PMC9748561_01
Left: T2 Sagittal Image (A) and fat suppressed T2 Axial Image (C) of the Pelvis at baseline showing a hyperintense vaginal mass (asterisk) outlined by orange arrows. Right: T2 Sagittal Image of the Pelvis (B) and Axial Image of the Pelvis (D) 3 months following the initiation ipilimumab and nivolumab neoadjuvant therapy, where the hyperintense vaginal mass is no longer visualized.
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This status persisted as imaged by PET/CT, transvaginal ultrasound and MRI imaging with continued follow-up up to 2 years;  Figure 1 .
Left: Histology slides at baseline showing neoplastic cells using SOX10 (A) and HMB45 (B) immunostains at 63X magnification. Right: Biopsy of tumor site displaying complete resolution of the tumor with no viable tumor cells and scar tissue formation as assessed 3 months following ipilimumab and nivolumab neoadjuvant therapy (C).
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The patient underwent 12 circumferential vaginal biopsies shortly after the MRI, and all 12 biopsies showed no evidence of viable melanoma tumor cells, indicating a complete pathologic response (pCR) as illustrated in  Figure 2 .
PMC9748561_02
PMC9748561_03
Left: T2 Sagittal Image (A) and fat suppressed T2 Axial Image (C) of the Pelvis at baseline showing a hyperintense vaginal mass (asterisk) outlined by orange arrows. Right: T2 Sagittal Image of the Pelvis (B) and Axial Image of the Pelvis (D) 3 months following the initiation ipilimumab and nivolumab neoadjuvant therapy, where the hyperintense vaginal mass is no longer visualized.
fonc-12-1044587-g001.jpg
PMC9748561_03_fonc-12-1044587-g001.jpg
f1
This status persisted as imaged by PET/CT, transvaginal ultrasound and MRI imaging with continued follow-up up to 2 years;  Figure 1 .
Left: Histology slides at baseline showing neoplastic cells using SOX10 (A) and HMB45 (B) immunostains at 63X magnification. Right: Biopsy of tumor site displaying complete resolution of the tumor with no viable tumor cells and scar tissue formation as assessed 3 months following ipilimumab and nivolumab neoadjuvant therapy (C).
fonc-12-1044587-g002.jpg
PMC9748561_03_fonc-12-1044587-g002.jpg
f2
The patient underwent 12 circumferential vaginal biopsies shortly after the MRI, and all 12 biopsies showed no evidence of viable melanoma tumor cells, indicating a complete pathologic response (pCR) as illustrated in  Figure 2 .
Multiplex immunofluorescence immunohistochemistry of tumor biopsies at baseline (A, C) and at 3 months (B, D) following the initiation of ipilimumab and nivolumab showing changes in CD3 (green), CD8 (yellow), PD-L1 (orange), MHCI (cyan), SOX10 (cyan) and DAPI (blue) immunostains. A significant increase in the expression of MHC-I+/PD-L1+ (p=0.0286, 2-Tailed Mann-Whitney) and of CD3+/CD8+ (p=0.0286, 2-Tailed Mann-Whitney) was found at 3 months compared to baseline. *, It designates a p value lower than 0.05.
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IHC results are presented in  Figure 3 .
Timeline with relevant data from the diagnosis.
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A timeline with relevant data from the time of diagnosis is summarized in  Figure 4 .