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case_images: Histopathologic examination of tumor. (a) On microscopic examination after H&E stain the skin shows poorly differentiated adenocarcinoma within the dermis and focally within the epidermis. The tumor cells are large with increased N:C ratio and increased mitotic activity. Immunohistochemical stains showed the tumor cells are positive for CDX2 (b), CK20 (c), and negative for CK7 (d) and PAX8, confirming metastasis from colorectal primary.
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case_images: Immunohistochemical stains were positive for CDx2, CK20, and negative for PAX8 and CK7 (Fig. 1).
case_images: Representative images from PET-CT study. Axial images from PET-CT at time of disease recurrence reveal (a) FDG-avid focus along the left labia as well as (b) FDG-avid right inguinal lymph nodes.
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case_images: Repeat PET at completion of six cycles of FOLFIRI revealed increased FDG-avidity in the right labia and the inferoposterior vagina (Fig. 2), and gynecologic exam revealed progression of vulvar disease.