Our patient is a 54 year old White/Caucasian male with past medical history of hypertension, stroke, and vertigo who was brought by ambulance to the emergency department with left-sided numbness concerning for a transient ischemic attack in the setting of an hypertensive emergency (SBP > 200). He has never smoked and reports no drug use, but has a history of excessive alcohol use (>20 standard drinks per week). There was no pertinent family history. Following an emergency department workup that consisted of unremarkable blood work, an MRI that revealed a new posterior pontine susceptibility, and a head CT that was negative for new changes, the patient was started on clopidogrel and admitted to the medical ward for control of blood pressure with gradual improvement of symptoms. During his stay, the patient voiced concerns of an ‘abscess’ of his right chest that had been present for 4 months prior to hospitalization, after which the general surgery service was consulted. A physical examination revealed a painless mass measuring 5 × 6 × 5 cm,with central ulceration and mild spontaneous and intermittent brown-colored discharge (). He firmly denied any accompanying fever/chills, tenderness, nausea/vomiting and malaise. An ultrasound examination revealed a complex mass with peripheral increased vascularity which at the time endorsed an infectious process. A computed tomography of the chest with IV contrast () revealed a soft tissue mass that did not invade the chest wall. Following the retrieval of aerobic and anaerobic cultures, the patient was started on intravenous clindamycin and medically optimized using hydralazine for surgical excision. The next day the patient was brought to the operating room for the procedure which was performed by a consultant general surgeon with assistance from a resident physician. Following successful excision using a 3:1 transverse elliptical incision, the specimen was sent with inked margins for examination by the pathology department. Sections of the specimen revealed a central well-circumscribed soft yellow lesion measuring 6 × 5 × 3.4 cm. The encapsulated lesion grossly extended to within 1 mm of the inked resection margin and all margins were considered to be free. shows microscopic views of the resected mass. The mass was later sent for additional pathologic examination and immunohistochemical (IHC) analysis for DNA mismatch repair defects. contains a summary of the results of the IHC analysis. Following the procedure, results of previously obtained cultures revealed growth of Methicillin-sensitive Staphylococcus aureus after which the patient's antibiotic coverage was switched to intravenous vancomycin. The patient was then discharged the following day on oral cephalexin with recommendations to follow up at the outpatient surgery clinic and to undergo a colonoscopy to exclude any occult gastrointestinal malignancies. Although the patient consented for removal of the mass, he has not followed up with the surgeon after discharge, nor is there any indication that he underwent the recommended colonoscopy. Several attempts have been made to contact the patient for continuity of care and to risk-stratify this patient, however to no avail. A retrospective calculation of the Mayo Muir-Torre score was not possible due to the lack of a documented negative family history, specifically for Lynch-related cancers.