To compare the histopathology of nodular fasciitis nf with the magnetic resonance imaging mri findings in order to evaluate the basis of the mr signal characteristics. Accurate diagnosis, particularly on small biopsies. Usp6 fish is a useful ancillary test in cases where nodular fasciitis is a potential diagnostic. Gross findings nodular fasciitis is an unencapsulated but wellcircumscribed and nodular mass that is usually less than three cm in size, although they may be larger. Mri findings, available in all 10 patients, were compared with. Nodular pseudosarcomatous fasciitis, a nonrecurrent lesion.
Nodular fasciitis nf is a rapidly growing, selflimited, myofibroblastic neoplasm that typically arises in subcutaneous tissues of young adults and regresses spontaneously. Accurate diagnosis, particularly on small biopsies, remains a challenge as morphology can. Histopathology and immunohistochemistry confirmed the lesion to be nodular fasciitis. This case report presents a 35yearold male, with a rapidly growing mass on the border of his left mandible, referred to a specialist head and neck unit. Accurate diagnosis, particularly on small biopsies, remains a challenge, as the morphology can be varied and the immunophenotype is essentially non. Nodular fasciitis, posttraumatic, cytology, myofibroblastic, tumour introduction fibrous tumours and tumourlike lesions form a large and diverse group of distinct entities that differ greatly in their behaviour. Histopathologic examination showed a subcutaneous tumour profoundly in. Jun 01, 2015 nodular fasciitis nf is a benign myofibroblastic proliferation that occurs predominantly in the subcutaneous tissue of young to middleaged adults. We report a case of nodular fasciitis mimicking a parotid tumour after a facelift. Most lesions are solitary and occur in adults 2040 years of age.
Nodular fasciitis of the breast and knee in the same patient ajr. Nodular fasciitis mimics sarcoma on clinical, radiological, and histological grounds and is. B, photomicrograph of histopathologic specimen of resected breast lesion. Nodular faseiitis presenting as a parotid tumour after face lifting. Nodular fasciitis nf is a relatively common massforming and selflimited subcutaneous pseudosarcomatous myofibroblastic proliferation of unknown pathogenesis.
Case presentation a 61yearold man was affected by rectal cancer. Uncommonly, nodular fasciitis may be found within a blood vessel intravascular fasciitis and in the oral cavity. Nodular fasciitis can be differentiated from other facial mesenchymal tumors, including sarcomatoid carcinoma, fibrosarcoma, leiomyosarcoma, and neurofibroma, based on histology, molecular biology, and immunohistochemistry 21. In the morphologically definitive cases, fish analysis for usp6 had a sensitivity of 86% and specificity of 100% for a diagnosis of nodular fasciitis. Usp6 gene rearrangement in nodular fasciitis and histological. Nodular fasciitis mimics sarcoma on clinical, radiological, and histological grounds and is usually, diagnosed following excision. Nodular fasciitis classic morphologic variants related tumors ischemic fasciitis proliferative fasciitis myositis ossificans intraabdominal myofibroblastic proliferations visceral tumors. Mar 02, 2021 webpathology is a free educational resource with 11063 high quality pathology images of benign and malignant neoplasms and related entities. It typically presents as a fastgrowing nodule that usually reaches 2 to 3 cm in size within few weeks. In cases of nodular fasciitis, proactive efforts are needed to perform histopathologic evaluation and treatment.
Although fibroma of tendon sheath is typically sclerotic and nodular fasciitis is typically not, there is sufficient variation in patterns to cause overlap. Nodular fasciitis like fibroblastic proliferations with metaplastic bone formation. Nodular fasciitis nf is an unusual, benign condition which can mimic more sinister, sarcomatous lesions both clinically and histologically. Nodular fasciitis is a benign connective tissue tumor that classically presents as a painless, rapidly growing subcutaneous mass. A clinicopathological analysis was made of data from 250 cases of nodular fasciitis. Ten patients with nf, nine females and 1 male, with an age ranging from to 58 years mean 26. Usp6 gene rearrangement in nodular fasciitis and histological mimics.
Description of a rare case of nodular fasciitis of the apical aspect. Updates on the cytogenetics and molecular cytogenetics of. Gross findings nodular fasciitis is an unencapsulated but wellcircumscribed and nodular mass that is usually less than three cm in size, although they may be. Despite its benign nature, it characteristically exhibits rapid growth, which is demonstrated on histology or cytology as increased mitotic activity. Nodular fasciitis, a benign nodular proliferation of connective tissue involving the. Intradermal variant of nodular fasciitis intradermal variant of nodular fasciitis goodlad, j. Postoperative spindle cell nodule uinflammatory myofibroblastic tumor imt lrecent developments nodular fasciitis is a p s e u o n o p a. As rearrangement of the usp6 gene has been recently recognised as a recurrent alteration in soft tissue nodular. A rare case of intraoral nodular fasciitis journal of oral and.
Apr 19, 2011 nodular fasciitis is a benign reactive proliferation that usually involves the deep fascia. Nodular fasciitis of soft tissue over the mandible bmj. Subsequent histology confirmed nf and helped in the management of the case. Histologically the features are similar to nodular fasciitis, however there are greater number of multinucleate giant cells and less prominent mucoid matrix. Pseudosarcomatous myofibroblastic proliferations of the genitourinary tract have a debatable relationship with inflammatory myofibroblastic tumour generally lacking alk rearrangement. Although up to 20% of cases occur in the head and neck region, lesions of the oral cavity are. Both nodular fasciitis and myxoma have abundant myxoid matrix. Due to its locally aggressive nature and rapid growth, nf can be mistaken as a malignant process on either clinical or histological grounds. The tumour is composed of haphazardly arranged mass of spindled and plump cells which is often compared to tissue culture. It usually involves a subcutaneous plane, but can also affect fascia or muscle.
Developed by renowned radiologists in each specialty, statdx provides comprehensive decision support you can rely on nodular and proliferative fasciitis. Intradermal variant of nodular fasciitis, histopathology. Owing to the size, location and findings of the magnetic. Abstract nodular fasciitis is a rare benign soft tissue lesion that is often confused with malignant sarcoma, which can make management of this pathology. Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis is known to be a benign mimic of sarcoma, both clinically and histologically. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast. The head and neck are relatively common locations for nodular fasciitis, particularly in children. A discussion of the histopathologic, clinical, and molecular features of nodular fasciitis. Printable nodular fasciitis surgical pathology criteria. The histopathological examination from the excisional biopsy.
This is the first reported case of nodular fasciitis arising in the posterior orbit of a child younger than 16. Oct 01, 2020 nodular fasciitis nf also known as infiltrative or pseudosarcomatous fasciitis, is a benign, selflimited fibroblastic and myofibroblastic proliferative process with most lesions being solitary 1, first described in 1955 by konwaler et al. Primary malignant mclanocytic tumours of the sympathetic ganglia. Local recurrence has been described after simple surgical excision but it is rare. Nodular fasciitis, a benign, pseudosarcomatous proliferative lesion of the soft tissue. Rapidly growing nodular fasciitis in the cheek of an infant. Pseudosarcomatous myofibroblastic proliferations of the. Nodular fasciitis nf is a benign reactive soft tissue lesion. Jan 01, 2018 nodular fasciitis, with characteristic pseudosarcomatous features, is considered a benign, reactive fibroblastic growth. Nodular fasciitis of soft tissue over the mandible bmj case.
Accurate diagnosis, particularly on small biopsies, remains a challenge, as the morphology can be varied and the immunophenotype is essentially nonspecific. It is a benign, reactive myofibroblastic proliferative lesion that arises from the superficial or deep fascia and involves predominately small to mediumsize arteries andor veins. Nodular fasciitis is a benign rapid reactive selflimiting proliferation of myofibroblasts leading to fibromatosis. Nodular fasciitis is a selflimited myofibroblastic lesion that can be misdiagnosed as a sarcoma as a result of its rapid growth, cellularity, and sometimes prominent mitotic activity. Differential diagnosis of nodular fasciitis includes, fibrosarcoma, fibroma, fibrous histiocytoma, and desmoids and histopathology and immunohistochemistry play a key role in identifying the condition.
Lesions in nodular fasciitis could be separated into 3 types based on a range of histological features, modified from those of price ef a myxoid. The positive predictive value was 100%, and the negative predictive value 90%. Nodular fasciitis resembles numerous benign mesenchymal lesions. Mri findings, available in all 10 patients, were compared with the. Nodular fasciitis is a rare benign soft tissue tumor. Nodular fasciitis is a rapidly proliferating fibroblastic lesion that presents as a tumourlike mass. Rapidly growing nodular fasciitis in the cheek of an. Nodular fasciitis explained by a soft tissue pathologist. Pseudosarcomatous myofibroblastic proliferations of the genitourinary tract are genetically different from nodular fasciitis and lack usp6, ros1 and etv6 gene rearrangements. The pathology archives at the johns hopkins hospital, the ohio state. We performed a robotic, highanterior resection with lymph node. Usp6 activation in nodular fasciitis by promoterswapping. Dermal and intravascular forms have also been described. Treatment of nodular fasciitis on the front surface of the.
Nodular fasciitis mimicking a soft tissue sarcoma a case. Francisco jadson lima, dds, msc, maria luiza diniz. Apr 01, 2019 nodular fasciitis, also referred to as pseudosarcomatous fasciitis, is a benign condition consisting of fibroblastic and myofibroblastic proliferation of soft tissue. The rapidly growing, the abundant cellularity, and the mitotic activity noted on histology can simulate an aggressive entity, such as sarcoma. Most such lesions on the hands are labeled fibroma of tendon sheath. Clinically, nodular fasciitis presents as a subcutaneous growth over a period of 36 weeks that eventually regresses. Wu, md,b bryan ebert, md,c and benn lieberman, dmdd acolumbia university college of physicians and surgeons, new york. Nodular fasciitis is known to be a benign mimic of sarcoma both clinically and histologically. The initial presentation, radiology and cytology were initially inconclusive and the possibility of. Dec 09, 2020 background nodular fasciitis nf is a type of rare and rapidly growing tumor that affects the muscular fascial layers.
Variants such as solid variant, clear cell and oxyphilic variant, papillary carcinoma with lipomatous stroma, warthinslike tumor or with nodular fasciitis like stroma and cribriform papillary carcinoma have been reported, but they are too few in number for an adequate assessment. Nodular fasciitis affects both men and women with equal frequency. It is the most common benign condition confused with sarcoma due to its rapid growth, high cellularity, and mitotic activity 2, 3. Nodular fasciitis in the axillary tail of the breast. Nodular fasciitis an overview sciencedirect topics. Nodular fasciitis lesions are classically found in the anterior ocular adnexa, especially in pediatric patients. Taken out of context, it is frequently misdiagnosed as a sarcoma, given its hypercellularity, rapid growth, irregular infiltrating borders not all cases, and increased mitotic activity. There was also an associated smaller lesion that was histologically identical and which involved the wall of a medium sized vein with protrusion into. Nodular fasciitis is a benign soft tissue lesion commonly diagnosed in human beings, but with rare description in dogs and cats. P tumors of soft tissues, in atlas of tumor pathology, section ii. Oral nodular fasciitis a case report with a diagnostic schema.
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