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Dual\u2010energy computed tomography (DECT) imaging revealed a mass in the left anal gland (LAG) and enlargement of the left medial iliac lymph node (LML) and the left internal iliac lymph node (LIL). The mass was surgically removed, and the histopathological diagnosis was anal sac gland adenocarcinoma, with metastasis to the LML and LIL. The pathological findings were concordant with those obtained from our evaluation of the spectral Hounsfield unit curve and iodine concentration DECT imaging. 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