Synchronous squamous cell carcinoma of rectum and anal canal- a rare entity

Rectal squamous cell carcinoma (SCC) is a rare entity whereas anal SCC is the most common malignancy of the anal canal. We discuss a case of 78 year old man who presented to us with 2-month history of altered bowel habits and anorexia. On evaluation, by digital rectal examination there were two growths one at 2 cms and another at 8 cms from anal verge. Multiple biopsies were negative for malignancy. He underwent PET/CT scan which confirmed one mid-rectal and another anal canal growth with high SUV uptake, suspicious of malignancy. He underwent a laparoscopic abdomino-perineal resection and the final histopathology showed synchronous rectal and anal SCC. This is only the second case of synchronous rectal and anal SCC reported in English literature. We discuss the challenges faced in the diagnosis and management of this case.