case_images: PMC5463110_01
case_images: Low power H&E images demonstrating variable amount of inflammatory infiltrate around tumour cells and extending into the subcutaneous tissue in each of the three biopsies (a), (b), and (c).
case_images: CRIPA2017-9842605.001.jpg
case_images: PMC5463110_01_CRIPA2017-9842605.001.jpg
case_images: fig1
case_images: There were numerous mitoses and a variable chronic inflammatory infiltrate was admixed with the tumour cells (Figures 1 and 2).
case_images: High power H&E images demonstrating variable inflammatory infiltrate surrounding neoplastic tumour cells in each of the three biopsies (a), (b), and (c).
case_images: CRIPA2017-9842605.002.jpg
case_images: PMC5463110_01_CRIPA2017-9842605.002.jpg
case_images: fig2
case_images: There were numerous mitoses and a variable chronic inflammatory infiltrate was admixed with the tumour cells (Figures 1 and 2).
case_images: Langerin immunohistochemistry highlights tumour cells at the three biopsy sites (a), (b), and (c).
case_images: CRIPA2017-9842605.003.jpg
case_images: PMC5463110_01_CRIPA2017-9842605.003.jpg
case_images: fig3
case_images: The tumour cells in all three biopsies were positive for CD1a and Langerin (Figure 3).
case_images: S100 immunohistochemistry positivity was variable in the three biopsies; these images compare the S100 positivity from the three different biopsy sites. (a) shows that tumour cells are S100 positive; (b) shows that occasional tumour cells are S100 positive; (c) shows that tumour cells are negative for S100. This variability within a single cutaneous lesion has not been reported within a single LCS lesion.
case_images: CRIPA2017-9842605.004.jpg
case_images: PMC5463110_01_CRIPA2017-9842605.004.jpg
case_images: fig4
case_images: Tumour cells from the first area biopsied were strongly positive for S100, whereas the cells from the second area biopsied showed weak positivity for S100 and from the third area they were negative with S100 (Figure 4).
case_images: CD45 immunohistochemistry. Biopsies from the first (a) and second site (b) were positive whereas the biopsy from the third site (c) was negative.
case_images: CRIPA2017-9842605.005.jpg
case_images: PMC5463110_01_CRIPA2017-9842605.005.jpg
case_images: fig5
case_images: There was equivocal staining in the first and second biopsies with CD45 but strong positive staining in the third biopsy (Figure 5).
case_images: Electron microscopy demonstrates Birbeck granules. Birbeck granules are racquet or rod shaped cell organelles which are a characteristic feature of Langerhans cell. The presence of these on ultrastructural analysis confirms that the cell of origin is from the dendritic cell family.
case_images: CRIPA2017-9842605.006.jpg
case_images: PMC5463110_01_CRIPA2017-9842605.006.jpg
case_images: fig6
case_images: The presence of Birbeck granules was confirmed by electron microscopy, confirming the Langerhans cell lineage of the tumour (Figure 6).