Fig 2.

Histopathologic analysis before and after combined systemic and intratumoral administration of the 9-valent HPV vaccine. A and B, On initial presentation, biopsy found full-thickness atypia of the epidermis with scattered mitotic figures. There is a “windblown” appearance of the cells without epidermal maturation. There is also overlying parakeratosis, consistent with a diagnosis of squamous cell carcinoma. C and D, Nine months after combined systemic and intratumoral administration of the 9-valent HPV vaccine, biopsy found hyperkeratosis and focal hypergranulosis of the acanthotic epidermis. Within the dermis is a band-like infiltrate with scattered Civatte bodies without evidence of residual carcinoma. (A-D, Hematoxylin-eosin stain; original magnifications: A and C, ×20; B and D, ×40.)