A number of patients with inflammatory arthritis due to inadequate clinical or laboratory data do not fulfill diagnostic criteria for a clinical disease categories. These patients with initial diagnosis of undifferentiated arthritis (UA) may remit or progress to a definite well- defined condition such as rheumatoid arthritis (RA) or remain as UA with persistence of inflammatory arthritis. The main objective in the evaluation of these patients is focused on differentiating self-limiting arthritis from those who progress to chronic destructive arthritis such as RA. The study reviews the background data regarding the associated factors of progressive diseases among patients with recent-onset arthritis as well as the evaluation and decision in the management of this population. At present, the major goal should be focused on the early identification of patients, who have progressive course and initiation of appropriate therapy by using Disease Modifying Anti Rheumatic Drugs, (DMARDs) as early as possible to achieve clinical remission.

Undifferentiated pleomorphic sarcoma is a common soft tissue sarcoma in the human body, but it is rarely reported in the oral cavity. This article aims to report a case of UPS in the mandible. An 83-year-old female patient was referred to the Department of Oral and Maxillofacial Pathology at the Faculty of Dentistry in Isfahan, Iran, with a complaint of sudden, painless swelling under her removable complete denture, which had grown gradually over three months. The size of the lesion was approximately 5cm, and there were no radiographic defects present. Neoplastic and malignant proliferation of cells, which is necessary for UPS final diagnosis, was present in the H&E microcopy evaluation. Furthermore, immunohistochemical examination proved that the lesion is an undifferentiated pleomorphic sarcoma. Because of the late diagnosis of the disease, the patient died due to lung metastasis before any treatment.  Keywords: Case report; Surgery; Undifferentiated pleomorphic sarcoma; Malignant fibrous histiocytoma.

Introduction: Oral metastases are rare,nevertheless, they must be considered in the differential diagnosis of lesions in patients with a previous history of malignancy or older adults. The clinical signs of oral metastasis typically comprise pain, dysphagia, ulceration, bleeding, and paresthesia. Soft tissue sarcomas tend to affect the extremities and retroperitoneum. The most common metastases in the oral cavity are carcinomas, and sarcomas rarely metastasize to this area. Undifferentiated pleomorphic sarcoma (UPS) is a mesenchymal malignancy that infrequently affects the head and neck site. It shows a male predilection and occurs in all age groups. The lung is the most common area of distant metastasis in undifferentiated pleomorphic sarcoma. Case Report: This report presents a 61-year-old female patient with a painful bluish-purple mass of the posterior right mandibular alveolar mucosa. She had a history of thigh UPS about four years ago. An incisional biopsy was performed, and the specimen was stained with hematoxylin and eosin. Immunohistochemical antibodies for CK, S100, desmin, myogenin, MDM2, SOX10, and caldesmon were negative and focally positive for CD68. Ki-67 index was about 70%. Conclusions: This report aimed to increase awareness of a rare lesion by describing the clinical, histopathologic, and immunohistochemical findings of metastatic undifferentiated pleomorphic sarcoma of the oral cavity.

Introduction: Some viral infections have been suggested to trigger or cause autoimmune diseases. One of these viruses is parvovirus B19 which can have various rheumatologic manifestations. In this study we investigated the association between parvovirus and rheumatoid arthritis (RA), systemic lupus erythematosis (SLE), systemic sclerosis (SSc) and undifferentiated arthritis at the Rheumatological Clinic, Imam Khomeini hospital.Methods: In this sectional case-control study, IgM and IgG antibodies against parvovirus B19 were measured with ELISA in 41 patients with RA, 28 patients with SLE, 13 patients with SSc, 8 patients with undifferentiated arthritis as well as 90 healthy controls. The ELISA kit (DRG, Germany) was semiquantitative and qualititative.Results: Parvovirus B19 IgM was detected in one patient with RA, one with SSc and four in the control group. IgG anti- B19-specific antibody was detected in 58.5% of RA patients, 67.9% of SLE patients, 69.2% of SSc patients, 87.5% of undifferentiated arthritis patients as compared to 53.3% of controls. The results were compared between the patient and control groups (p>0.05).Conclusion: According to the results, there was no significant correlation for the antibody titer against parvovirus B19 in the patient and control group. The highly positive response of IgG against parvovirus in undifferentiated arthritis implies the need for more research.

Purpose: To report a case of limbal mass that was the initial manifestation of metastasis from an undifferentiated carcinoma of parotid gland.Case Report: A 56-year-old man without known systemic disease developed simultaneously a limbal and parotid mass in his left side. He underwent excisional biopsy of the limbal mass and subtotal parotidectomy in the same session and underwent systemic evaluations. Histopathologic evaluations and immunohistochemistry staining of both limbal and parotidal masses disclosed an undifferentiated carcinoma of both sites. Further evaluations revealed no other sites of involvement or metastasis. The patient underwent systemic chemotherapy and local radiotherapy.Conclusion: This is the first report of limbal mass that was the initial manifestation of metastasis from an undifferentiated carcinoma of parotid gland. It should be considered in the differential diagnosis of limbal masses.

Introduction: Sarcomas account for 1% of all tumors originated in the head and neck regions in adults. They constitute a heterogeneous group of tumors of mesenchymal origin with multiple histological variants. The undifferentiated pleomorphic sarcoma (UPS) subtype is the most frequent variant with an incidence range of 2. 7-38%. Materials and Methods: This retrospective case series was conducted on 11 patients who were diagnosed with UPS and treated in our institution in the last 11 years. Results: According to the results, 26. 8% of the sarcomas corresponded to UPS variant. Out of 11 patients, 5 cases were female. The median age of the participants was 58 years (range: 18-74 years). Seven and four patients were T1b and T2b, respectively. Ten patients had no metastasis at the moment of diagnosis. Six patients were categorized as intermediate-grade, and the remaining (n=5) were classified as high-grade. The most frequent location was the scalp (n=3). In the patients undergoing surgery, the mean follow-up duration was 52 months. Disease-free survival (DFS) rates were obtained at 70%, 50%, and 50% in the 1st, 3rd, and 5th years, respectively, with the mean DFS of 36 months. In addition, the overall survival rates in the 1st, 3rd, and 5th years were 100%, 100%, and 83%, respectively. Conclusion: The UPS represented the most common histological subtype in our series. They tend to be intermediate or high-grade tumors. An acceptable global survival rate justifies surgical treatment as the main therapeutic tool.

The existence of differences in couple interactions is due to the intrapersonal and interpersonal characteristics of couples. The aim of this study is identify patterns of marital interaction in the context of undifferentiated. This research was conducted using qualitative method and phenomenological design. Participants included 11 females and 7 males whose differentiation scores were one standard deviation below average and whose anxiety was one standard deviation above average. Participants were selected by using purposive sampling and Criterion-based method. Data collection was made through semi-structured interview. Also, scales of Skowron and Friedlander differentiation and General Health Questionnaire were used to cover the inclusion criteria. The interviews were coded and analyzed according to Dickelmann's seven-step approach. The analysis of the interviews led to the identification of 118 initial codes, Based on semantic similarity, it was classified into 14 subcategory. Then related concepts were categorized into 5 main categories, which are: Passivity constructor interactive patterns, 2-Hostile interactive patterns, 3-Controlling interactive patterns, 4-Responsibility-oriented interactive patterns, 5-Patterns based on Lack of understanding another point of view. This study emphasizes the role of differentiation of self in marital interaction patterns. In addition, the results indicate the existence of destructive patterns of marital interaction in undifferentiated individuals.