Ann Short Rep | Volume 2, Issue 4 | Case Report | Open Access
Hiroka K*, Yasumitsu H, Toshimasa I, Kiyoka H, Obara N, Liming W, Masahiro A, Misato I and Yamaguchi S
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Japan
Fulltext PDFBackground: Verrucous Carcinoma (VC) is a variant of squamous cell carcinoma discovered by Lauren V Ackerman in 1948. It develops relatively slowly, and lymph node metastasis and distant metastasis are rare. It is most commonly found in the oral cavity, vulva, and foot however, there have been reports of VC in the anus. Here we report a case of VC occurring in the anus of a patient who presented with fecal incontinence, which persisted after an Intersphincteric Resection (ISR) for rectal cancer. Case Presentation: The patient was a 77-year-old man with multiple primary colorectal cancer. He had undergone a laparoscopic right hemicolectomy and intersphincteric resection with a diverting ileostomy. After closure of the ileostomy, he had fecal incontinence and frequent bowel movements in spite of the use of antidiarrhea agents. Anal pain appeared two months after the ileostomy closure. At that point, on physical exam he had multiple warts around the anus, and a biopsy suggested squamous cell carcinoma. Because no distant metastasis or lymph node metastasis was found on computed tomography scan, a skin resection of the perianal region was performed. Postoperatively, he suffered from frequent bowel movements and his fecal incontinence persisted. Multiple warts recurred around the anus three months after the local excision. He underwent an abdominoperineal excision of the rectum. He was discharged on the sixth postoperative day. It has been one year since his surgery and the VC has not recurred. Conclusion: When a patient presents with a perianal wart and risk factors such as wounds, burn scars, chemical irritation, chronic inflammation, a filthy state due to poor hygiene or incontinence, or HPV infection, it is important to rule out VC. Local excision is considered to be appropriate treatment for VC if there is no obvious metastasis. However, recurrence was observed three months after local excision in this case. Since the anastomosis was closed after an ISR, this recurrence indicates that the margin around the VC lesions may have been insufficient. Thus, it seems that visual examination alone is not thorough enough to assure clear margins and rapid pathological examination of local excision margins is required to assure complete removal of VC cells.
Verrucous carcinoma; Anal; HPV
Hiroka K, Yasumitsu H, Toshimasa I, Kiyoka H, Obara N, Liming W, et al. A Case of Verrucous Carcinoma of Anus. Ann Short Reports. 2019; 2: 1046.