PMC5287963_01
Metastatic islets of squamous cell carcinoma in an inguinal lymph node (A: hematoxylin and eosin; B: in situ hybridization for HR-HPV detection). The in situ hybridization technique was performed on the BenchMark Ultra automated system (Ventana, Tucson, AZ) using INFORM HPV III Family 16 probe (B) (Ventana, Tucson, AZ), which contains a cocktail of DNP-labeled HPV genomic DNA probes (high-risk oncogenic genotypes detected: 16,18,31,33,35,39,45,51,52,56,58,66). The episomal pattern appears as a large, homogeneous, globular navy-blue precipitate within the epithelial cell nucleus. The integrative pattern is a discrete, stippled navy blue nuclear pattern. Both these patterns of staining, indicating positivity for oncogenic type HPV infection, are evident in the image. DNP = dinitrophenol, HPV = human papillomavirus, HR-HPV = high-risk human papillomavirus.
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F1
The subsequent surgical excision of bulky groin nodes revealed a lymph node metastasis from clinically undetectable primary squamous cell carcinoma; viral genome of HR-HPV was detected through in situ hybridization technique (INFORM HPV III Family 16 probe (B):Ventana, Tucson, AZ) (Fig. 1).
Vulvar high-grade squamous intraepithelial lesion (A: hematoxylin and eosin; B: in situ hybridization for HR-HPV detection). HR-HPV = high-risk human papillomavirus.
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F2
The lesion was excised with a final histopathological diagnosis of usual type (HPV-related) vulvar intraepithelial neoplasia (VIN) (Fig. 2).
Squamous cell carcinoma of the anus: superficial epithelium with severe dysplasia is evident in the upper right of the image, whereas infiltrative carcinoma can be observed in the lower right. Normal intestinal glands are evident on the left (A: hematoxylin and eosin; B: in situ hybridization for HR-HPV detection). HR-HPV = high-risk human papillomavirus.
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F3
The subsequent anoscopy revealed the presence of an ulcerated lesion at the anorectal junction, and the biopsy of the lesion showed an invasive squamous cell carcinoma of the anus (Fig. 3).