A case study of squamous cell carcinoma of the vulva in complete remission after radical radiotherapy
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摘要: 患者女，80岁，外阴不适2年，发现双侧大阴唇斑块、溃疡3月余。组织病理活检：表皮不规则增生，并向真皮内浸润，形成鳞状细胞团块，可见核异型性，真皮浅层可见淋巴细胞浸润。免疫组织化学染色：PD-L1 CPS=80。高危型HPV核酸分型提示：HPV16阳性(+)。诊断：外阴低分化角化型鳞状细胞癌。患者皮损面积巨大，经根治性放疗后效果极为显著，皮损完全消退，症状基本缓解，达到肿瘤根治的标准，无须进一步手术或免疫靶向治疗。随访期间未见明显放疗相关副作用及肿瘤复发。Abstract: The patient is a female, 80-year old, with vulvar discomfort for 2 years, with bilateral labia majora plaques and ulcers for more than 3 months. Histopathological examination of tissue biopsies showed irregular epidermal hyperplasia with infiltration into the dermis, formation of squamous cell masses with visible nuclear heterogeneity, and lymphocytic infiltration in the superficial dermis. Immunohistochemistry demonstrated that the combined positive score (CPS) of programmed death-ligand 1 (PD-L1) was 80. Nucleic acid testing for high-risk HPV typing suggested HPV16 positive (+). The woman was diagnosed with vulvar hypofractionated keratinized squamous cell carcinoma based on the aforementioned evidence. The patient was greatly improved after radical radiotherapy, with manifestations of complete regression of the original large skin lesion and basic relief of symptoms, and required no further surgery or targeted immunotherapy, since the treatment effect met the criteria for radical tumor treatment. No significant radiotherapy-related side effects or tumor recurrence were observed during the follow-up period.
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Key words:
- Radiation therapy /
- Vulvar tumor /
- Squamous cell carcinoma
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图 2 溃疡皮损组织病理
注：A示表皮不规则增生，并向真皮内浸润，形成鳞状细胞团块(HE染色，×200)，B示可见核异型性，真皮浅层可见淋巴细胞浸润(HE染色，×400)。
Figure 2. Histopathology of ulcerated skin lesions
图 3 溃疡皮损免疫组织化学染色
注：PD-L1 CPS=80(×400)。
Figure 3. Immunohistochemical staining of ulcerated skin lesions
图 4 治疗结束后3个月原皮损处组织病理
注：A示真皮层增厚(HE染色，×100)，B示细胞核分裂象增加，未见肿瘤细胞(HE染色，×400)。
Figure 4. Histopathology of the original skin lesions performed 3 months after the end of treatment
图 5 治疗结束后3个月原皮损处免疫组织化学染色
注：Ki67(+)，P16(+)(SP × 400)。
Figure 5. Immunohistochemical staining of the original skin lesions performed 3 months after the end of treatment
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