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Unusual association of diseases/symptoms
CASE REPORT
Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma
  1. Temitope Ajala-Agbo,
  2. Pok Tin Tang and
  3. Tsetsegdemberel Bat-Ulzii Davidson
  1. Department of General Surgery, Stoke Mandeville Hospital, Aylesbury, UK
  1. Correspondence to Dr Pok Tin Tang, poktin.tang{at}doctors.org.uk

Abstract

A 58-year-old man presented to colorectal clinic with intermittent rectal bleeding, weight loss, also pain and weakness affecting his lower back and right leg. On inspection, there were perianal warts (condyloma acuminata), with an additional palpable anal lesion on digital rectal examination, confirmed by colonoscopy. Subsequent imaging revealed a large right psoas abscess, and an associated paravertebral soft tissue component invading the right lumbosacral plexus and nerve roots at L4, L5 and S1. Biopsy of the paravertebral mass revealed metastatic squamous cell carcinoma. Given his symptomatology, and also as biopsy of the perianal warts revealed high-grade squamous intraepithelial lesion/grade III anal intraepithelial neoplasia on histology with infection by human papillomavirus type 6, the primary was presumed to be anal. This was a case of sciatic pain which proved to be diagnostically challenging on initial presentation to primary care. This mode of presentation and pattern of metastasis are uncommon in anal cancer.

  • oncology
  • genital ulcers
  • human papilloma virus
  • gastrointestinal surgery
  • surgical oncology

https://doi.org/10.1136/bcr-2018-227563

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    Footnotes

    • TAA and PTT contributed equally.

    • Contributors PTT and TA-A contributed equally to the manuscript, being jointly responsible for the gathering of clinical information and data, as well as drafting and editing initial and further copies of the manuscript. All three authors were directly involved in the patient’s clinical care. TB-UD was responsible for supervising the information collection and drafting process. All three authors gave final approval for the above work to be published. This case has previously been presented as an oral presentation with a supporting PowerPoint slideshow at a regional conference, the Oxford Regional Chapter of the Association of Coloproctologists of Great Britain and Ireland, at Wycombe General Hospital in March 2018.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.