Paget's like tumor cells could be found, marked in yellow arrow. (E) Pathologic result of anal adenocarcinoma; (F) Pathologic result of resected perianal and vulva lesions. nCRT, neoadjuvant chemoradiotherapy.
case_images: fonc-13-1327173-g003.jpg
case_images: PMC10755467_03_fonc-13-1327173-g003.jpg
case_images: f3
case_images: Pathological review of the resected specimens revealed that the anal mass was a moderately differentiated adenocarcinoma staged as ypT2N0, and the tumor regression grade was reaching CAP 2 (Figure 3E), there was no evidence of tumor cells in the resected perianal and vulvar lesions (Figure 3F), Immunohistochemistry indicated positivity for CK20 (+), CDX-2 (+), MUC2 (+), GCDFP-15 (+), and negative CK-7.