Adenocarcinoma arising from an anal gland-Report of a case

Takashi Sakamoto; Fumio Konishi; Takayoshi Yoshida; Yasuo Yoshinaga; Toshiyuki Izumo; Alan Lefor

doi:10.1016/j.ijscr.2014.02.010

Adenocarcinoma arising from an anal gland-Report of a case

Int J Surg Case Rep. 2014;5(5):234-6. doi: 10.1016/j.ijscr.2014.02.010. Epub 2014 Mar 12.

Authors

Takashi Sakamoto¹, Fumio Konishi², Takayoshi Yoshida², Yasuo Yoshinaga³, Toshiyuki Izumo⁴, Alan Lefor⁵

Affiliations

¹ Department of Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan; Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. Electronic address: takac93@gmail.com.
² Department of Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.
³ Department of Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan; Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
⁴ Department of Pathology, Nerima Hikarigaoka Hospital, Tokyo, Japan; Diagnostic Oral Pathology, Tokyo Medical and Dental University, Tokyo, Japan.
⁵ Department of Surgery, Jichi Medical University, Tochigi, Japan.

Abstract

Introduction: Adenocarcinoma arising from an anal gland is extremely rare. Most anal canal cancers are squamous cell carcinoma, and adenocarcinoma is infrequently diagnosed. Diagnostic criteria and the standard treatment for adenocarcinoma of the anal canal have not been clearly defined, in part because of the rarity of this lesion.

Presentation of case: An 84-year-old man who presented with a piece of tissue prolapsing from the anus. An incisional biopsy showed adenocarcinoma, and an abdomino-perineal resection was then performed. Cytokeratin 7 (CK7), cytokeratin 19 (CK19) stained positive in the specimen, suggesting that the tumor developed from an anal gland. The patient was discharged after surgery without any complications.

Discussion: Exact diagnostic criteria for adenocarcinoma of the anal canal have not been previously described. In the present case, CK7 and CK19 were stained, and the tumor showed positivity for both of these markers, which is compatible with the staining patterns of anal gland origin cancer. Radical resection is recommended rather than local resection, because of the tumor's high recurrence rate. Some authors recommend combined modality treatment with preoperative or postoperative chemoradiotherapy because of the high rate of distant recurrence.

Conclusion: The preoperative diagnosis of adenocarcinoma arising from an anal gland is not easily established. However, it may be possible to suspect an anal glandular adenocarcinoma based on a meticulous physical examination, appropriate diagnostic studies and pathological findings on biopsy.

Keywords: Adenocarcinoma of an anal gland; Cytokeratin 19; Cytokeratin 7; Immune-histochemical marker; Pagetoid spread.