PMC9879774_01
Clinical photographs prior to treatment.
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Several lymph nodes could be palpated in the groin bilaterally and were not enlarged (Figure 1).
(A and B) Basophilic cell-forming tumor masses can be seen, with dense cellular arrangements and a lack of the classic fenestrated arrangement around them. (Hematoxylin and eosin;x20).
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Histopathological examination of ulcerated lesions: irregular epidermal hyperplasia and infiltration into the dermis, formation of squamous cell masses, visible nuclear heterogeneity, lymphocytic infiltration in the superficial dermis (Figure 2A and B).
(A) Ki-67(+), (B) P16(+). (Immunohistochemical staining;x20).
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Immunohistochemical staining:Ki-67 (Lower one-third layer), P16(+) (Figure 3A and B); PD-L1 CPS>1.High-risk HPV ribosomal acid typing suggests HPV l6 positive (+).Diagnosis:PD-L1-positive HPV-associated basaloid squamous cell carcinoma of the vulva.   
Pathology sampling biopsy three months after the end of treatment.(Hematoxylin and eosin;x20).
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After three months, the plaques and ulcers were basically healed and no new lesions appeared.The biopsy was taken again from the central location of the original ulcer and showed: no tumor cells were seen (Figure 4).
(A)Just after the VMAT, (B) three months after completion of treatment, (C) six months after completion of treatment.
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Regular follow-up checkups every three months.The skin lesions of the patients before and after radical radiotherapy are shown in (Figure 5).