case_images: PMC8722817_01
case_images: 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.
case_images: autopsy-11-e2021344-g01.jpg
case_images: PMC8722817_01_autopsy-11-e2021344-g01.jpg
case_images: gf01
case_images: 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).
case_images: 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).
case_images: autopsy-11-e2021344-g02.jpg
case_images: PMC8722817_01_autopsy-11-e2021344-g02.jpg
case_images: gf02
case_images: 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).
case_images: 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.
case_images: autopsy-11-e2021344-g03.jpg
case_images: PMC8722817_01_autopsy-11-e2021344-g03.jpg
case_images: gf03
case_images: 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).
case_images: Photomicrograph of the IHC analysis revealing the tumor cells to be positive for S100 (400X).
case_images: autopsy-11-e2021344-g04.jpg
case_images: PMC8722817_01_autopsy-11-e2021344-g04.jpg
case_images: gf04
case_images: 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).