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Trichilemmal cysts constitute the second most common cutaneous cysts and are mostly presented on the scalp of middle aged women. It is, therefore, unusual for a young person to have a trichilemmal cyst and it is extremely rare for a trichilemmal cyst to be ossified. In literature, only 8 cases of trichilemmal cysts with concomitant ossification have been described. We report the case of a 22 year old female who presented with a scalp nodule and was treated via surgical excision of the lesion. The pathology examination of the surgical specimen revealed a lesion consisting of a multilayered squamous epithelium of slightly eosinophilic maturing keratinocytes. There was no granular layer, whereas the core of the lesion was occupied by mature bone tissue with calcium deposits. The definite diagnosis of the pathology report was ossifying trichilemmal cyst. The aim of this report is, to enlighten clinicians about this rare pathological entity.

Introduction: Rhinosporidiosis is a chronic mucocutaneous infection caused by Rhinosporidium seeberi , which mainly affects the mucus membranes of the nose, oropharynx, skin, eyes, and genital mucosa. The purpose of this case report was to illustrate the importance of clinicians in understanding the unusual incidence of this fungal infection, clinical presentation, treatment modalities, and recurrence rate. Observations: A clinical case report showed rare occurrence of rhinosporidiosis in the lower third of the face. The lesion was surgically excised by electrocauterization at its base. Commentaries: The patient showed no signs of recurrence even after 3 years of follow-up. Further research should be carried out to analyze the role of genetic predisposition in causing zoonotic infection. Conclusion: Rhinosporidiosis should also be considered as the differential diagnosis when facial swelling is encountered.

Rhinophyma is a chronic, progressive dermatological disorder characterized by hypertrophy and hyperplasia of sebaceous glands localized to the nasal region. It is frequently associated with phymatous rosacea in its advanced stages and manifests clinically with significant tissue overgrowth, leading to distortion of nasal contours and, in severe cases, functional impairment such as external nasal valve collapse and airway obstruction. Given the irreversible nature of the structural changes and the lack of spontaneous regression, surgical intervention remains the definitive treatment modality. A recent case of rhinophyma managed within our department provided valuable insights into its clinical features, diagnostic considerations, and therapeutic decision-making. This report presents the essential aspects of the case and reflects on the practical implications for effective management of this condition.

Asadbek Dadaboev,1,* Malikakhon Shukurova,1,* Makhmudjon Madrakhimov,1,* Sedigheh Shakib Kotamjani2,* 1School of Medicine, Central Asian University, Tashkent, Uzbekistan; 2English Language Teaching and Educational Management, Central Asian University, Tashkent, Uzbekistan*These authors contributed equally to this workCorrespondence: Asadbek Dadaboev, School of Medicine, Central Asian University, Tashkent, 111221, Uzbekistan, Email asadbekdadaboev23@gmail.comBackground: Infantile hemangiomas (IH) are the most common tumors in infancy and childhood. They are characterized by a fast proliferation phase followed by gradual involution. While most IHs follow a predictable course, those involving the parotid gland pose unique diagnostic and therapeutic challenges due to their location and potential for functional impairment. This case illustrates an unusual example of unilateral parotid hemangioma with prolonged growth, requiring alternative management strategies.Case Presentation: A two-month-old girl presented with a large unilateral parotid hemangioma, first noted on the 15th day of life, which had been rapidly increasing in size. Oral propranolol was initially prescribed, but treatment was not started by the parents, and the patient was lost to follow-up. At 3.5 months of age, the patient underwent an unplanned cosmetic surgical excision at a rural hospital, which resulted in facial nerve paresis and functional facial asymmetry. She re-presented at 7 months with a markedly enlarged lesion. Propranolol (3 mg/kg/day) was reinitiated; however, despite dose escalation, the hemangioma remained unresponsive. Systemic corticosteroids (prednisolone, 1– 3 mg/kg/day) at 8 months were added, but the lesion continued to progress. At 9 months of age, metronomic chemotherapy with vinblastine (1 mg/m² IV every 3 days) and cyclophosphamide (50 mg/m² orally for 10 days) was introduced under clinical supervision. This combination resulted in significant tumor regression, as confirmed by serial imaging and clinical examination.Conclusion: This case reflects the challenges of managing IHs that do not respond to standard treatment guidelines. Early surgical intervention is contraindicated when other alternative medical treatment methods are available. Otherwise, it might result in significant complications, highlighting the importance of conservative management and adherence to treatment protocols. Metronomic chemotherapy has shown to be a useful option for patients who do not respond to standard beta-blockers and corticosteroids.Keywords: infantile hemangioma, metronomic chemotherapy, parotid gland, propranolol, surgical excision

Angioleiomyoma (ALM) is a rare, benign tumor involving the peripheral soft tissues. Preoperative diagnosis of ALM is challenging, since there are no characteristic clinical or imaging findings. The objective of this article is to present two rare cases of ALM with torsion involving the female genital tract and review published similar cases. We report two cases of ALM with torsion originating from the uterus and mesosalpinx, respectively. The two cases presented with abdominal dull pain or a palpable abdominal mass, and imaging findings revealed a large cystic mass, which was suspected to be an ovarian neoplasm. During the surgical procedure, it was found that the mass had undergone torsion. The final histological and immunohistochemical reports of the resected masses validate the diagnosis of ALM. To our knowledge, this is the first report of torsion of ALM originating from the female genital tract. ALM poses a significant diagnostic challenge in cases of a pelvic cystic mass with torsion, as it is frequently misdiagnosed as an ovarian tumor. Surgical excision of the mass while preserving the uterus and adnexa should be strongly recommended for young patients, as ALM has an excellent prognosis.

PurposeThe status of human epidermal growth factor receptor 2 (HER2) is important for treatment decision-making of breast cancer and was commonly determined by core needle biopsy (CNB). The concordance of CNB with surgical excision biopsy (SEB) has been verified, but remain unclear according to the newly developed classification of HER2 status. Our study aimed to re-evaluate the diagnostic value of CNB for determining HER2 status in breast cancer, especially in the HER2-low population.MethodsEligible breast cancer patients in West China Hospital between January 1, 2007 and December 31, 2021 were enrolled consecutively and data were extracted from the Hospital Information System. The agreement of HER2 status between CNB and SEB was calculated by concordance rate and κ statistics, as well as the sensitivity, specificity, positive, and negative predictive values (PPV & NPV). Logistic models were used to explore potential factors associated with the discordance between both tests.ResultsOf 1829 eligible patients, 1097 (60.0%) and 1358 (74.2%) were consistent between CNB and SEB by pathological and clinical classifications, respectively, with κ value being 0.46 (0.43–0.49) and 0.57 (0.53–0.60). The sensitivity (50.9%–52.7%) and PPV (50.5%-55.2%) of CNB were especially low among IHC 1+ and 2+/ISH - subgroups by pathological classifications; however, it showed the highest sensitivity (77.5%) and the lowest specificity (73.9%) in HER2-low population by clinical classifications. Advanced N stages might be a stable indicator for the discordance between both tests.ConclusionThe diagnostic value of CNB was limited for determining HER2 status in breast cancer, especially in HER2-low population.

The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.

Primary cardiac sarcomas are exceedingly rare tumours associated with a poor prognosis due to delayed diagnosis, advanced presentation and limited known chemotherapy efficacy. While surgical excision is the preferred treatment, it is often not feasible. The role of systemic therapy remains uncertain. We analysed the medical records of patients diagnosed with primary cardiac sarcoma registered at a sarcoma clinic between January 2016 and July 2023. Clinicopathological and imaging data and treatment information were collected. Descriptive statistics were employed for clinicopathological characteristics, and Kaplan-Meier analysis was used for survival assessment. A total of 12 patients were identified with primary cardiac sarcoma, with a median age at diagnosis of 33 years (IQR 20.5; range: 17-53). At presentation, 66.7% had pericardial effusion requiring pericardiocentesis with or without pleuropericardial window. Half (6 of 12 patients) were misdiagnosed initially as either tubercular pericardial effusion or cardiac hydatid cyst. Upfront resection was done for 4 patients (33.3%), while 4 (33.3%) had locally advanced/unresectable disease and the remaining 4 (33.3%) presented with de-novo metastatic disease. Angiosarcoma constituted 50% (6 out of 12), all arising from the right atrium. Of the 12 patients included, 6 received a median two lines of therapy. Of the total 9 response assessments (both as first line and subsequent lines), 55.5% had an objective response rate with an 88.8% clinical benefit rate. The median progression-free survival for first-line systemic therapy was 5.4 months. The median overall survival for patients who received systemic therapy and the entire cohort were 19.2 and 5.1 months, respectively. This study highlights the advanced presentation and poor outcomes in patients with cardiac sarcoma. Due to the rarity of the tumour, it is often misdiagnosed. Systemic chemotherapy could alleviate symptoms and prolong survival. However, sarcoma pathology is heterogenous and cannot be generalised. As this is a retrospective observational study, no trial registration has been done.

Abstract To date, ~200 cases of pilomatrix carcinoma have been reported in the literature. These tumors usually present as atypical, solitary, firm nodules, most commonly in the head and neck region. Published data indicate that these tumors exhibit aggressive behavior and have a high potential for recurrence. Therefore, surgical excision with wide margins is recommended. We report a case of pilomatrix carcinoma located on the shoulder, initially presenting as a small pimple with purulent discharge in a 64-year-old man. We also review the relevant literature, with particular focus on the clinical characteristics, early identification, and treatment modalities associated with this disease.

Background: HER2-Low status is found in approximately half of breast cancer patients and shows potential benefits from novel antibody–drug conjugates (ADCs). Data on the accuracy of HER2-Low status between core needle biopsy (CNB) and surgical excision specimen (SES) samples are lacking. We aimed to investigate the accuracy of HER2-Low status diagnosis between CNB and SES samples. Methods: Consecutive early-stage breast cancer patients who underwent surgery from January 2009 to March 2022 with paired CNB and SES samples were retrospectively reviewed. HER2-Low was defined as IHC 1+ or IHC2+ and FISH-negative. Concordance rates were analyzed by the Kappa test. Further clinicopathological characteristics were compared among different HER2 status and their changes. Results: A total of 5610 patients were included, of whom 3209 (57.2%) and 3320 (59.2%) had HER2-Low status in CNB and SES samples, respectively. The concordance rate of HER2 status in the whole population was 82.37% (Kappa = 0.684, p < 0.001), and was 76.87% in the HER2-Negative patients (Kappa = 0.372, p < 0.001). Among 1066 HER2-0 cases by CNB, 530 patients were classified as HER2-Low tumors. On the contrary, in 3209 patients with HER2-Low tumor by CNB, 387 were scored as HER2-0 on the SES samples. ER-negative or Ki67 high expression tumor by CNB had a high concordance rate of HER2-Low status. Conclusions: A relatively low concordance rate was found when evaluating HER2-Low status between CNB and SES samples in HER2-Negative breast cancer patients, indicating the necessity of retesting HER2 low status at surgery, which may guide further therapy in the era of anti-HER2 ADCs.