Abstract
Anal canal cancer is the least common malignancy of the gastrointestinal tract. Main risk factors include infection with human papillomavirus strains, immunosuppression, multiple sexual partners, and receptive anal intercourse. We present a rare case of anal canal carcinoma with fungating right axillary lymph node metastasis. A 65-year-old farmer had presented to the surgical department with complaints of bleeding per rectum and ulceration around the anus for 6 months. He also gives a history of fecal incontinence and right axillary swelling. On examination, there was an ulcer around the anus circumferentially with everted edges and indurated base. There were multiple enlarged bilateral inguinal lymph nodes and fungating right axillary lymph node. Magnetic resonance imaging of the pelvis revealed features suggestive of neoplastic etiology of anal canal. Biopsy of ulcer margin and axillary lymph node was suggestive of squamous cell carcinoma. Positron emission tomography/computed tomography (PET/CT) of the whole body revealed no other site metastatic foci. The patient underwent diversion sigmoid colostomy and was started on chemoradiation (Nigro regimen). The patient had very good response to the regimen, and follow-up PET/CT scan showed no active uptake in the tumor foci.
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