case_images: PMC11782013_01
case_images: (A) Multiple red hard and smooth papules and nodules with a diameter of 0.5-2 cm on the left upper limb. Dense, nodular lymphocytic infiltrate in the dermis [hematoxylin-eosin, original magnification: (B) x40; (C) x100]. (D) A dense infiltration of lymphocytes, histiocytes, and plasma cells was observed in the dermis (hematoxylin-eosin, original magnification x400). (E) Immunohistochemical staining results (original magnification x40) revealed that most of the infiltrating cells were positive for the B-cell makers CD20. (F) Some lymphoid cells was positive for the T-cell maker CD3. Bcl-2 (G) was negative and Bcl-6 (H) was weakly positive in the center of the nodular infiltrated cells in the dermis.
case_images: fmed-11-1507399-g002.jpg
case_images: PMC11782013_01_fmed-11-1507399-g002.jpg
case_images: fig2
case_images: A 69-year-old woman presented for the evaluation of multiple red firm and smooth papules and nodules with a diameter of 0.5-2 cm on both upper limbs (Figure 2A) and the scalp, which had occurred without obvious causes 6 months ago. Histopathological analysis of the papule on the left upper limb showed chronic inflammation of the skin tissue with atypical hyperplasia of local dermal lymphocytes (Figures 2B-D). CD3 (Figure 2F). Bcl-2 (Figure 2G) was negative and Bcl-6 (Figure 2H) was weakly positive in the center of the nodular infiltrated cells in the dermis. The patient was preliminarily diagnosed with CPL. Considering that the lesions were relatively limited with no obvious subjective symptoms, further observation has been recommended.
case_images: PMC11782013_02
case_images: (A) After the first hirudotherapy, red patches appeared with a "Y" shaped depression visible in the center and a purplish halo surrounding it. (B) Multiple firm and red nodules developed at the site where the leeches were applied. (C) After being treated with intralesional glucocorticoids and fractional laser, some lesions thinned or even nearly resolved. (D) The rashes that had thinned or even disappeared before reappeared a few weeks later. (E,F) The epidermis showed irregular hyperplasia, with intact basal cells, and infiltration of a large number of lymphocytes, histiocytes, plasma cells and a small number of eosinophils in the dermis and subcutis, without obvious atypia (hematoxylin-eosin, original magnification: E x100; F x400). (G) Immunohistochemical stains (original magnification x200) showed that the expression of B cell markers CD20 was positive. (H) The expression of T cell markers CD3 was positive.
case_images: fmed-11-1507399-g003.jpg
case_images: PMC11782013_02_fmed-11-1507399-g003.jpg
case_images: fig3
case_images: She had undergone hirudotherapy for a 5 x 6 cm mass on her left chest in a private clinic (Figure 3A). A few days later the nodules developed at the site where the leeches were applied without symptom (Figure 3B). HIV tests were negative. Histopathological biopsy showed irregular epidermal hyperplasia, with abundant infiltration of lymphocytes, histiocytes, plasma cells and few eosinophils in dermis and subcutaneous areas, and no obvious atypia (Figures 3E,F). T cell markers CD3 (Figure 3H) and CD4 were positive, while the expression of Bcl-2 was negative. The proliferative rate, highlighted with Ki-67, was elevated in dermal infiltrate. Intralesional glucocorticoids and fractional laser were applied, after which the lesions thinned or even nearly resolved (Figure 3C), but they recurred several weeks later (Figure 3D).