ABSTRACT Breast fibromatosis is a benign, locally aggressive spindle‐cell tumor mimicking carcinoma. We report two cases in patients aged 15 and 61 years, highlighting its wide age range. Accurate histopathology prevents overtreatment. Modern management emphasizes individualized care, including active surveillance, complete surgical excision when needed, and long‐term follow‐up.

Based on the available evidence, the cold-inducible RNA-binding protein (CIRBP) appears to play a role in increasing the stability of hypoxia-inducible factor 1-alpha (HIF1α) mRNA. This research aimed to examine the levels of CIRBP and HIF1α mRNA within breast tumor tissues and explore the relationship between their gene expression and tumor Microvascular density (MVD). The results revealed a significant upregulation of CIRBP (5.07-fold) and HIF1α (4.5-fold) gene expression in BC samples compared to the surrounding normal tissues (p < 0.001). This upregulation was also associated with various clinicopathologic features. Furthermore, there was a correlation between CIRBP mRNA expression, HIF1α mRNA expression, and MVD. Consequently, this study suggests that CIRBP may have a role in promoting angiogenesis in BC.

Vancomycin is widely used for methicillin-resistant Staphylococcus aureus infections. However, it is associated with nephrotoxicity, which is mostly induced by the creation of free radicals in the kidney. Several studies indicated the antioxidant effect of silymarin, particularly nano-formulations with high oral bioavailability. The aim of this study was to evaluate the potential preventive effects of silymarin against vancomycin-induced nephrotoxicity. In this randomized, triple-blinded, placebo-controlled clinical trial, 60 patients who fulfilled the inclusion criteria were randomly assigned to placebo and nano-silymarin (Sinalive® 70 mg twice daily) groups in 1:1 ratio, and received them for a maximum of 14 days beside vancomycin. Patients’ serum creatinine (Scr) and urea and incidence of AKI were assessed on days 3, 7, 10, and 14. The trough level of vancomycin was evaluated 30 min before the fourth dose of vancomycin. AKI incidence was significantly lower in the nano-silymarin group (P < 0.001). The comparison of serum creatinine between the placebo and treatment group showed no significant difference on days 0, 3, 7, and 14; but it was significant on days 10 (P = 0.045). The same finding was found about urea serum levels (P = 0.005 and .016, on days 10 and 14 respectively). Moreover, Scr and urea levels increased considerably in the placebo group during the study (P < 0.001) but not in the silymarin group. Our data suggested that nano-silymarin can be nephroprotective and has a preventive effect against vancomycin nephrotoxicity. However, further human studies are needed to prove these effects. It was registered at the Iranian Registry of Clinical Trials (IRCT20200408046990N9, 2022–04-06).

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast condition with diverse clinical and radiologic features, often misdiagnosed as malignancy prior to sampling. Therefore, histological findings are one of the most essential bases of diagnosis. METHODS: We retrospectively searched the histopathologic database of the Cancer Institute of Imam Hospital for IGM cases and collected clinical and radiological data. After ruling out other causes of granulomatous mastitis, the histopathologic features of each case were evaluated. The pattern of inflammation was classed as lobulocentric, lobular spared, or confluent. The presence of granulomas was evaluated based on descriptive features, including well-formed or poorly defined granulomas, as well as the presence or absence of multinucleated giant cells. Granulation tissue, empty space, fat necrosis, and necrosis were also assessed. RESULTS: Overall, 40 cases of IGM were reviewed. All patients were female, within the age range of 22 to 64, with the majority falling into the 30-39 category. The most common clinical manifestation was a palpable mass. 30% of patients had a history of breastfeeding over the past 5 years, and one patient had a history of prolactinoma. BI-RADS 4a was the most reported radiologic score. In histopathologic assessment, lobulocentric inflammation was reported as a predominant finding (45% of cases). Granuloma was present in 39 cases (97.5%), but was only well-defined in 33 cases (82.5%). Neutrophilic aggregates were present in 37 cases (92.5%). CONCLUSION: The diagnosis of IGM depends on assessing the clinical and radiologic findings along with pathologic features. IGM is microscopically defined by a non-caseating lobulocentric granulomatous inflammation, composed of tight aggregates of epithelioid histiocytes. One of the variants, cystic neutrophilic granulomatous mastitis (CNGM), is characterized by the presence of cystic empty vacuoles lined by neutrophils.

Background: Three main cell signaling pathways including the endoplasmic reticulum stress (ERS) response, autophagy, and apoptosis play critical roles in both cell survival and death. They were found to crosstalk with one another during tumorigenesis and cancer progression. This study aimed to investigate the expression of the spliced form of X-box binding protein 1 (XBP1s), p62, and caspase-3, as the essential biomarkers of ERS, autophagy, and apoptosis in patients with colorectal cancer (CRC), as well as the correlation between their expression and clinicopathological data. Methods: This retrospective study was conducted on formalin-fixed paraffin-embedded (FFPE) blocks, which were collected from patients and their tumor margins, from the tumor bank of Imam Khomeini Hospital (Tehran, Iran) from 2017 to 2019. Tissue microarray (TMA) was used to measure the XBP1s, p62, and caspase-3 biomarkers. Data were analyzed using SPSS software version 20, and P≤0.05 was considered statistically significant. Results: Evaluating the total of 91 patients, a significant relationship was found between XBP1s expression and TNM stage (P=0.003), primary tumor (pT) (P=0.054), and the degree of differentiation (P=0.006); and between caspase-3 with pT (P=0.004), and lymphovascular invasion (P=0.02). However, no significant correlation was found between p62 and clinicopathological data. Furthermore, a positive relationship between XBP1s and p62 was confirmed (correlation coefficient: 22.2% and P=0.05).Conclusion: Our findings indicated that XBP1s could be considered as a target for therapy in personalized medicine.

Introduction: Lungs are one of the most common sites for metastatic tumors in the body. In addition, primary lung tumors are the most common cause of death due to neoplasms in both genders. Treatment strategies are completely different for primary and metastatic lung tumors making accurate diagnosis of lung tumors an effective factor in planning the correct treatment. The development of personalized medicine and targeted therapy, especially in the treatment of primary lung tumors, has highlighted the importance of correct diagnosis of these tumors. Case report: The Pathology Center of Imam Khomeini Hospital Cancer Institute in Tehran, Iran, as a referral center for cancer across the country, is faced with a large number of lung biopsies, and therefore, there will be numerous diagnostic challenges. In this article, we presented two cases of primary female genital tract (cervical) tumors that during follow up lung masses were detected. Diagnosis on lung biopsy assigned as primary lung adenocarcinoma. Both cases referred to our lab for second opinion accompanied with related resected sample and implementation of further supplementary markers documented metastatic origin of tumors. Discussion & conclusion: In both cases, similarity in immunohistochemical characteristics of metastatic tumors with primary lung adenocarcinoma, especially positive nuclear TTF1 staining led to misdiagnosis of lung tumor origin. This finding emphasizes on the use of other specific markers related to primary site of tumor to decrease possibility of incorrect diagnosis of the origin of the tumor in metastatic setting. Due to remarkable influence of primary versus metastatic origin of lung tumor on selection of treatment, pathologists should be considered correct diagnosis and notice to similarity of immunohistochemical markers of primary lung tumors to other organs and implementation of more specific markers are necessary.

Vertebral body location of hemangioblastomas (HB) is extremely rare. The authors report a case of spinal mass involving lower thoracic region with cord compression, approved to be spinal HB. A 57-year-old man presented to our center with eight months history of progressive intractable back pain and paraparesis. Admission computed tomography and magnetic resonance imaging (MRI) of the thoracolumbar spine demonstrated a lytic and expansile spinal mass with pedicle expansion and vivid contrast enhancement involving T11 and T12 vertebral bodies on the right side. He was a known case of von Hippel-Lindau (VHL) and he had history of 4th ventricular asymptomatic hemangioblastoma near Obex, multiple pancreatic cystic adenomas, multiple liver cysts, and right non-chromaffin adrenal mass. The patient underwent a T11-T12 partial transpedicular corpectomy with T5 to L3 posterior spinal fixation to bridge the invaded segment. The pathological and immunohistochemical findings were consistent with vertebral HB. Spinal HB although extremely rare, may be managed with subtotal tumor resection and fixation of normal adjacent vertebrae by cemented screws.

Background: Human epidermal growth factor 2 (HER2) is known to be an important prognostic factor in breast cancer. Numerous studies have shown HER2+ breast cancers have reduced overall survival and recovery time, as well as the efficacy of anti-HER2 therapies along with chemotherapy in improving disease outcomes. For this reason, it is recommended that all patients with breast cancer should be evaluated for HER2 status. This study aimed to assess the HER2 gene amplification by the CISH method in evaluating the HER2 status in patients with immunohistochemistry (IHC) 2+ (equivocal) results. Methods: This retrospective cross-sectional study examined HER2 status based on the Chromogenic in situ hybridization (CISH) method in 280 breast carcinoma samples with an initial 2+ (equivocal) score in IHC. The relationship between HER2 amplification and hormone receptors (estrogen and progesterone) and Ki67 level was also investigated. Results: In sixty samples (21.4%), the HER2 gene was amplified based on the CISH method. The majority (215, 76.8%) of the samples were negative and 5 (1.8%) samples were indeterminate. No significant relationship was observed between HER2 amplification, estrogen receptor (p=0.143), and ki.67 protein level (p=0.977). There was a significant inverse relationship between HER2 amplification and progesterone receptor positivity (p=0.007). Conclusion: These results demonstrate that CISH is a helpful method to assess HER2 status in equivocal breast cancer and is positive (amplified) in about 21.4% of them.

BACKGROUND:Markers related to the mechanism of tumoral cell escape from the immune system have received more attention. The PD-L1 molecule encoded by the "CD274" gene binds to T lymphocytes and can inhibit these cells. Therefore, increasing the expression of this marker on inflammatory or tumor cells can indicate tumor progression invasiveness and long-term consequences. The present study aimed to determine the expression of the PD-L1 marker in thyroid medullary tumors and to evaluate its role in predicting long-term outcomes after cancer.METHODS:This retrospective longitudinal study was performed on pathology samples of patients with medullary thyroid carcinoma referred to the Cancer Institute of Imam Khomeini Hospital from 2015 to 2020. Slides related to medullary thyroid tumors were examined. A tissue microarray was used to evaluate the immunohistochemistry of PD-L1. Patients were followed up to assess the occurrence of recurrence. Out of 207 patients evaluated in the present study, histopathological information of 144 patients was available.RESULTS:The expression rate of PD-L1 in our community was 14.6% in lymphocyte cells, 35.4% in tumor cells, and 12.5% in both cells. The presence of metastasis at the time of diagnosis was reported in 35 cases (72.9%), and the occurrence of tumor recurrence was reported in 38 cases (79.2%). There was no relationship between the expression of this marker and the sex and age of patients. In addition, PD-L1 expression was unrelated to the two main characteristics of this cancer, namely tumor size and its focality. The presentation of tumor PD (L1) (but not lymphocytic) was a prognostic marker for synchronous metastasis at cancer diagnosis but could not predict tumor recurrence.CONCLUSION:PD-L1 tumor marker expression is predictable in 14.6% of lymphocyte cells, 35.4% of tumor cells, and 12.5% in the selected Iranian population with medullary thyroid cancer. The expression of this marker is not related to the morphological characteristics of the tumor, such as tumor size or focality.

Mechanical and microstructural properties evaluation of AISI4130 steel after backward flow forming process

Reactive oxygen species (ROS) are produced in the mitochondrial respiratory pathway and cellular metabolism. They are responsible for creating oxidative stress and lipid peroxidation. In living organisms, there is a balance between oxidative stress and the antioxidant system, but some factors such as medicines disturb the balance and cause many problems. These effects can impact bacterial death and division and also in humans can induce therapeutic or adverse reactions. Web of Science and Pubmed databases were used for searching. This review focuses on the oxidant and antioxidant effects of different classes of antibacterial agents and the mechanisms of oxidative stress. Some of these agents have beneficial effects on killing bacteria due to their antioxidant or oxidant effects. However, some of their side effects may be due to their oxidative effects. Based on the results of this review, minocycline is an antioxidant, but aminoglycosides, chloramphenicol, glycopeptides, antituberculosis drugs, fluoroquinolones, and sulfamethoxazole agents have oxidant effects. Furthermore, cephalosporins, penicillins, metronidazole, and macrolides have both oxidant and antioxidant effects in different studies. It is concluded that some antibacterial agents have oxidant and other antioxidant effects. These activities may affect their therapeutic effects or side effects. Some antioxidants can prevent the adverse effects of antibacterial agents. Clarifying the exact oxidant and antioxidant effects of some antimicrobial agents needs more research projects.

Background: Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that forms tumefactive lesions in various organs, presenting with diverse clinical manifestations. Diagnosis of IgG4-RD could be challenging and relies on characteristic histopathological findings and elevated IgG4+ plasma cell counts. Case Presentation: The patient was a 48-year-old woman with diabetes mellitus initially presented with a painless breast mass. Imaging indicated irregular opacities and lymph nodes in the breast. Biopsy results revealed lymphoplasmacytic infiltration with IgG and IgG4 positivity, overall compatible with IG4-related disease. A mass resection was performed, and intraoperative assessment ruled out malignancy. Then, with a 5-month interval of no symptoms, the patient developed a cheek mass, initially misdiagnosed as low-grade spindle cell sarcoma. Subsequently, she underwent partial maxillectomy and further examination and histology confirmed IgG4-RD, meeting all diagnostic criteria. Conclusion: IgG4-RD is a rare, systemic fibroinflammatory condition with potential to mimic neoplastic processes. While IgG4 serum levels can be elevated, they are not a reliable diagnostic criterion. The two main features of IgG-related disease are an elevated number of IgG4-positive plasma cells within the tissue and a characteristic histopathological appearance including a dense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis. Overall, diagnosis is based on the balance of clinical features, histopathology, and serum markers. This case underscores the diagnostic challenges posed by IgG4-RD, often mistaken for malignancies due to its invasive behavior and emphasizes the importance of considering IgG4-RD in differential diagnoses for tumor-like lesions, particularly when affecting multiple organs, to enable timely treatment decisions and prevent unnecessary interventions.

Background: Hodgkin's lymphoma (HL) is among the most prevalent lymphomas worldwide. PAX5 has a great value in separating this entity from other T cell lymphoma; however, it is weakly expressed in neoplastic cells. Polyclonal PAX8 was positive in a variety of lymphoid neoplasms in several previous studies and the staining paralleled that of PAX5 but monoclonal PAX8 was negative in the same neoplasms. The aim of this study was to compare immunohistochemical patterns of monoclonal PAX8 with PAX5 in Classical and NLPHL samples. Material and methods: This retrospective study was conducted on 89 formalin-fixed paraffin embedded blocks from HL patients (69 Classical and 20 NLPHL) admitted to Imam Khomeini and Dr. Shariati hospitals, Tehran, Iran during 2016-2020. Diagnoses were confirmed by reviewing previous immunohistochemistry (IHC) studies, including PAX5. All samples were stained for PAX8 (clone MRQ-50). Expression intensity scoring was made for both antibodies in neoplastic and background cells based on nuclear staining percentage. Results: PAX8 was positive in neoplastic and background B lymphocytes of all classical and NLPHL samples. PAX8 Expression intensity was significantly higher in neoplastic and background cells compared to PAX5 in classical HL samples (P = 0.001). PAX5 expression intensity in neoplastic cells was significantly higher in NLPHL samples compared to classical HL (P = 0.040); however, no significant difference in PAX8 expression between neoplastic cells of NLPHL and HL was seen. PAX8 expression intensity was not significantly correlated with gender, his-tologic subtype, tumor location, and relapse. Conclusions: PAX8 monoclonal antibody (clone MRQ-50) showed strong nuclear reactivity in neoplastic and background cells of classical HL and NLPHL samples. Therefore, this marker can be utilized as a valuable alternative for PAX5 in differentiating HL from other T cell lymphoma in challenging cases.

Background: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast condition, mostly affecting women of reproductive age within a few years of pregnancy. Due to diverse clinical and radiologic features, IGM can mimic a vast spectrum of breast conditions. Therefore, histological findings are one of the most essential bases of diagnosis. Methods: A literature search was performed to review the characteristics of IGM with an emphasis on histopathological features in English sources from 2010 to 2022. The key words used for PubMed database search were “breast”, “granulomatous mastitis”, “histopathology”, and “pathology.” Results: In total, 192 articles were retrieved, from which 38 most relevant manuscripts were selected for this review article. Conclusion: The diagnosis of IGM depends on clinical, radiologic, and pathologic findings. Palpable mass is the most frequent complaint. An irregular hypoechoic mass with varying degrees of posterior phenomena is the most common sonographic finding. Histologically, IGM is characterized by a non-caseating lobulocentric granulomatous inflammation; composed of tight aggregates of epithelioid histiocytes with or without multinucleated giant cells. At times, the presence of cystic empty vacuoles lined by neutrophils is noted that is commonly associated with cystic neutrophilic granulomatous mastitis (CNGM), a variant of IGM. Atypical findings for IGM includes: The presence of atypia and/or malignancy, caseous necrosis, marked eosinophilic infiltration, absence of granulomatous inflammation, etc.

Background microRNA-125a-5p (miR-125a) is a tumor suppressor gene whose role in autophagy remains poorly understood. In the current study, we aimed to investigate the methylation status of miR-125a, its transfection into SK-BR3 cells, and its effects on autophagy. Methods Sixty samples of tumor and non-tumor adjacent tissue were collected and the methylation status of miR-125a was evaluated by methylation-specific PCR (MSP). The effect of 5-Aza-dC on miR-125a expression was investigated in the SK-BR3 cells. Cells were also transfected with miR-125a mimic/antimiR. The expression of miR-125a and its target genes was evaluated by Real-Time PCR. Protein levels of ATG5 and LC3 were assessed by Western blotting. HER2 expression was investigated by immunocytochemistry (ICC). Results The data showed that the miR-125a promoter CpG Island was significantly hypermethylated in breast cancer tissues (p < 0.01) and in SK-BR3 cells. The 5-Aza-dC could significantly increase miR-125a expression by decreasing its methylation (p < 0.05). In addition, Western blot analysis indicated the expression of ATG5 and LC3 II/ LC3I, as autophagy biomarkers, was significantly reduced in SK-BR3 cells transfected with miR-125a (p < 0.05). Conclusions Our data showed miR-125a expression was significantly decreased in tumor tissues due to its promoter hypermethylation. Overexpression of miR-125a was associated with a reduction in autophagy, which could provide a new therapeutic avenue for advanced-stage breast cancer treatment.

Introduction: Placental teratoma is an uncommon, non-trophoblastic benign tumor. Since the first description of this type of tumor by Morvilli in 1925, only a few cases of this abnormality have been diagnosed and reported. Case presentation: We describe here a 35-year-old pregnant woman admitted for an elective cesarean section. The placenta and membranes were delivered spontaneously. After delivering the placenta, a tumor mass containing hair was detected between the extraplacental amnion and chorion. On gross examination, a singleton placenta weighing 173 g, measuring 15 x 11 cm in area and 5.5 cm thick, with an attached cord and membranes, was observed. Microscopic examination showed orthokeratinized stratified squamous epithelium with underlying hair follicles, telangiectatic vessels, and sebaceous glands accompanied by subcutaneous fat. The fat also contained fibrocollagenous bundles. In addition, interconnecting bone trabecula rimmed by osteoblasts and attached mature cartilage were also found. Conclusion: An awareness of placental teratoma from a pathological perspective is needed to include this anomaly in the differential diagnosis of benign placental nodules, obtain more information about this unusual lesion, and to conduct more studies on this prenatal abnormality.

Background Currently, breast cancers are divided into four major molecular subtypes. The distinction between the luminal A and luminal B subtypes is mainly based on the cellular proliferation indices and is assessed by the Ki-67 scoring. Due to the limitations in the assessment and expression of Ki-67, we hypothesized that minichromosome maintenance protein 6 (MCM6) might be taken as a surrogate marker to differentiate molecular subtypes and aid in more precise grading of tumors. Methods We performed a retrospective, cross-sectional study on 124 samples of breast cancer and 40 samples of normal breast tissue. Relevant clinical information was retrieved from the Cancer Institute database. Results MCM6 could discriminate between various categories of histologic grades, tubule formation, mitotic indices, and nuclear pleomorphism ( P = 0.002 for tubule formation and P < 0.001 for other). Moreover, the MCM6 score exhibited a significant correlation with the mitotic count ( P < 0.001). However, the Ki-67 score could not discriminate subgroups of the mitotic index and nuclear pleomorphism. Compared to the luminal A subtype, luminal B exhibited a higher MCM6 score ( P = 0.01). Besides, MCM6 scores were higher for certain subtypes with more aggressive behaviors, such as hormone receptor (HR)-negative disease, and human epidermal growth factor receptor 2 (HER2)-enriched and triple-negative breast cancers, as there was a significantly higher MCM6 mean score in the HR-negative in comparison to the luminal breast cancers ( P < 0.001). Similarly, higher MCM6 scores were observed among samples with more advanced nuclear grades, tubule formation, and overall grades. Conclusion MCM6 can differentiate luminal A and luminal B subtypes and is correlated with mitotic counts. However, this study was unable to prove the superiority of MCM6 in differentiating between molecular subtypes compared to the Ki-67 score. Nevertheless, in our study, MCM6 was superior to Ki-67 in exhibiting correlations with the mitotic grade, tubule formation, and nuclear grades. More studies are needed to standardize its assessment methods, determine more robust cut-off values, and evaluate its associations with prognostic features of breast cancer.

Trichilemmal carcinoma is a rare tumor of the outer sheath cells of hair follicles. These tumors occur on the sun-exposed skin of the elderly in the majority of cases. The gross tumor demonstrates exophytic, polypoid, ulcerative, or nodular lesions with or without bleeding. Histopathologically, it is characterized by an anastomosing trabecular, diffuse, or lobular growth pattern with clear keratinization. A critical differential diagnosis is squamous cell carcinoma (SCC), where the prognosis of trichilemmal carcinoma is far better than SCC. Surgery is a significant and effective treatment for trichilemmal carcinoma cases, and recurrence after complete surgical resection with a negative margin is uncommon. Trichilemmal carcinoma is considered a low-grade tumor with low metastatic potential. This paper reports a 48-year-old Iranian male with trichilemmal carcinoma of the scalp treated with surgery, having no recurrence after three years of follow-up. The role of other treatment modalities like radiation, local therapy, and systemic therapy are also discussed.

Background: Triple-negative breast cancer (TNBC) is a heterogeneous disease that characterized by aggressiveness features with increased metastasis and poor clinical prognosis. However, the molecular mechanisms underlying this highly malignant phenotype are still poorly understood. It has been well documented that the dysregulation of neural genes is profoundly implicated in cancer development and metastasis. Objectives: In the present study, the expression level of GABA receptor π subunit (GABRP) as the most up-regulated gene in TNBC and a hub node in the co-expression network were investigated. Methods: In this study, the importance of GABRP as the most up-regulated gene in TNBC was discovered through integrative analysis of multiple microarray expression datasets, containing about 1000 samples. Furthermore, the co-expression network analysis was constructed based on the up-regulated genes. Quantitative Real‐time polymerase chain reaction (qRT-PCR) was used to evaluate of the GABRP expression in 50 TNBC compared to 33 non-TNBC tumors. Results: According to the bioinformatics analysis, GABRP occupies a key position in the co-expression network which is mainly enriched in the nervous systems development. The qRT-PCR results indicated that up-regulation of GABRP was highly concordant with integrative analysis findings. Moreover, the receiver operating characteristic (ROC) curve analysis revealed that GABRP can be a potential biomarker to distinguish TNBC from non-TNBC samples. Conclusions: Our study revealed that up-regulation of GABRP is among the most remarkable molecular signature in TNBC and may play a critical role in tumorigenesis. The results may provide a deeper insight into molecular mechanisms underlying the brain metastasis in TNBC tumors and propose the potential targets for therapeutic interventions.

Introduction: Malignant melanomas of the parotid gland are relatively uncommon and usually seen as metastases from cutaneous or mucous sites of the head and neck region. Some malignant melanomas may metastasize before they regress. Therefore, identifying the primary origin of metastatic melanoma is sometimes difficult. Furthermore, metastasis to the breast from an extramammary site is uncommon and challenging. It may present as a well-defined rounded mass that histopathologically mimics the various architecture and cellular phenotypes. In addition, the immunohistochemical stains of some metastatic melanomas are equivocal and challenging. Case Presentation: We presented a case of parotid gland malignant melanoma in a 42-year-old woman with metastasis to the breast in a short interval. Biopsy of parotid and breast lesions showed loss of immune-reactivity for several melanoma markers and was initially considered as malignant peripheral nerve sheath tumor and primary breast tumor, respectively. Conclusions: This case highlights the importance of obtaining past clinical history in surgical pathology cases to make a correct diagnosis. It also enhances our understanding regarding malignant melanoma as a mysterious tumor with various morphology and immunophenotype.