Metastasis from basal cell carcinoma of the skin is very rare with cases being documented in the lymph nodes, lung, bone and parotid gland. The main histopathological differential diagnosis is the locally arising basal cell adenocarcinoma from which it is difficult to distinguish by morphology and routine immunohistochemistry. Approximately 85 % of all reported metastatic basal cell carcinomas arise in the head and neck region. Here we present a case of basal cell carcinoma of the skin of the left lateral canthus of the eye which metastasized to the intraparotid lymph nodes with infiltration of the adjacent parotid parenchyma. More awareness and vigilance is required on the part of the reporting pathologist to consider metastasis in the presence of a parotid tumour. Features favouring metastasis include history of primary cutaneous basal cell carcinoma, histological similarity to the primary lesion and absence of any demonstrable direct extension from the skin lesion. We also review the literature on metastatic basal cell carcinoma and discuss the need for adequate follow up in high risk patients.

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Abstract:Background: Follicular lymphoma in situ (FLIS) is characterized by the presence of germinal centers that strongly express BCL-2 protein and germinal center markers CD10 and BCL-6, although most of the remaining lymph node shows a pattern of follicular hyperplasia, in the absence of interfollicular infiltration. Here, we present five cases of FLIS and discuss their presentation and pathological identification in a wide variety of clinical settings. Materials and Methods: The present study includes five cases of FLIS diagnosed in the department of surgical pathology over a period of three years (2010 to 2013). The clinical data and the follow-up information were obtained from the medical records. Results: The present study included three male and two female patients with an age range of 46-72 years. One case of FLIS was associated with diffuse large B-cell lymphoma (DLBCL), while in two cases this was an incidental finding associated with other non-lymphoid malignancies. Conclusion: FLIS has a very low rate of progression to clinically significant follicular lymphoma (FL), and the management strategy recommended is to watch and wait. However, some cases may develop into full blown FL and also many non-FL lymphoid malignancies have been seen associated with it. Hence, a staging workup is strongly advocated by many authors for FLIS. ollicular lymphoma (FL) comprises approximately 20% of all lymphomas and shows presence of the t(14;18)(q32;q21) translocation in approximately 85% of cases. Normal germinal centers within lymphoid tissue lack BCL-2 and immunohistochemistry for this marker is valuable for diagnosis of FL. In 2002, follicular lymphoma in situ (FLIS) was defined as abnormal expression of BCL-2 confined to germinal centers and associated with preserved follicular architecture, residual reactive germinal centers and without any evidence of disseminated disease [1,2] . Diagnosis of FLIS requires a high degree of clinical and diagnostic suspicion and it is usually diagnosed as an incidental finding. Here we present five cases of FLIS and discuss their presentation and behavior. Materials and methodsThe present study includes five cases of FLIS diagnosed in the department of surgical pathology over a period of three years (2010 to 2013) from a wide range of in-house surgical major cancer resection specimens as well as F

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