The patient is a 45-year-old gentleman with multiple sclerosing infiltrating patches in different parts of the body with a clinical suspicion for scleroderma. The past medical history is also remarkable for diabetes mellitus and chronic renal failure. He underwent a radiographic study using gadolinium. The patient is concerned that he has nephrogenic systemic fibrosis. The temporal association between the administration of the gadolinium and the onset of the sclerosis is unclear. The biopsy was sent in consultation due to an infiltrative neoplasm suspicious for microcystic adenexal carcinoma.