PMC8714461_01
Skin lesions observed on the third visit before diagnosis. (A) Red to yellow papules on her left cheek, measuring approximately 3 cm x 3 cm. (B) Papules and erythema on her left chest, measuring approximately 6 cm x 3.5 cm.
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The surface was smooth and had a waxy luster (Figure 1A). A similar rash was seen on the left chest, covering an area of approximately 6 cm x 3.5 cm with a clear boundary, smooth surface, waxy luster, mild infiltration and hypertrophy, normal skin temperature, and no tenderness (Figure 1B).
Epidermis is generally normal. Cell masses can be seen infiltrating the dermis. Phagocytosis of histiocytes can be seen; the cytoplasm appears pale and frothy, and some nuclei are deeply stained and irregular in shape. (40X).
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Lymphocytes, plasma cells, a small number of neutrophils and eosinophils were observed in the mass upon hematoxylin and eosin (HE) staining (Figure 2).
Highly magnified (400x) microscopic image shows emperipolesis.
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Emperipolesis phenomenon was also observed (Figure 3).
Immunohistochemical (staining) findings. (A) S100 (+) (40x). (B) CD68 (+) (40x). (C) CD1a (-) (40x).
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IHC staining showed S100 (+) (Figure 4A), CD68 (+) (Figure 4B), and CD1a (-) (Figure 4C).
Three months after diagnosis, skin lesions partially disappeared. (A) Papules on the left cheek disappeared, but erythema (approximately 3 cm x 3 cm) is noted. (B) Papules on left chest were smaller in size (approximately 5 cm x 3 cm).
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No treatment was initiated and the skin lesions partially disappeared three months after diagnosis (Figure 5A and B).
Timeline.
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The patient is still being monitored via follow-up examinations (Figure 6).