PMC10151084_01
Clinical picture of patient at presentation showing the perianal lesion (black arrow) with separate skip lesion in vulva (red arrow).
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figure1
Another lesion of 1 x 1 cm was noted over the right labia (Figure 1).
(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.
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The biopsy was confirmative of squamous cell carcinoma with p16 positive on immunohistochemistry (Figure 2).
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).
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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.
CECT showing (a): non-metastatic status of the patient in the thorax and (b): no lymphadenopathy.
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CECT thorax, abdomen and pelvis showed no distant metastases (Figure 4).
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.
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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).
(A) Axial and (B) sagittal CT images showing the dose coverage of the gross disease and nodal volumes.
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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).
Clinical picture of the patient at the conclusion of treatment showing regression in the size of the lesion.
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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).
T2 weighted MRI sequence, (a): sagittal, (b): axial and (c): DWI sequence showing complete resolution of the lesion.
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Re-assessment MRI revealed complete resolution of the tumour (Figure 8).