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Atypical fibroxanthoma (AFX) with osteoclast-like giant cells is a rare entity. We present the case of an elderly woman who presented with a pink-purple dome-shaped nodule with central hyperkeratotic crust. Biopsy revealed a cellular, dermal-based tumor comprised of spindle, oval, and osteoclast-like giant cells with pleomorphism. The immunohistochemistry profile supported a diagnosis of AFX with osteoclast-like giant cells. We performed a literature review through PubMed and Google Scholar for AFX with osteoclast-like giant cell formation and found 16 previously reported cases. We aim to provide a review and discuss features of these cases. We also discuss the pathogenesis of these osteoclast-like cells as well as potential pitfalls in diagnosis.

Monkeypox is a rare viral disease that initially appeared in West and Central Africa, and is primarily transmitted to humans from animals. It moved to the United States in 2003, which was the first time the disease had left the African continent. It is still uncommon in the United States and elsewhere, although outbreaks have occurred, especially in gay communities

Importance: Treating AD with dupilumab, a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13), may be associated with progression of MF. Objective: To examine the associations between length of dupilumab treatment, age and sex, and onset of MF. Design, Setting, and Participants: An institutional data registry and literature search were used for a retrospective cross-sectional study. Only patients with a diagnosis of MF on dupilumab for the treatment of AD and eczematous dermatitis were included. Exposure: AD patients treated with dupilumab. Main Outcomes and Measures: The primary outcome was the length of dupilmab exposure, age and sex, and MF onset. Linear correlations (Pearson) and Cox regression analysis were used to assess the correlation and the risk. Results: Five eligible patients were identified at our institution. In addition, the PubMed review identified an additional 20 patients. The median age was 58 years, with 42% female. Disease history was significant for adult-onset AD in most patients (n=17, 65.4%) or recent flare of AD previously in remission (n=3, 11.5%). All patients were diagnosed with MF, and one patient progressed to Sezary syndrome while on dupilumab, with an average duration of 13.5 months of therapy prior to diagnosis. Tumor stage was described in 19 of the cases and ranged from an early-stage disease (IA) to advanced disease (IV). Treatment strategies included narrow-band UVB therapy, topical corticosteroids, brentuximab, praladextrate, and acitretin. Male gender, advanced-stage disease, and older age correlated significantly with the hazard of MF onset and a shorter time to onset during dupilumab treatment. Conclusion and Relevance: Our results suggest a correlation between the duration of dupilumab treatment and the diagnosis of MF, the higher MF stage at diagnosis the shorter the duration of using dupilumab to MF onset. Furthermore, elderly male patients appeared to be more at risk as both male gender and older age correlated with hazard of MF diagnosis. The results raise the question as to whether the patients had MF misdiagnosed as AD that was unmasked by dupilumab or if MF truly is an adverse effect of treatment with dupilumab. Close Monitoring of these patients and further investigation of the relationship between dupilumab and MF can shed more light into this question.