Merkel cell carcinoma (MCC) is a rare primary neuroendocrine skin tumor that presents as a flesh-colored or bluish-red nodule on the face, neck, or head. Long-term ultraviolet radiation exposure and Merkel cell polyomavirus are associated with MCC pathogenesis. We present a case of MCC on the right cheek in a male patient aged 87 years. Our primary goal in presenting the case is to bring MCC, which is a diagnostic challenge, to the notice of dermatologists and oncologists, as early detection and prompt treatment are important. The patient had a significant past medical history, including diabetes mellitus, hypertension, dyslipidemia, stage 3 chronic kidney disease, benign prostatic hyperplasia, chronic hyponatremia, acute pancreatitis, essential thrombocytosis on hydroxyurea, and ischemic heart disease. The patient presented with a mildly swollen right upper lip showing a poorly defined, relatively homogeneous subcutaneous lesion with a history of persistence for 1.5 months. The clinical examination revealed a 5 × 3-cm nodular lesion on the right side of the cheek with swelling of the right upper lip. Immunohistochemistry markers and histopathological features confirmed the diagnosis of MCC. The patient was referred to the oncology department for further management. MCC of the skin is an aggressive lesion with a high risk of metastasis and recurrence, which is more common in immunocompromised people. Prompt management and treatment of MCC is essential because if left untreated, it can spread to other parts of the body and can also metastasize to lymph nodes and other organs. The patient is 87 years old and has a significant past medical history of diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease stage 3, benign prostatic hyperplasia, chronic hyponatremia, acute pancreatitis, essential thrombocytosis on hydroxyurea, and ischemic heart disease. Currently, the patient presented with a mildly swollen right upper lip showing a poorly defined, relatively homogenous subcutaneous lesion with a history of persistence for 1.5 months. The clinical examination revealed a 5x3 cm nodular lesion on the right side of the cheek with swelling of the right upper lip. Immunohistochemistry markers results and histopathological features confirmed the diagnosis of Merkel cell carcinoma. The patient was referred to the oncology department for further management. Merkel cell carcinoma of the skin is an aggressive lesion with a high risk of metastasis and recurrence, which is more common in immunocompromised people. Prompt management and treatment of Merkel cell carcinoma is essential because if left untreated, it can spread to other parts of the body and can also metastasize to lymph nodes and other organs.

We report the case of a 59-year-old female patient, a former smoker, who was diagnosed with bilateral pulmonary nodules. Extensive medical investigations were conducted, including a surgical lung biopsy, which led to the diagnosis of pulmonary amyloidoma. The diagnostic process was guided by the presence of a persistent, polymorphic, and nonspecific clinical picture, strengthened by imaging findings characterized by mixed nodular lesions and the addition of interstitial involvement, along with partial deterioration of the pulmonary parenchyma architecture. Although it is recognized as a benign tumor, pulmonary amyloidoma requires special care in order to rule out systemic involvement, association with lymphomas, or systemic amyloidosis. This case highlights the comprehensive investigations required in the presence of multiple pulmonary nodules and the wide range of possible diagnoses. It underscores the pivotal role of surgical lung biopsy and histopathological examination. The case is instructive, addressing a rare pathology, on the border between specialties, while also emphasizing potential evolving challenges and providing further insights into the clinical course of this disease.

An uncommon variation of lupus erythematosus is lupus panniculitis. İt can exist on its own or in conjunction with discoid or systemic lupus erythematosus. Persistent, sensitive, and hard nodules that are localized on the face, arms, shoulders, breast, and buttocks are its defining features. Scarring, lipoatrophy, and ulceration are occasionally associated with the healing of lesions. We are reporting the first case of lupus erythematosus panniculitis from Somalia. A 60-year-old male patient visited our polyclinic with an upper back nodule and a left upper ulcerated lesion that had been present for four months.

Tracheobronchopathia Osteochondroplastica (TO) is a rare benign disorder that is seldom progressive. Here, we report a case diagnosed with TO in our hospital. Bronchoscopy revealed multiple cartilaginous and ossifying nodules that are diagnostic for TO. Nodules protruding into the airways were observed as widespread and extended by the repeat bronchoscopy after 2 months of the diagnosis. TO was confirmed with the histopathology of the biopsies from nodules. Then he was referred to an interventional pulmonologist for laser ablation.

Lung cancer is the most lethal cancer type in Taiwan and worldwide. Early detection and treatment advancements have improved survival. However, small peripheral pulmonary nodules (PPN) biopsy is often challenging, relying solely on bronchoscopy with radial endobronchial ultrasound (EBUS). Augmented fluoroscopy overlays the intra-procedural cone-beam computed tomography (CBCT) images with fluoroscopy enabling real-time three-dimensional localization during bronchoscopic transbronchial biopsy. The hybrid operating room (HOR), equipped with various types of C-arm CBCT, is a perfect suite for PPN diagnosis and other interventional pulmonology. This study shares the single institute experience of EBUS transbronchial biopsy of PPN with the aid of augmented fluoroscopic bronchoscopy (AFB) and CBCT in an HOR. We retrospectively enrolled patients who underwent robotic CBCT, augmented fluoroscopy-guided, radial endobronchial ultrasound-confirmed transbronchial biopsy and cryobiopsy in a hybrid operating room. Patient demographic characteristics, computed tomography images, rapid on-site evaluation cytology, and final pathology reports were collected. Forty-one patients underwent transbronchial biopsy and 6 received additional percutaneous transthoracic core-needle biopsy during the same procedure. The overall diagnostic yield was 88%. The complications included three patients with pneumothorax after receiving subsequent CT-guided percutaneous transthoracic needle biopsy, and two patients with hemothorax who underwent transbronchial cryobiopsy. Overall, the bronchoscopic biopsy of PPN using AFB and CBCT as precise guidance in the hybrid operating room is feasible and can be performed safely with a high diagnostic yield.

To evaluate reasons for performing ultrasonography (US) and completeness of US reports in patients undergoing endocrine consultation with the first diagnosis of nodular disease.
Since January 1 to June 30, 2021, we prospectively collected patient data (age and thyroid-stimulating hormone concentrations), reasons for performing thyroid US, and completeness of reports regarding the description of the thyroid gland and nodules. In the case of multiple nodules, we considered the nodule suspected of malignancy and the largest one. To evaluate the accuracy of thyroid nodule description, we referred to the five characteristics suggested by the ACR TI-RADS system.
A total of 341 patients with thyroid nodules received endocrine consultation (female, 78%). The most frequent reasons for performing thyroid US were unrelated to a suspected thyroid disease (31.7%), followed by incidentaloma (23.5%), dysfunction or positivity for thyroid antibodies (19.1%), symptomatic or visible nodules (17.6%), and family history of any thyroid disease (8.2%). Gland texture was not reported in 41.9%. The depth of the lobes was the dimension reported most frequently (42.2%), but any diameter was not reported in 57.8% of the cases. As regards the description of the most relevant nodule, length was reported more frequently (75.9%). Margins and echogenicity were more frequently described (54.5% and 44.3%, respectively) than other characteristics (composition: 27%; shape: 8.8%; echogenic foci: 6.7%). No reports had indicated the malignancy risk stratification.
The results of the study demonstrate that in patients undergoing endocrine consultation with first detected thyroid nodules, US was mostly performed in asymptomatic cases, US reports were incomplete, and no risk stratification system was reported.

Knuckle pads are benign papules, nodules, or plaques overlying joints and typically manifest at the proximal interphalangeal joints (PIPs). They may be confused with other dermatologic or rheumatologic diseases. Treatment options for primary knuckle pads are limited and acquired knuckle pads typically improve with withdrawal of the offending insult.

Pneumoconiosis is an occupational disease found in workers with environmental exposure to organic and inorganic dust, as in mining, sandblasting, pottery, stone masonry, and farming. The inflammatory response of the lung to respirable dust causes the formation of macules, nodules, and fibrosis, and higher silica content in inhaled dust is associated with increased fibrosis. Mixed dust pneumoconiosis (MDP) is characterized by exposure to dust containing 10-20% silica, and its lung imaging show irregular opacities. Histopathology plays a vital role in the diagnosis of MDP. Though it has a favorable outcome, it evolves slowly over many years of constant exposure and is characterized by worsening dyspnea and cough gradually progressing to cor pulmonale. The only effective treatment is removing exposure, which makes it essential to recognize the disease early for a favorable outcome. We present a case of mixed dust pneumoconiosis in a farmer from South America who had asthma. He presented with worsening dyspnea and multiple nodules in both lungs on imaging and cor pulmonale. An extensive workup was done, and it ruled out any malignancy and tuberculosis. Analysis of video-assisted thoracoscopic surgery (VATS) biopsy samples confirmed the diagnosis of mixed dust pneumoconiosis. He had a confluence of irregular nodes in the upper lobes of the lungs, and the largest was 2.1 cm. This fits the International Labour Organization (ILO) definition of progressive massive fibrosis. This, along with cor pulmonale present in him, gives it a poor prognosis even after he is removed from dust exposure. He received steroids, which led to symptomatic improvement, and he was discharged to follow up with the pulmonologist.

Plasma cell leukemia (PCL) is a rare variant of leukemia with an aggressive clinical course and a poor prognosis. The cutaneous involvement in PCL is very rare either at clinical presentation of leukemia, namely leukemia cutis, or in the metastatic PCL to the skin. We present a case of eruptive multiple cutaneous nodules in a 56-year-old man with metastatic PCL. Histologically, a diffuse dermal and subcutaneous infiltration of ovoid cells with amphophilic cytoplasm and eccentrically located nucleus consistent with plasmacytoid morphology was observed. Neoplastic cells showed strong immunoexpression for CD138 and CD38 consistent with plasma cells phenotype, and loss of expression of CD56. Kappa light chain restriction similar to the phenotype of his PCL was demonstrated. We suggest that the evaluation of new skin lesions in leukemic patients should include a histopathologic examination to establish the diagnosis as soon as possible and a correct management of the disease.

BACKGROUND: Most severe-appearing keloids tend to occur around joints because of the increased extensional stimulation of the scar in those areas. However, erythema elevatum diutinum (EED) appears more commonly on friction sites including extensor surfaces of the extremities and dorsal surfaces of joints. EEDs also presents as red-brown and elevated lesions.
METHODS: In this report, we describe a 42-year-old female who presented with firm, sporadic, brown-colored raised nodules on her bilateral lower extremities. As the appearance of these nodules resembled keloids, resection of the affected area with subsequent radiation therapy was initiated. However, histopathologic examination performed after treatment revealed tuberous lesions in the dermis, increased wired collagen fibers, neutrophilic infiltrate with nuclear dust, and edematous endothelial cells in the small vessels. Consequently, the patient was later diagnosed with EED. Post-surgery, no recurrence or abnormal scars appeared.
CONCLUSIONS: Whereas clinical findings of EED are similar to that of keloids, the mechanisms of the two conditions differ considerably, leading to varying management strategies. EEDs can be misdiagnosed as keloids on several grounds; they can both appear morphologically similar, exhibit as stiff lesions, demonstrate chronic inflammation of the reticular dermis, and appear anywhere on the body. The only definitive method of differentiating between the two is through histopathologic examination.
CONCLUSIONS: EED should be considered as one of the differential diagnoses for any patients presenting with keloid-like lesions on friction sites and biopsy should be performed prior to resection and radiotherapy.