case_images: PMC4677189_01
case_images: (a) Photomicrograph of the tumor showing epidermis and dermis along with a tumor arranged in tubules, nests, and islands invading into the deeper tissue (H&E, x100). (b) Photomicrograph showing the tumor arranged in complex papillary fronds having central fibrovascular core; surrounding stroma shows dense lymphocytic infiltration (H&E, x100). (c) Photomicrograph showing papillae lined by multilayered round to columnar cells showing mild to moderate nuclear atypia, with vesicular chromatin and some showed prominent nucleoli (H&E, x400).
case_images: CRIONM2015-638294.001.jpg
case_images: PMC4677189_01_CRIONM2015-638294.001.jpg
case_images: fig1
case_images: The tumor was made up of multiple nodules comprising of duct-like structures, some appearing to be cystically dilated, papillary structures having central fibrovascular cores, solid nests, and islands (Figure 1(a)). Dense infiltrate of lymphocytes was seen inside the ducts and papillae and in the surrounding stroma (Figure 1(b)). These ductal and papillary structures were made up of multilayered round to oval to columnar cells having scanty eosinophilic cytoplasm exhibiting moderate nuclear atypia with vesicular chromatin and some showed prominent nucleoli (Figure 1(c)).
case_images: FNA cytosmears from inguinal lymph node showing round to oval tumor cells arranged in papillary structures; background shows many lymphocytes and eosinophilic proteinaceous material (Leishman, x100).
case_images: CRIONM2015-638294.002.jpg
case_images: PMC4677189_01_CRIONM2015-638294.002.jpg
case_images: fig2
case_images: Background showed numerous mature and transformed lymphocytes and eosinophilic proteinaceous material (Figure 2).
case_images: (a) Pretreatment sagittal magnetic resonance (MR) image depicting the superficial inguinal lymph nodal mass measuring 5.3 cm x 7.5 cm in size. (b) Pretreatment axial MR image showing the primary vulvar lesion and the right superficial inguinal lymph nodal mass.
case_images: CRIONM2015-638294.003.jpg
case_images: PMC4677189_01_CRIONM2015-638294.003.jpg
case_images: fig3
case_images: Magnetic resonance imaging of the pelvis demonstrated an irregular, intermediate signal intensity lesion in the left side of the labia of size of 10 mm x 10 mm along with multiple oval to round lymph nodal masses in the right superficial inguinal region measuring 5.3 cm x 7.5 cm in size (Figures 3(a) and 3(b)).
case_images: ((a) and (b)) Posttreatment MR images in sagittal and axial section show complete resolution of the inguinal lymph nodes.
case_images: CRIONM2015-638294.004.jpg
case_images: PMC4677189_01_CRIONM2015-638294.004.jpg
case_images: fig4
case_images: Following this, the primary tumor and the contralateral inguinal nodes regressed completely (Figures 4(a) and 4(b)).