Basal cell carcinoma (BCC) is the most common human cancer and represents a growing public health care problem. Although it is known that basal cell carcinoma is minimally associated with the risk of metastasis, this risk is increasingly reported in recent years. As BCC tumors display great variability in morphology, aggressiveness, and response to treatment, there is a need for further understanding of these tumors including diagnosis, molecular alterations, and management. In this report, we present a case of an 88-year-old man with history of BCC of the skin of his right breast, which eventually lead to death due to wide metastatic disease. We describe the features associated with the risk of metastasis and provide a brief review of the current literature.

Extraskeletalmyxoidchondrosarcoma is an uncommon soft tissue sarcoma that can resemble a much more common sarcoma, myxoidliposarcoma, leading to misdiagnosis. This has important clinical implications as these pathologies differ in treatment, recurrence rates, and metastasis. Here, we present a case of a 29-year-old man, who presented with a large soft tissue mass at the front of the left ankle. This case presented a diagnostic challenge based on histomorphology and IHC studies alone. Molecular testing was essential for definitive diagnosis due to lack of agreement among soft tissue pathology experts. Reporting cases of EMC is imperative in order to bridge the gap between the known pathological features of this tumor and the consideration of this neoplasm in differential diagnoses.

We report a case of a 26-year-old who woman presented with a 2.6 cm solitary slowly growing subcutaneous nodule covered by normally appearing skin on her left groin. The Original pathological examination of the mass was described as storiform-appearing cellular with slight subcutaneous fat infiltration positive CD34 immunostain. On second opinion the mass was described as well-circumscribed surrounded by a thin, membranous layer. Histomorphologic examination of the lesion described a storiform architectural pattern composed of spindle cells with plump nuclei, characteristic of Schwann cells. Further evidence of a schwannoma was supported by a positive S-100 stain along with the positive CD34 stain. However, an additional stain of epithelial membrane antigen (EMA) was positive, more consistent with a perineurioma. The clinicopathologic and immunohistochemical features of the lesion supported the diagnosis of a hybrid perineurioma/schwannoma, a unique form of peripheral nerve sheath tumors.

Introduction: Angiomatoid fibrous histiocytoma (AFH) is a rare soft-tissue neoplasm often arising in children and young adults. They commonly occur in somatic soft tissue, mainly the upper and lower extremities. AFH is a translocation associated neoplasm, with the majority of cases positive for EWSR1-CREB1 translocation. The tumor was initially described as “malignant” AFH. However, it has a relatively rare chance of metastasis. AFH shows a broad spectrum of morphological patterns, and metastatic lesions may or may not show malignant features.

Report: We report a case of a 12-year-old female who presented with a left supraclavicular mass that was initially diagnosed as a benign fibrous histiocytoma. The mass was excised with clear surgical margins. Six years later, the patient presented with multiple retroperitoneal masses and later succumbed to metastatic disease. Molecular studies confirmed an EWSR1-CREB1 fusion gene in the primary and metastatic lesions. The culmination of these features led to the diagnosis of a metastatic angiomatoid fibrous histiocytoma.

Conclusion: AFH is a rare neoplasm with a spectrum of morphological characteristics and a vast array of immunophenotypical profiles. This can make the diagnosis of AFH challenging. Few cases of metastatic AFH have been reported in literature. However, when these lesions do metastasize, they are often fatal. It is our hope that this report raises awareness of what remains an unmet need in the diagnosis and management of “angiomatoid fibrous histiocytoma with malignant features.”

Metastatic melanoma may simulate a broad spectrum of primary malignant tumors. Significant similarity in cytomorphologic features can exist in both melanoma and lobular carcinoma of the breast. This can cause significant diagnostic difficulty, especially when there is inadequate patient history and/or limited biopsy material. The extraordinary phenotypic plasticity of metastatic melanoma adds to the diagnostic challenge of these tumors. Awareness of this pattern variance is essential to avoid diagnostic errors and inappropriate treatment. Here we present a case of metastatic lobular carcinoma, which was initially diagnosed as metastatic melanoma. Awareness of the similar cytomorphologic features of both melanoma and lobular carcinoma as well as the use of immunohistochemistry studies aided in providing the final diagnosis of this case and avoiding a diagnostic error.

Introduction: The most common cause of primary spontaneous pneumothorax (PSP) is sub pleural bleb apical rupture. Little is known about the relationship between PSP and exercise and return to exercise time. In this study, we tend to investigate the relationship between exercise and PSP and time of return to exercise and previous activities.

Method: This study was designed as a case series and the sample size included all patients diagnosed with PSP in Razi and Poursina and Aria hospitals of Rasht during 2015-2019 based on inclusion criteria. Variables were analyzed using Fisher’s exact test, Chi square, Mann Whitney U and t-test (p<0.05).

Results: The most common type of treatment in patients was transaxillary thoracotomy with pleurodesis with iodine (TTP) in 58.2% and tube thoracostomy and pleurodesis in 41.7%, which was not statistically significant between athletes and non-athletes (p=0.806). Athletes who underwent TTP after 4 weeks and those treated with tube thoracostomy and pleurodesis after 8-12 weeks were advised to return to their previous activity. Of athletes, 9.5% had recurrence; of non-athletes, 9.8% had recurrence. Of athletes, 4.8% did not tolerate a return to their previous activity; of non-athletes, 7.3% did not tolerate returning to their previous activity regardless of treatment, and this difference was not significant.

Conclusion: Our study showed no significant difference between clinical manifestations and image findings as well as frequency of treatment and complications in both athlete and non-athlete patients. There is no increase in recurrence and intolerance at the time recommended for return to previous activity.

Adenoid Cystic Carcinoma (ACC) is a slow growing neoplasm which often recurs within one to two decades after treatment. There are many subtypes of ACC, including cribriform, tubular, and solid forms, which have been found to correlate with overall prognosis as well as recurrence among patients with history of previously resected or treated ACC. Review of the existing literature shows that it is difficult to detect and control recurrence of ACC as most sites of metastasis do not show clinical signs or indications until the neoplasm has become increasingly advanced. Adenoid cystic carcinoma of the head and neck is usually found in the salivary glands, oral cavity, nasopharynx, and palate. There have been only a few reported cases of adenoid cystic carcinoma involving the External Auditory Canal (EAC). We present a case of ACC of the EAC along with a review and discussion of the literature to date.

Decubital ischemic fasciitis is a rare disease process characterized by pseudosarcomatous fibroblastic proliferation. The disease process is most commonly observed in elderly debilitated or immobilized patients. Its pathophysiology is characterized by degeneration and regeneration of mitotically active fibroblasts. Due to its histologic appearance, proximity to bone, and patient population, decubital ischemic fasciitis is occasionally mistaken for a soft tissue sarcoma. We report a case of this rare condition, diagnosed utilizing magnetic resonance imaging and subsequent core needle biopsy with microscopic evaluation. We also discuss the importance of early and accurate diagnosis in patients suspected of having this condition, as it is vital to rule out the potentially malignant soft tissue sarcoma, while also utilizing effective quaternary prevention and avoiding overtreatment in patients with benign decubital ischemic fasciitis.

This report presents the diagnosis of Kaposi sarcoma by the minimally invasive procedure of fine needle aspiration. The patient, a 65-year-old HIV negative Mediterranean man with a history of colon cancer, presented with right inguinal lymphadenopathy. Biopsy of the lymph node showed histological morphology consistent with Kaposi sarcoma confirmed by HHV-8 positive immuno stain. We review the role of HHV-8 in the pathogenesis of Kaposi sarcoma. We also discuss how it presents differently than Multicentric Castleman disease of the lymph node, caused by the same virus. How the latent and lytic pathways of the virus can influence the progression of the Kaposi sarcoma and Multicentric Castleman disease, respectively. Also, we review various treatment modalities for Kaposi sarcoma.

Osteoid osteoma is a benign tumor of the bone widely regarded as devoid of malignant capacity or invasive potential. Osteosarcoma is a highly aggressive tumor with generally unfavorable prognosis. We present a case of a 65-year-old woman who presented with a large thigh mass proved to be a dedifferentiated high-grade parosteal osteosarcoma arising from the left femur with metastasis to the ribs, spine, and pelvic bones. The patient reported history of osteoid osteoma at the same site of the current osteosarcoma surgically removed 46 years prior to current presentation. In this report, we describe the difference between osteoid osteoma and osteosarcoma, and attempt to answer the question of possible progression of osteoma to osteosarcoma, or if it is just a coincidence.

Ovarian granulosa cell tumor (GCT) is the most common malignant sex cord–stromal tumor, representing 2% to 3% of all ovarian cancers. It is generally considered to have a good prognosis with late recurrence typically occurring 5 to 20 years later. The majority of these tumors are locally aggressive and recur in the abdomen, pelvis, or lymph nodes. Distant metastases have been reported, particularly to the  lung and liver, bone metastases are extremely rare and reflect hematogenous spreading. We present a case of a 60-year-old woman who was found to have an isolated lytic lesion in the right medial clavicle. The clavicle lesion proved to be a metastatic GCT with recurrence 20 years later. There are only a few GCTs with bone metastases reported in the literature and to the best of our knowledge this is the first reported metastasis to the clavicle bone.

We report a case of a 37-year-old woman presenting with a 2.8 cm hypoechoic mass in the upper outer quadrant of the right breast. The original core and fine needle aspiration (FNA) at presentation led to the diagnosis of a fibroadenoma, however the cytopathologist noted few atypical cells insufficient for a malignant diagnosis. The mass was found to be enlarged in size at 3.6 cm at a follow up eleven months later. Repeat FNA and core biopsies demonstrated cytologic features of both fibroadenoma (FA) and invasive ductal carcinoma (IDC). Can a fibroadenoma progress into an invasive carcinoma? Or, is the presence of both of these modalities just a coincidence? We report this case with a brief literature review to investigate this phenomenon.

The diagnosis of pre-cancerous breast lesions is important to evaluate the risk of recurrence and progression to invasive carcinomas. In this report, we present a 35-year-old female with suspicious microcalcification foci consistent with atypical ductal hyperplasia, but short of the qualifying 2 mm size of low-grade ductal carcinoma in situ. We used high molecular weight cytokeratin (HMW-CK- 903) as a marker to further analyze the lesion. A final diagnosis of two small foci of low-grade DCIS in the background of ADH was rendered. In challenging cases, like our case here, the use of such markers can be useful to reach accurate diagnosis and guide management plan. This is especially true when the patient is pregnant, and the lesion is borderline on size for the arbitrary limit of 2 mm, which determines the upgrade of atypical ductal hyperplasia to low-grade ductal carcinoma in situ. After full resection of the lesion, the patient elected not to have post-operative radiation therapy and subsequently had no recurrence at 7 years follow-up. In this manuscript, we review the literature on the difference between, benign ductal hyperplasia, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma. We also discuss the importance of a proper diagnosis of pre-cancerous lesions, and how different treatments can be approached during pregnancy.

Adenoid cystic carcinoma is a rare malignancy involving exocrine mucus glands, typically presenting in the salivary glands of the head and neck, but also as a primary lung neoplasm. The intention of this report is to provide more insight to adenoid cystic carcinoma due to its rarity. We present a case of a 50-year-old non-smoking Hispanic man presenting with shortness of breath and the presence of lung nodules on imaging. Biopsy of one of the Lung nodules proved to be metastatic adenoid cystic carcinoma originating from a prior adenoid cystic carcinoma from the right submandibular gland. This case report discusses the diagnosis of metastatic Adenoid Cystic Carcinoma utilizing cytology samples obtained by Fine Needle Aspiration alone, without the need for surgical biopsy. We review the histological presentation, demographics, molecular basis, metastasis, and treatment of adenoid cystic carcinoma.