PMC9256389_01
Pinkish mild erosions and small punched-out ulcers in genital area.
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Hospital with a chief complaint of small punched-out ulcers located in the genitalia area concomitant with pruritus and posturination dysuria since two years before. Her physical examination was normal except for mild pinkish erosions and two punched-out ulcers in the genital area (Figure 1).
(a). There are some aggregates of Langerhans cells in the epidermal layer and diffuse upper and mid-dermal predominantly Langerhans cell infiltration (H&E x 100) (b). There are some aggregates of Langerhans cells in the epidermal layer and diffuse dermal predominantly Langerhans cell infiltration admixed with some eosinophils and few lymphocytes (H&E x 200) (c). Follicular epithelium involved by Langerhans cells (H&E x 400) (d). There is diffuse upper dermal predominantly Langerhans cell infiltration with mitotic figures admixed with some eosinophils and neutrophils and a few lymphocytes (H&E x 400).
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The follicular epithelium was involved by some aggregates of Langerhans cells (Figure 2).
(a). S100 immunostaining shows strong diffuse positivity in upper dermis and scattered single as well as aggregates of Langerhans cells in the epidermis (x100) (b). CD1a immunostaining of Langerhans cells shows strong diffuse positivity in the upper dermis and scattered single as well as aggregates in the epidermis (x100) (c). CD68 immunostaining shows scattered weak positivity upper dermis (x100).
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Finally, the probable diagnosis was LCH (Figure 3).
Remission after treatment by thalidomide.
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Finally, the patient's lesions disappeared after one year (Figure 4).