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We report a case of a 66 year old male with an unusual case of mucinous adenocarcinoma associated with fistula-in-ano. The presentation was typical for fistula-in-ano with anal pain and chronic discharge. Standard treatment with resection and seton were carried out. Subsequent review of the histology revealed underlying adenocarcinoma and upon review of MRI imaging showed possible extensive local invasion. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.