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Presented by Pedram Argani, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 4: 62 year old male who undergoes proctocolectomy s/p chemoradiation for colonic adenocarcinoma.
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1. Question
Week 252: Case 4
62 year old male who undergoes proctocolectomy s/p chemoradiation for colonic adenocarcinoma. The section is from the anal margin.images/1 9 05 case 4 1.jpg
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images/1 9 05 case 4 5.jpgCorrect
Answer: Paget’s disease of the anus
Histology: There is a nearly-full thickness proliferation of atypical cells throughout the anal mucosa. Closer inspection reveals that these malignant cells occasionally demonstrate cytoplasmic vacuoles, lack melanin pigment, and do not form intercellular junctions with the adjacent squamous epithelial cells. Immunohistochemical studies revealed that these cells were immunoreactive for cytokeratin 7, cytokeratin 20, and CEA, but negative for GCDFP.
Discussion: Melanoma would label for HMB45 and S-100 protein. Squamous carcinoma in situ would typically not label for low molecular weight cytokeratins, but might label for high molecular weight cytokeratins like cytokeratin 903 (34ßE12).
Paget’s Disease is essentially an intraepithelial adenocarcinoma. In the anus, 50-75% of Paget’s Disease is associated with an underlying rectal or anal gland adenocarcinoma. These cases are usually immunoreactive for cytokeratin 7 and 20, but negative for GCDFP. The remaining anal Paget’s Disease cases are probably intraepithelial apocrine adenocarcinomas that are immunoreactive for cytokeratin 7 and GCDFP, but are negative for cytokeratin 20.
Reference(s):
– American Journal of Surgical Pathology 1997;21: 1178-1187.
– American Journal of surgical Pathology 1998;22: 170-179.Incorrect
Answer: Paget’s disease of the anus
Histology: There is a nearly-full thickness proliferation of atypical cells throughout the anal mucosa. Closer inspection reveals that these malignant cells occasionally demonstrate cytoplasmic vacuoles, lack melanin pigment, and do not form intercellular junctions with the adjacent squamous epithelial cells. Immunohistochemical studies revealed that these cells were immunoreactive for cytokeratin 7, cytokeratin 20, and CEA, but negative for GCDFP.
Discussion: Melanoma would label for HMB45 and S-100 protein. Squamous carcinoma in situ would typically not label for low molecular weight cytokeratins, but might label for high molecular weight cytokeratins like cytokeratin 903 (34ßE12).
Paget’s Disease is essentially an intraepithelial adenocarcinoma. In the anus, 50-75% of Paget’s Disease is associated with an underlying rectal or anal gland adenocarcinoma. These cases are usually immunoreactive for cytokeratin 7 and 20, but negative for GCDFP. The remaining anal Paget’s Disease cases are probably intraepithelial apocrine adenocarcinomas that are immunoreactive for cytokeratin 7 and GCDFP, but are negative for cytokeratin 20.
Reference(s):
– American Journal of Surgical Pathology 1997;21: 1178-1187.
– American Journal of surgical Pathology 1998;22: 170-179.