case_images: PMC11788580_01
case_images: Shows the changes in the size of the dynamic inguinal lymph during the course of the disease. (A) Shows that the size of the left inguinal lymph node was 0.93cm on 30 May 2022, two months after the patient was enrolled in the placebo- controlled phase III clinical study. (B) Shows that the size of the left inguinal lymph node was 1.94cm on 4 April 2023, the day on which the clinical study was terminated; this indicated the recurrence of cervical cancer, but the patient refused in-hospital treatment. (C) Shows that the left inguinal lymph node was smaller but that the right inguinal lymph node was significantly larger when molecular diagnosis was used to establish the occurrence of skin metastasis from cervical cancer. (D) Shows that, after two cycles of albumin-bound paclitaxel, cisplatin and bevacizumab, the inguinal lymph nodes were significantly smaller. (E) Shows that after four cycles of albumin-bound paclitaxel, cisplatin, bevacizumab and albumin-bound paclitaxel, cisplatin, bevacizumab and terprelimab, the inguinal lymph nodes regressed to a normal size, and that the skin metastasis completely regressed.
case_images: fimmu-15-1528957-g001.jpg
case_images: PMC11788580_01_fimmu-15-1528957-g001.jpg
case_images: f1
case_images: Due to the significant enlargement of the left inguinal lymph node ( Figure 1A ), which is highly suggestive of recurrence, the patient was enrolled in a placebo-controlled phase III clinical study of combination immunochemotherapy (the use of AK104 730 mg or placebo + bevacizumab 1095 mg + paclitaxel 313.2 mg + carboplatin 50 mg for six cycles was initially planned). The patient was later given AK 104 + bevacizumab for 11 cycles until March 6, 2023 ( Figure 1B ). However, during this period, the right inguinal lymph node had enlarged compared to the previous examination ( Figure 1C ). Consequently, the therapy was adjusted to a new regimen: albumin-bound paclitaxel 400 mg, cisplatin 125 mg, and bevacizumab 800 mg; this was administered over two cycles ( Figure 1D ). NCCN guidelines, the patient received four cycles of a modified regimen from February 19 to May 2 2024, consisting of albumin-bound paclitaxel 400 mg, cisplatin 100 mg, bevacizumab 800 mg, and terprelimab 240 mg. Notably, since March 13 2024, following the third cycle, all cutaneous and lymph node metastases had fully regressed, and the patient's condition has remained stable and favorable ( Figures 2D, E ,  1E ).
case_images: (A) Shows the red herpes-like solid papules and nodules of rice grain to soybean size on the pubic mound, vulva, labia majora and minora, the upper third of the left thigh, and the root of the right thigh. (B, C) Show the solid papules and nodules that grew to the size of soybeans or peanuts. (D) Shows the partial regression of skin metastases after the third cycle of changed treatment. (E) Shows the complete regression of skin metastasis after the fourth cycle of changed treatment, and CT confirmed the regression of inguinal lymph nodes.
case_images: fimmu-15-1528957-g002.jpg
case_images: PMC11788580_01_fimmu-15-1528957-g002.jpg
case_images: f2
case_images: After 2 weeks of antiviral treatment, solid papules and nodules that were the size of soybeans or peanuts appeared on the vulva, labia majora and minora, inguinal area, lower abdomen, the root of the right thigh, and the upper one-third of the left thigh; some of these were smooth and shiny with blisters ( Figures 2A-C ). NCCN guidelines, the patient received four cycles of a modified regimen from February 19 to May 2 2024, consisting of albumin-bound paclitaxel 400 mg, cisplatin 100 mg, bevacizumab 800 mg, and terprelimab 240 mg. Notably, since March 13 2024, following the third cycle, all cutaneous and lymph node metastases had fully regressed, and the patient's condition has remained stable and favorable ( Figures 2D, E ,  1E ).
case_images: Shows the upper metastatic and moderately to lowly differentiated squamous cell carcinoma nested in the dermis, highly suggestive of the cutaneous metastasis of the primary cervical carcinoma, which was similarly differentiated and nested. The middle panel of 
  Figure 3
   presents the immunohistochemical tests that showed the metastatic tumor cells CK(+), CK5/6(+) and P40(+), with the same pattern as primary squamous cervical carcinoma cells. The lower panel of 
  Figure 3
   presents the primary cervical lesion and the metastatic nodule cells that show the same HPV16(+) and twenty other (-) genotypes; therefore, it is clear that these lesions are caused by the same carcinogen and exhibit the same monoclonal nature.
case_images: fimmu-15-1528957-g003.jpg
case_images: PMC11788580_01_fimmu-15-1528957-g003.jpg
case_images: f3
case_images: Pathological examination revealed the appearance of metastatic and moderately to poorly differentiated squamous cell carcinoma nested in the dermis, involving the deep dermis; this was highly suggestive of the cutaneous metastasis of the previous cervical carcinoma ( Figure 3 ). Subsequent immunohistochemical tests at our hospital showed the same CKpan(+), CK5/6(+), S-100 (-), P40(+), CK7(-), SOX-10(-) and SYN(-) in the tumor cells as before ( Figure 3 ). HPV nucleic acid and genotype tests reported that both the cervical carcinoma and cutaneous metastasis were HPV16 (+) and other genotypes including HPV6,11,18,26,31,33,35, 39,45,51,52,53,56,58, 59,66,68,70,73 and 82(-) ( Figure 3 ).