PMC8722817_01
Photomicrograph of the histopathology [H & E, (A) 100X, (B) & (C) 400X] and the cytopathology [Giemsa (D) 400X], displaying a few cohesive clusters of medium to large-sized pleomorphic atypical cells with variable morphology admixed with small lymphocytes, histiocytes, few plasma cells, neutrophils, occasional eosinophils, and foamy macrophages. A fair number of the cells were large-sized with wreath-like nuclei and plasmacytoid appearance along with the presence of atypical mitosis.
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gf01
A fair number of the cells were large-sized with wreath-like nuclei and plasmacytoid appearance (Figures 1A, 1B, and 1C). Many multinucleated giant cells containing wreath-like nuclei were evident, accompanied by increased phagocytic activity and marked cytologic atypia, especially in the cells seen in the clusters (Figure 1D).
Photomicrograph of the IHC analysis revealing the tumor cells to be positive for CD1a (A, 400X), CD4 (B, 400X), CD68 [variably] (C, 200X) and negative for CD20 (D, 200X).
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gf02
Additional IHC was resorted to, which illustrated diffuse and strong positivity of the atypical cells for CD1a, S100, and langerin (CD207) and negativity for CD21 and CD23, thus confirming a Langerhans cell neoplasm (Figure 2, 3, and 4).
Photomicrograph of the IHC analysis revealing the tumor cells to be negative CD3 (A, 200X), CD30 (B, 200X), and CD23 (C, 200X). Ki67 index (D, 400X) was approximately 65-70% in the highest proliferating zone.
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PMC8722817_01_autopsy-11-e2021344-g03.jpg
gf03
Additional IHC was resorted to, which illustrated diffuse and strong positivity of the atypical cells for CD1a, S100, and langerin (CD207) and negativity for CD21 and CD23, thus confirming a Langerhans cell neoplasm (Figure 2, 3, and 4).
Photomicrograph of the IHC analysis revealing the tumor cells to be positive for S100 (400X).
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PMC8722817_01_autopsy-11-e2021344-g04.jpg
gf04
Additional IHC was resorted to, which illustrated diffuse and strong positivity of the atypical cells for CD1a, S100, and langerin (CD207) and negativity for CD21 and CD23, thus confirming a Langerhans cell neoplasm (Figure 2, 3, and 4).