PMC8716999_01
HPV independent vulvar squamous cell carcinoma G1: a. back-to-back nests of well differentiated squamous epithelium with massive hyperkeratosis and parakeratosis (HE, x40); b. moderate chronic inflammation in stroma (left bottom) (HE, x100); c. abundant pale, eosinophilic cytoplasm with low nuclear to cytoplasmic ratio, mild nuclear pleomorphism, basally located mitotic figures (HE, x200); d. negative p16 in tumor cells (IHC, anti-p16 antibody, x200).
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PMC8716999_02
Axial CT scan sequences, venous phase: a) bilateral inguinal lymph nodes (white arrows) December 2019; b) abdominal wall subcutaneous metastasis (white arrow) December 2019; c) increased bilateral inguinal lymph nodes (white arrows) April 2020; d) bilateral lung metastasis and right lung lymphangitis (white arrows) April 2020.
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A thorax-abdominal-pelvic CT (TAP CT) with contrast was performed and revealed local recurrence in the pelvis, left inguinal lymphadenopathies and multiple nodular subcutaneous lesions in the abdominal wall, suggesting progressive disease (Figures 2a and 2b). We decided to perform a TAP CT scan with contrast which revealed bilateral pulmonary metastasis, tumor pleural thickening, right lung carcinomatous lymphangitis and bilateral inguinal and external iliac lymphadenopathies (Figures 2c and 2d).
Case management outline for metastatic vulvar squamous cell carcinoma
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Four more cycles of Gemcitabine and Carboplatin were eventually given, until the patient's death in July 2020 (Figure 3).