{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:22:58Z","timestamp":1777861378772,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Pagetoid spread (PS) of anorectal cancer is relatively rare and is associated with poor prognosis compared with Extramammary Paget disease. It is therefore essential to accurately differentiate between the two entities. In PS cases, the primary tumor lesion is usually obvious; however, this is not the case in nonmass\u2010forming type anorectal cancer, making it difficult to distinguish between the two. We hereby report the case of a 79\u2010year\u2010old woman who presented with a six\u2010month history of perianal skin eruption. Physical examination revealed maceration and erosion around the anus. On endoscopy, no obvious tumor formation was observed; however, an ulcer with a whitish coating extending from the anal region into the anal canal was noted. Biopsy was positive for CK7, CK20, and CDX2, and negative for GCDFP\u201015. The patient was diagnosed with nonmass\u2010forming type anorectal cancer with PS. Laparoscopic abdominoperineal resection was performed with lymph node dissection and mapping biopsy. Postoperative immunohistochemical staining confirmed the diagnosis. Since primary Paget disease differs from perianal pagetoid spread with respect to treatment strategy as well as prognosis, accurate differentiation between the two is necessary. Diagnosis based on several immunohistochemical stains is highly effective for distinguishing between these entities.<\/jats:p>","DOI":"10.1002\/ccr3.72628","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:56:36Z","timestamp":1777521396000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonmass\u2010Forming Type Anocanal Cancer With Pagetoid Spread With a Challenging Differential Diagnosis: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0599-8351","authenticated-orcid":false,"given":"Mizunori","family":"Yaegashi","sequence":"first","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Shiwa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Sugimoto","sequence":"additional","affiliation":[{"name":"Departement of Molecular Diagnostic Pathology Iwate Medical University School of Medicine  Shiwa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Shimada","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Shiwa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Surgery Iwate Medical University School of Medicine  Shiwa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"issue":"2","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1159\/000363177","article-title":"Perianal Paget's Disease co\u2010Associated With Anorectal Adenocarcinoma: Primary or Secondary Disease?","volume":"8","author":"Liao X.","year":"2014","journal-title":"Case Reports in Gastroenterology"},{"issue":"2","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/00000372-197900120-00002","article-title":"Extramammary Paget's Disease","volume":"1","author":"Jones R. E.","year":"1979","journal-title":"A Critical Reexamination. Am J Dermatopathol"},{"issue":"6","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1007\/BF02052147","article-title":"Perianal Paget's Disease. Classification and Review of Management: Report of Two Cases","volume":"33","author":"Shutze W. P.","year":"1990","journal-title":"Diseases of the Colon and Rectum"},{"issue":"5","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/jjco\/28.5.347","article-title":"Perianal Paget's Disease Associated With Rectal Carcinoma: A Case Report","volume":"28","author":"Kubota K.","year":"1998","journal-title":"Japanese Journal of Clinical Oncology"},{"issue":"1","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s40792-018-0469-5","article-title":"Anal Gland Adenocarcinoma In\u00a0Situ With Pagetoid Spread: A Case Report","volume":"4","author":"Ishioka K.","year":"2018","journal-title":"Surg Case Rep"},{"issue":"4","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/1346-8138.16744","article-title":"Clinical Features of Pagetoid Spread: Analysis of Perianal Lesions Associated With Anal Canal Adenocarcinoma and Perianal Primary Extramammary Paget Disease","volume":"50","author":"Kosano M.","year":"2023","journal-title":"Journal of Dermatology"},{"issue":"12","key":"e_1_2_14_8_1","first-page":"1077","article-title":"Perianal Paget's Disease: Distinguishing Primary and Secondary Lesions Using Immunohistochemical Studies Including Gross Cystic Disease Fluid Protein\u201015 and Cytokeratin 20 Expression","volume":"122","author":"Nowak M. A.","year":"1998","journal-title":"Archives of Pathology & Laboratory Medicine"},{"issue":"3","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/PAI.0b013e31819268f2","article-title":"CDX2, Cytokeratins 7 and 20 Immunoreactivity in Rectal Adenocarcinoma","volume":"17","author":"Saad R. S.","year":"2009","journal-title":"Applied Immunohistochemistry & Molecular Morphology"},{"issue":"9","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1038\/modpathol.3880175","article-title":"Cytokeratin 7 and Cytokeratin 20 Expression in Epithelial Neoplasms: A Survey of 435 Cases","volume":"13","author":"Chu P.","year":"2000","journal-title":"Modern Pathology"},{"issue":"8","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.5858\/2001-125-1074-CSIIRA","article-title":"Cytokeratin Subset Immunostaining in Rectal Adenocarcinoma and Normal Anal Glands","volume":"125","author":"Ramalingam P.","year":"2001","journal-title":"Archives of Pathology & Laboratory Medicine"},{"issue":"11","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1111\/j.1600-0560.2009.01395.x","article-title":"Perianal Paget's Disease Happening With Mucinous Adenocarcinoma of the Anal Canal: Managing Rarities","volume":"37","author":"Selvaggi F.","year":"2010","journal-title":"Journal of Cutaneous Pathology"},{"issue":"7","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1746-1596-7-9","article-title":"The Value of CDX2 and Cytokeratins 7 and 20 Expression in Differentiating Colorectal Adenocarcinomas From Extraintestinal Gastrointestinal Adenocarcinomas: Cytokeratin 7\u2212\/20+ Phenotype Is More Specific Than CDX2 Antibody","volume":"23","author":"Bayrak R.","year":"2012","journal-title":"Diagnostic Pathology"},{"issue":"2","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/BF00495832","article-title":"Immunoperoxidase Staining of Carcinoembryonic Antigen With Monoclonal Antibodies in Adenocarcinoma of the Colon","volume":"74","author":"Lindgren J.","year":"1982","journal-title":"Histochemistry"},{"issue":"8","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.5858\/2007-131-1304-ICOAGC","article-title":"Immunophenotypic Characterization of Anal Gland Carcinoma: Loss of p63 and Cytokeratin 5\/6","volume":"131","author":"Lisovsky M.","year":"2007","journal-title":"Archives of Pathology & Laboratory Medicine"},{"issue":"24","key":"e_1_2_14_16_1","doi-asserted-by":"crossref","DOI":"10.3390\/cancers17244014","article-title":"Diagnostic Algorithm for Secondary Extramammary Paget Disease From Institutional Cases and Literature Review","volume":"17","author":"Kiratikanon S.","year":"2025","journal-title":"Cancers (Basel)"},{"issue":"5","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.3919\/jjsa.68.1234","article-title":"A Case of Rectal Adenocarcinoma Complicated With Secondary Extramammary Peget Disease","volume":"68","author":"Kobayashi S.","year":"2007","journal-title":"J Jpn Surg Assoc"},{"issue":"4","key":"e_1_2_14_18_1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/ases.13217","article-title":"Nonmass\u2010Forming Type Anorectal Cancer With Pagetoid Spread: A Report of Two Cases","volume":"16","author":"Yamamoto M.","year":"2023","journal-title":"Asian J Endosc Surg"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72628","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72628","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72628","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:56:40Z","timestamp":1777521400000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/ccr3.72628"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72628","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"2025-12-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72628"}}