Anal squamous cell carcinoma
This article describes the case of a 74-year-old man with a history of prostate cancer diagnosed with anal squamous cell carcinoma. He presented to the outpatient clinic with a 6-month history of rectal bleeding. The patient underwent brachytherapy for his prostate cancer and was well before the current evaluation. He visited the outpatient clinic after he noted small amounts of fresh red blood with defecation. The blood was not seen to be mixed with the stool. Further history revealed that 2 months before his presentation, the calibre of his stool also decreased. Evaluation showed daily bowel movement with no abdominal pain or signs of weight loss.
3 years earlier the patient underwent a normal colonoscopy. There was no history of rectal or abdominal surgery. Nine years prior to this presentation, he was also found with an elevated level of prostate-specific antigen during routine screening. For further diagnosis, doctors performed a biopsy of the prostate. The biopsy showed a presence of cancer in four out of the five specimens taken from the right side, whereas one of the five specimens from the left side.
Both sides had moderately differentiated adenocarcinoma.
Prostate cancer is graded with Gleason grading and scoring system. The grades range from 1 to 5 and higher grades indicate more aggressive disease. The disease was graded with Gleason grade of 3 and Gleason score of 6. Most cases of prostate cancer are Gleason grade 3. However, biopsy samples may show more than one grade of cancer. Further imaging studies did not show any signs of metastases. The patient was treated with iodine-125 brachytherapy. His medical history was also consistent with actinic keratoses, obesity and hyperlipidaemia. In addition, the had undergone several excisions of cutaneous squamous-cell and basal-cell carcinomas. He had no known allergies and drank alcohol occasionally. He had no history of smoking tobacco, was retired, and previously worked at an office position. His history further revealed that he had two sisters who died of cancer.
Examination was consistent with a systolic murmur, organomegaly, mild-to-moderate abdominal adiposity with no signs of tenderness or masses and external haemorrhoids. The inguinal regions appeared to be normal on palpation with no inguinal lymphadenopathy. Pedal pulses were normal with no leg oedema. A digital rectal examination was also done which showed a firm mass in the lower right lateral rectum, extending 4 cm proximally to the right lateral wall. The mass appeared to be ulcerated and tethered. After a complete blood count, the patient was given the diagnosis of anal-squamous cell carcinoma, secondary to brachytherapy for prostate cancer.
Source: NEJM
