case_images: PMC10915755_01
case_images: The PET-CT scans obtained from case 1 ("+" presents the vulvar/cervical lesion): (A) The CT showed a low-density nodular shadow in the vulva. (B) The PET-CT showed significantly increased 18F-FDG metabolism in the vulvar lesion. (C) The CT showed an uneven density mass shadow in the cervix. (D) The PET-CT showed significantly increased 18F-FDG metabolism in the cervical lesion.18F-FDG, 18F-fluorodeoxyglucose.
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case_images: Positron emission tomography-computed tomography indicated a cervical mass (1.8x2.8cm) and a vulvar mass (2.4x1.0cm) with significantly increased metabolism of 18F-fluorodeoxyglucose, suggestive of cervical cancer ( Figures 1 A-D ).
case_images: Characteristics of the cervical squamous cell carcinoma and vulvar squamous cell carcinoma for case 1. (A) The cervical tumor cells were arranged in a nest-like pattern, with obvious cell abnormalities. (B) The cervical tumor cells were polygonal and the nuclei were round or oval. The mitotic appearance was easy to see, and no keratinized beads were observed. (C) P16 was diffuse positive in the cervical tumor cells. (D) P40 was diffuse positive in cervical tumor cells. (E) The vulvar tumor cells were arranged in a nested pattern, invading the stroma. (F) Keratinocytes were visible in vulvar tumor cells. (G) Ki-67 was approximately 90% positive in vulvar tumor cells. (H) P16 was diffusely positive in vulvar tumor cells.
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case_images: Histologically, the cervix showed moderately differentiated SCC with nest-like arrangements of cells ( Figures 2A, B ), significant cellular atypia, numerous mitotic figures, and lymph-vascular space invasion. Vulvar mass showed high- to moderately differentiated SCC ( Figures 2E, F ): tumor with nest-like arrangements, marked cellular atypia, numerous mitotic figures, keratin pearl formation, invasive growth of the tumor, high-grade squamous intraepithelial lesion (HSIL) in the surrounding rough area, and negative surgical margins around the skin and at the base. Immunohistochemistry indicated that the tumor cells were positive for epithelial markers CK5/6 and P40 ( Figure 2D ). The ki-67 index of cervical tumors was 70%, and that of vulvar tumors was 90% ( Figure 2G ). The strong positive expression of P16 proved that the tumor was HPV-related ( Figures 2C, H ).
case_images: PMC10915755_02
case_images: Characteristics of the cervical squamous cell carcinoma, vulvar squamous cell carcinoma, and vaginal squamous cell carcinoma for case 2. (A) The cervix was HSIL/CIN III with microinvasion (stroma invasion depth, <0.3cm).(B) HSIL in the vulva with focal invasion (stroma invasion depth, <0.1cm). (C) The Ki-67 was about 90% positive in vulvar tumor cells.(D) The P16 was diffusely positive in vulvar tumor cells. (E) The D2-40 is negative in the partial basal layer of the vulvar squamous epithelium at the microinvasion.(F) HSIL in the vaginal wall with focal invasion (stroma invasion depth, <0.1cm).(G) The D2-40 was negative in the partial basal layer of the vaginal squamous epithelium at the microinvasion. (H) The Ki-67 epithelial was 90% positive in vaginal tumor cells.
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case_images: Histology suggested the cervix was HSIL/CIN III with microinvasion, invading the stroma. ( Figure 3A ). HSIL with focal invasion was noted in the vulva and the vagina ( Figures 3B, F ), with no lymph node metastasis detected. H ). However, negative staining for D2-40 was observed in the partial area of the basal lamina ( Figures 3E, G ).