Friends of Endoscopy
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
Search
Picture
​

Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
Become a Better Endoscopist ! 

A sore bottom

31/5/2021

Comments

 
Picture
This patient was referred for a flexible sigmoidoscopy because of PR bleeding. However, the only abnormality found was a sore anal canal.  Samples are taken of course. 
HOW WOULD YOU NOW ADVICE THE PATIENT?
■ We'll see you in clinic once histology is to hand
But there is a degree of urgency here!
■ Symptoms may improve with 'anusol'
No they will not!
■ We will try topical mononitrate first
You are barking up the wrong tree!
■ We will organise a scan next
Yes, a rectal MRI revealed something important!
■ Inject 80mg of triamcolonone
You are missing the point!
explanation
Actually, this isn't a case of haemorrhoids or an anal fissure. Histology reported; " Within hyperkeratotic epidermis there are scattered individual highly atypical infiltrating malignant cells with frequent apoptosis and moderate clear cytoplasm.  There is no ulceration or significant inflammation."  

Actually, this is a case of Perianal Paget's disease, - a VERY rare condition!!!   You'll remember that a 'puckering' of the skin around the breast areola is associated with underlying breast cancer. This was first reported by Sir James Paget in 1874.  However, a few years later, the same phenomenon was described elsewhere, so called "extramammary Paget's disease".  In descending order of frequency, this has been described at; the skin of the vulva, perineal skin, perianal skin and the skin of the scrotum.  

Paget's disease, is usually NOT a primary cancer of the apocrine glands of the skin. It's almost always secondary to a nearby cancer of the rectum, anus or prostate.  In this particular case, further imaging revealed a nearby prostate cancer! ! 
Comments

    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
    Corrosive Ingestion
    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
    HPB
    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors