case_images: PMC10151084_01
case_images: Clinical picture of patient at presentation showing the perianal lesion (black arrow) with separate skip lesion in vulva (red arrow).
case_images: can-17-1534fig1.jpg
case_images: PMC10151084_01_can-17-1534fig1.jpg
case_images: figure1
case_images: Another lesion of 1 x 1 cm was noted over the right labia (Figure 1).
case_images: (a): Photomicrograph showing atypical squamous cell in nests, cords and sheets. (b): Large cells with eosinophilic cytoplasm, elongated nucleoli with keratins pearls and have diffuse cytoplasmic and (c): nuclear positivity for p16.
case_images: can-17-1534fig2.jpg
case_images: PMC10151084_01_can-17-1534fig2.jpg
case_images: figure2
case_images: The biopsy was confirmative of squamous cell carcinoma with p16 positive on immunohistochemistry (Figure 2).
case_images: T2 weighted MRI images sagittal view (a): axial view (b): diffusion-weighted axial image (c): at presentation showing T2 hyperintense mass lesion (arrows in a and b) showing diffusion restriction (arrows c) in the ano-vaginal space of the urogenital triangle with loss of fat planes with the vagina (arrowhead in a) and anterior external anal sphincter (arrowhead in b).
case_images: can-17-1534fig3.jpg
case_images: PMC10151084_01_can-17-1534fig3.jpg
case_images: figure3
case_images: T2 hyperintense lesion in the ano-vaginal space of the urogenital triangle extending anteriorly up to the posterior wall of the vagina, and posteriorly up to the external anal sphincter at the anal verge, without any apparent mucosal infiltration (Figure 3). There was a loss of fat planes in the external anal sphincter.
case_images: CECT showing (a): non-metastatic status of the patient in the thorax and (b): no lymphadenopathy.
case_images: can-17-1534fig4.jpg
case_images: PMC10151084_01_can-17-1534fig4.jpg
case_images: figure4
case_images: CECT thorax, abdomen and pelvis showed no distant metastases (Figure 4).
case_images: Contouring volumes of the pelvic lymph nodes in (a): the axial view, (b): the gross disease, (c): coronal view and (d): sagittal view. GTV: cyan, CTV-56: bright red, CTV-50.4: peach, CTV-42: lavender, PTV-56: red, PTV-50.4: green, PTV-42: dark blue, Lt femur: yellow, Rt femur: blue, Ext genitalia: light blue, bladder: lime green, bowel bag: pink, small bowel: red, iliac crest: orange, external: beige.
case_images: can-17-1534fig5.jpg
case_images: PMC10151084_01_can-17-1534fig5.jpg
case_images: figure5
case_images: She was treated with a volumetric modulated arc therapy technique using 6 MV photons over 5.5 weeks, 5 days per week (Figure 5 and 6).
case_images: (A) Axial and (B) sagittal CT images showing the dose coverage of the gross disease and nodal volumes.
case_images: can-17-1534fig6.jpg
case_images: PMC10151084_01_can-17-1534fig6.jpg
case_images: figure6
case_images: She was treated with a volumetric modulated arc therapy technique using 6 MV photons over 5.5 weeks, 5 days per week (Figure 5 and 6).
case_images: Clinical picture of the patient at the conclusion of treatment showing regression in the size of the lesion.
case_images: can-17-1534fig7.jpg
case_images: PMC10151084_01_can-17-1534fig7.jpg
case_images: figure7
case_images: At completion, a single 1.5 x 1 cm lesion was present at the posterior fourchette of the vagina, with a complete response of the lesions over the labia (Figure 7).
case_images: T2 weighted MRI sequence, (a): sagittal, (b): axial and (c): DWI sequence showing complete resolution of the lesion.
case_images: can-17-1534fig8.jpg
case_images: PMC10151084_01_can-17-1534fig8.jpg
case_images: figure8
case_images: Re-assessment MRI revealed complete resolution of the tumour (Figure 8).