Histopathology and immunohistochemistry confirmed the lesion to be nodular fasciitis. Nodular fasciitis is a benign proliferative lesion that is usually found in the soft tissue of the upper extremity and trunk in young to middleaged persons. Review of the orthopedic oncology and pathology databases yielded 51 cases of histologically proven nodular fasciitis. Ten patients with nf, nine females and 1 male, with an age ranging from to 58 years mean 26. Histopathologic diagnosis of this type of lesion can be challenging due to its differential diagnosis, which principally includes sarcoma. Nodular fasciitis mimics malignant cancerous tumors, which makes it a challenge to diagnose.
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. Proliferative myositis pm and nodular fasciitis nf are within a spectrum of benign myofibroblastic tumorlike lesions 1,2. Primary malignant mclanocytic tumours of the sympathetic ganglia. The most common sites of these growths are in the extremities although nodular. It is the most common benign condition confused with sarcoma due to its rapid growth, high cellularity, and mitotic activity 2,3. To evaluate mri imaging appearances of nodular fasciitis in a pathologicproven series of 29 patients. It usually involves a subcutaneous plane, but can also affect fascia or muscle.
The pathogenesis of nodular fasciitis is still unknown, however, reactive or inflammatory processes have been proposed. Nodular fasciitis is probably the most common benign mesenchymal lesion that is histopathologically misdiagnosed as sarcoma, with resultant unnecessary. Dermal and intravascular forms have also been described the tumour is composed of haphazardly arranged mass of spindled and. Histopathology of cancer bonnie balzer, md july 18, 2008. Differential diagnosis of nodular fasciitis includes, fibrosarcoma, fibroma, fibrous histiocytoma, and desmoids and histopathology and. Since they appear as rapidly growing masses, pm and nf are easily and mistakenly diagnosed as each other or even as sarcoma 1,3. Nodular fasciitis nf is a rapidly growing, selflimited, myofibroblastic neoplasm that typically arises in subcutaneous tissues of young adults and regresses spontaneously. Nodular fasciitis mimicking a soft tissue sarcoma a case. A case report on nodular fasciitis 1444 int j clin exp med 2017. Nodular fasciitis nf is a relatively common massforming and selflimited subcutaneous pseudosarcomatous myofibroblastic proliferation of unknown pathogenesis. Variants such as solid variant, clear cell and oxyphilic variant, papillary carcinoma with lipomatous stroma, warthinslike tumor or with nodular fasciitislike stroma and cribriform papillary carcinoma have been reported, but they are too few in number for an adequate assessment.
Variable ki67 proliferative index in 65 cases of nodular. Nodular fasciitis in the oral cavity canadian dental association. Nodular fasciitis presents as a rapidly growing soft tissue mass which may follow a history of trauma histology of nodular fasciitis. Nodular fasciitis of the breast mimicking breast cancer. Usp6 activation in nodular fasciitis by promoterswapping.
Shin jh, lee hk, cho kj, han mh, na dg, choi cg, suh dc. It is one of the most underdiagnosed lesion and can be confused with spindle cell sarcoma, fibromatosis, fibrous histiocytoma, proliferative fasciitis, benign nerve sheath tumors, and pleomorphic adenoma because of features. The lesion is seen more frequently in the upper limbs and trunk of young to middleaged individuals, so development in the breast area is rare. A database search was performed at the middlemore hospital histopathology department. Nodular fasciitis, with characteristic pseudosarcomatous features, is considered a benign, reactive fibroblastic growth. The lesion commonly occurs in the first three decades of life. Usp6 fish is a useful ancillary test in cases where nodular fasciitis is a potential diagnostic. Nodular fasciitis is a benign, reactive, fibroblastic proliferation in which nodules most commonly develop in the subcutaneous or superficial fascia of the extremities. The occurrence of these growths in the orbital region is relatively rare. Journal of clinical imaging science common soft tissue. Nodular fasciitis of the breast pubmed central pmc. Nodular fasciitis was first described in 1955 by konwaler et al, as subcutaneous pseudosarcomatous fibromatosis fasciitis. A 26yearold female presented at surveillance computed.
Nodular fasciitis, is a benign soft tissue lesion most commonly found in the superficial fascia. It can appear in soft tissue anywhere on your body. Nodular fasciitis is the most common pseudosarcomatous lesion of soft tissue. The differential diagnosis depends on the consideration of magnetic resonance imaging mri or computed tomography ct. Local excision is the treatment of choice of nodular fasciitis and recurrences are rare odom et. In the morphologically definitive cases, fish analysis for usp6 had a sensitivity of 86% and specificity of 100% for a diagnosis of nodular fasciitis. Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts that may be mistaken for a sarcomatous lesion because of its rapid growth, abundant spindleshaped cells, and mitotic activity, 1.
Nodular fasciitis is a benign rapid reactive selflimiting proliferation of myofibroblasts leading to fibromatosis. Spindle cell desmoid tumor fibromatosis, fibroma, nodular fasciitis, lowgrade fibromyxoid sarcoma, dermatofibrosarcoma protuberance, solitary fibrous tumor, fibrosarcoma, leiomyoma, leiomyosarcoma. Nodular fasciitis, also known as nodular fibrositis, subcutaneous fibromatosis, 1 pseudosarcomatous fasciitis, proliferative fasciitis, subcutaneous pseudosarcomatous fibromatosis and infiltrative fasciitis, 2,3 is an uncommon tumourlike fibroblastic proliferation that was first reported by konwaler and others in 1955. Nodular fasciitis, first described by konwaler and weiss in 1955 is also known as pseudosarcomatous fasciitis, pseudosarcomatous fibromatosis and infiltrative fasciitis. Importance nodular fasciitis is a rare benign tumor that can present in the head and neck in children. Nodular fasciitis, also referred to as pseudosarcomatous fasciitis, is a benign condition consisting of fibroblastic and myofibroblastic proliferation of soft tissue. Myofibroblastic sarcoma vs nodular fasciitis american. Nodular fasciitis mimicking a soft tissue sarcoma a case report. Nodular fasciitis nf is the commonest of the benign pseudosarcomatous lesions. Mri findings, available in all 10 patients, were compared with the. Description of a rare case of nodular fasciitis of the apical aspect. Owing to hypercellular, polymorphic pattern of lesional cells and giant cells, nf is the most common benign. There are three general subtypes of nodular fasciitis on the basis of lesion location.
The positive predictive value was 100%, and the negative predictive value 90%. None of the patients whose data were included in the study received therapy before operation. Ki67 was considered as a useful marker for distinguishing some benign and malignant lesions. Nodular fasciitis may occur virtually anywhere in the body, but there is a predilection for certain sites. Request pdf ultrasonographic findings and histopathology of nodular fasciitis objective. Cytological diagnosis and misdiagnosis of nodular fasciitis. Benign, self limited, neoplasm of fibroblastic myofibroblastic derivation iarc. This paper describes the clinical presentation and microscopic features of this rare benign lesion and it emphasizes the need for accurate histopathology and. Low power examination of nodular fasciitis shows a wellcircumscribed discrete mass in the subcutaneous adipose tissue figure 1. From the department of pathology, james homer wright laboratories, massachusetts general hospital, harvard medical school, boston.
Nodular pseudosarcomatous fasciitis, a nonrecurrent lesion. 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. Intradermal variant of nodular fasciitis, histopathology. It presents as a rapidly enlarging, often painful or tender subcutaneous nodule, most often affecting young adults and showing a predilection for the upper limb, especially the forearm. The clinicopathologic data for 5 cases of nodular fasciitis are summarized in table 2. Nodular fasciitis mimics sarcoma on clinical, radiological, and histological grounds and is usually, diagnosed following excision. Rarely, intravascular, intradermal, and cranial variants have been described.
Nodular fasciitis dermatology jama dermatology jama. This is the first reported case of nodular fasciitis arising in the posterior orbit of a child younger than 16. A local excision was performed, and the histopathological findings were consistent with nodular fasciitis. Myh9usp6 is the most common fusion product, although other usp6 partners have been identified lab invest 2011. Three cases of nodular fasciitis presenting as neck lumps are reported. It was elastichard, mm in size, and located mainly in the upper inner quadrant of the left breast. Nodular fasciitis is a benign lesion that develops due to proliferation of fibroblastic and myofibroblastic cells within subcutaneous tissue, commonly found in soft tissues. Nodular fasciitis lesions are classically found in the anterior ocular adnexa, especially in pediatric patients. Nodular fasciitis of the head and neck cambridge core. Ultrasonographic findings and histopathology of nodular. 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 definition of nodular fasciitis by.
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. Nodular fasciitis is a benign proliferation of fibroblasts in the subcutaneous tissues, commonly associated with the deep fascia. Pathologic and mr imaging features of benign fibrous soft. Nodular fasciitis in the axillary tail of the breast. The clinical differential diagnosis of nodular fasciitis depends in part on the location of the lesion. Nodular fasciitis is a relatively common soft tissue tumor that exceeds in frequency. Nodular fasciitis is a benign lesion despite areas of marked hypercellularity. Nodular fasciitis is a reactive process that can occur in patients of all ages, but most commonly occurs between 2040 years of age.
To study the usefulness of ki67 in diagnosis of nodular fasciitis, the expression of ki67 was examined by using immunostaining in 65 nodular fasciitis specimens, 15 desmoid fibromatosis specimens and 20. Nodular fasciitis of the external ear region lester dr thompson. While it can occur within any site of the body, the upper extremitiesespecially the forearmsare the most frequent site involved. The pathology archives at the johns hopkins hospital, the ohio state. Who classification of tumours of soft tissue and bone, 4th edition, 20 virtually all cases contain fusion genes. Most lesions are located in the subcutaneous tissue of the upper extremities.
The 5 cases of nodular fasciitis were selected from the surgical pathology archives of west china hospital, sichuan university in 2005. Mesenchymal lesions to be covered in lecture 2 vulva. Abstract nodular fasciitis is a rare benign soft tissue lesion that is often confused with malignant sarcoma, which can make management of this pathology. They were successfully treated with local excision, with no signs of recurrence following two years of follow up. A 35yearold woman had noticed a mass in her left breast. It should not to be confused with necrotizing fasciitis. Braz j vet pathol, 2009, 21, 41 44 brazilian journal of veterinary pathology. The specimen was a spindlecell lesion composed of loose, plump, bipolar. A case report pohsuan lu yangchih lin yuhung wu nodular fasciitis is a reactive myofibroblastic proliferative lesion frequently misdiagnosed as a sarcoma. Most lesions are solitary and occur in adults 2040 years of age. Nodular fasciitis affects both men and women with equal frequency. Sonographic imaging features of superficial type nodular. To analyze histopathological type and ultrasonographic findings of nodular fasciitis nf, in order to. Upper extremities and trunk are the most common affected anatomical areas.