PMC9946006_01
(A) Domed-shaped, mild indurated erythematous papules with smooth surfaces coalesced into irregular annular plaques. (B and C) Granulomatous infiltration includes mainly histiocytes, focally accumulated or dispersed between collagen bundles, (B) (HEx100), (C) (HEx200). (D) AB-PAS (+ focally and weakly, Special stainx200). (E) CD68 (KP-1, + IHCx100). (F) CD3 (+, IHCx100).
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The circinate papules were remarkably seen on the periphery and tended to resolve in the center of plaques which were distributed on the trunk and extremities (Figure 1A).  Some perivascular lymphocytes and accidental eosinophils were seen (Figure 1B and C). Special stains revealed AB-PAS (+focally and weakly) (Figure 1D), acid fast (-), and silver stain (-). Immunohistochemistry revealed KP-1(+) (Figure 1E), CD3(+) (Figure 1F), and CD20(-).
(A) Focal periductal localized lymphocytic infiltrates in exocrine glandular tissue along with otherwise intact acinar. Interstitial infiltration and focal aggregation of plasma cells were seen (3 focus, >= 50 cells/focus), (HEx100). (B) CD3 (+ focally and sparsely, IHCx100). (C) CD20 (+ focally and sparsely, IHCx100). (D) CD38 (+, IHCx100).
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Immunohistochemistry revealed CD20 (+ focally and sparsely), CD3 (+ focally and sparsely), CD38 (+ focally and sparsely), and IgG4 (-) (Figure 2).