A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy
A 78-year-old woman was diagnosed with lower rectal cancer extending to the dentate line. She underwent preoperative chemoradiotherapy, which resulted in tumor shrinkage and clinical complete response (cCR), leading to the implementation of the “Watch and Wait” strategy. At the 21-month surveillance...
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| Format: | Article |
| Language: | English |
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The Japan Society of Coloproctology
2025-07-01
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| Series: | Journal of the Anus, Rectum and Colon |
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| Online Access: | https://www.jstage.jst.go.jp/article/jarc/9/3/9_2025-007/_pdf/-char/en |
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| _version_ | 1849418697212428288 |
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| author | Takahiro Amano Toshiki Mukai Masashi Akiya Tatsuki Noguchi Takashi Sakamoto Shimpei Matsui Senzo Taguchi Tomohiro Yamaguchi Akiko Chino Tomoyuki Yano Hiroshi Kawachi Takashi Akiyoshi |
| author_facet | Takahiro Amano Toshiki Mukai Masashi Akiya Tatsuki Noguchi Takashi Sakamoto Shimpei Matsui Senzo Taguchi Tomohiro Yamaguchi Akiko Chino Tomoyuki Yano Hiroshi Kawachi Takashi Akiyoshi |
| author_sort | Takahiro Amano |
| collection | DOAJ |
| description | A 78-year-old woman was diagnosed with lower rectal cancer extending to the dentate line. She underwent preoperative chemoradiotherapy, which resulted in tumor shrinkage and clinical complete response (cCR), leading to the implementation of the “Watch and Wait” strategy. At the 21-month surveillance mark, pruritus and erythematous lesions appeared around her anus, which were histologically diagnosed as secondary Paget disease with invasion based on biopsy specimens. Because the primary lesion maintained cCR, local excision of the skin lesion was performed, and negative resection margins were confirmed by pathological examination. At the 4-year postoperative follow-up, neither local recurrence nor distant metastases were observed. This case suggests that although the primary focus disappeared entirely with the use of chemoradiotherapy, microscopic perianal secondary Paget disease hidden outside the radiation field became apparent during surveillance. As total neoadjuvant therapy (TNT) becomes more widespread, the frequency of cCR is expected to increase. During the “Watch and Wait” period, vigilant observation of the perianal skin as well as the rectal region should be performed. |
| format | Article |
| id | doaj-art-6080720edd204387a8e8dfac41b4c3bc |
| institution | Kabale University |
| issn | 2432-3853 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | The Japan Society of Coloproctology |
| record_format | Article |
| series | Journal of the Anus, Rectum and Colon |
| spelling | doaj-art-6080720edd204387a8e8dfac41b4c3bc2025-08-20T03:32:23ZengThe Japan Society of ColoproctologyJournal of the Anus, Rectum and Colon2432-38532025-07-019335035510.23922/jarc.2025-0072025-007A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative ChemoradiotherapyTakahiro Amano0Toshiki Mukai1Masashi Akiya2Tatsuki Noguchi3Takashi Sakamoto4Shimpei Matsui5Senzo Taguchi6Tomohiro Yamaguchi7Akiko Chino8Tomoyuki Yano9Hiroshi Kawachi10Takashi Akiyoshi11Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchDepartment of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer ResearchA 78-year-old woman was diagnosed with lower rectal cancer extending to the dentate line. She underwent preoperative chemoradiotherapy, which resulted in tumor shrinkage and clinical complete response (cCR), leading to the implementation of the “Watch and Wait” strategy. At the 21-month surveillance mark, pruritus and erythematous lesions appeared around her anus, which were histologically diagnosed as secondary Paget disease with invasion based on biopsy specimens. Because the primary lesion maintained cCR, local excision of the skin lesion was performed, and negative resection margins were confirmed by pathological examination. At the 4-year postoperative follow-up, neither local recurrence nor distant metastases were observed. This case suggests that although the primary focus disappeared entirely with the use of chemoradiotherapy, microscopic perianal secondary Paget disease hidden outside the radiation field became apparent during surveillance. As total neoadjuvant therapy (TNT) becomes more widespread, the frequency of cCR is expected to increase. During the “Watch and Wait” period, vigilant observation of the perianal skin as well as the rectal region should be performed.https://www.jstage.jst.go.jp/article/jarc/9/3/9_2025-007/_pdf/-char/ensecondary perianal paget diseaselocal resectionwatch and waitrectal cancer |
| spellingShingle | Takahiro Amano Toshiki Mukai Masashi Akiya Tatsuki Noguchi Takashi Sakamoto Shimpei Matsui Senzo Taguchi Tomohiro Yamaguchi Akiko Chino Tomoyuki Yano Hiroshi Kawachi Takashi Akiyoshi A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy Journal of the Anus, Rectum and Colon secondary perianal paget disease local resection watch and wait rectal cancer |
| title | A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy |
| title_full | A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy |
| title_fullStr | A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy |
| title_full_unstemmed | A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy |
| title_short | A Case of Local Resection of Secondary Perianal Paget Disease Appearing during “Watch and Wait” Management of Locally Advanced Rectal Cancer after Preoperative Chemoradiotherapy |
| title_sort | case of local resection of secondary perianal paget disease appearing during watch and wait management of locally advanced rectal cancer after preoperative chemoradiotherapy |
| topic | secondary perianal paget disease local resection watch and wait rectal cancer |
| url | https://www.jstage.jst.go.jp/article/jarc/9/3/9_2025-007/_pdf/-char/en |
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