Difference between revisions of "Nodular fasciitis"

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#redirect [[Soft_tissue_lesions#Nodular_fasciitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Nodular_fasciitis_-_intermed_mag.jpg
| Width      =
| Caption    = Nodular fasciitis. [[H&E stain]].
| Micro      = usu. well-circumscribed, clusters of (non-pleomorphic) spindle cells, inflammation (lymphocytes), microcysts in cellular regions - uncommon, mitoses - common, [[extravasated RBC]]s.
| Subtypes  =
| LMDDx      = myxoid [[dermatofibrosarcoma protuberans]], cellular [[dermatofibroma]], [[desmoid-type fibromatosis]], other [[spindle cell lesions of the skin]]
| Stains    =
| IHC        = CD34 -ve, desmin -ve, SMA -ve, S-100 -ve, AE1/AE3 -ve.
| EM        =
| Molecular  = t(15;15) ?
| IF        =
| Gross      = usu. upper extremity ~45% of cases
| Grossing  =
| Site      = [[soft tissue lesions|soft tissue]] - [[fibroblastic/myofibroblastic tumours]]
| Assdx      =
| Syndromes  =
| Clinicalhx = associated with trauma
| Signs      =
| Symptoms  =
| Prevalence = common soft tissue lesion
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
}}
'''Nodular fasciitis''' is a benign [[soft tissue lesion]].
 
It should '''not''' to be confused with [[necrotizing fasciitis]].
==General==
*Benign.
*All age groups - though typically 20-40 years old.
*Associated with trauma.
*Often rapidily growing - clinically concerning for malignancy.<ref name=pmid14569327>{{Cite journal  | last1 = Chi | first1 = CC. | last2 = Kuo | first2 = TT. | last3 = Wang | first3 = SH. | title = Nodular fasciitis: clinical characteristics and preoperative diagnosis. | journal = J Formos Med Assoc | volume = 102 | issue = 8 | pages = 586-9 | month = Aug | year = 2003 | doi =  | PMID = 14569327 }}</ref>
*Commonly misdiagnosed as malignant.<ref name=pmid17235006 >{{Cite journal  | last1 = Dinauer | first1 = PA. | last2 = Brixey | first2 = CJ. | last3 = Moncur | first3 = JT. | last4 = Fanburg-Smith | first4 = JC. | last5 = Murphey | first5 = MD. | title = Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. | journal = Radiographics | volume = 27 | issue = 1 | pages = 173-87 | month =  | year =  | doi = 10.1148/rg.271065065 | PMID = 17235006 | URL = http://radiographics.rsna.org/content/27/1/173.long }}</ref>
 
Subtypes - location:<ref name=pmid17235006/>
*Subcutaneous.
*Intramuscular.
*Fascial
*Dermal - rare.
*Intravascular - rare.
 
==Gross==
*Usually upper extremity ~45% of cases.<ref name=pmid17235006/>
**Other locations in order: trunk (~20%), head and neck (~20%), and lower extremities (~15%).
 
==Microscopic==
Features:<ref name=Ref_WMSP606>{{Ref WMSP|606}}</ref><ref>{{cite journal |author=de Feraudy S, Fletcher CD |title=Intradermal nodular fasciitis: a rare lesion analyzed in a series of 24 cases |journal=Am. J. Surg. Pathol. |volume=34 |issue=9 |pages=1377–81 |year=2010 |month=September |pmid=20716998 |doi=10.1097/PAS.0b013e3181ed7374 |url=}}</ref>
*Usu. well-circumscribed.
*Clusters of (non-pleomorphic) spindle cells.
*Inflammation (lymphocytes).
*Microcysts in cellular regions - uncommon - ''discriminatory''.
*Mitoses - common.
*[[Extravasated RBC]]s.
 
The BD feature list:<ref>Dickson, B. 26 April 2011.</ref><ref>URL: [http://anvita.info/wiki/Nodular_Fasciitis http://anvita.info/wiki/Nodular_Fasciitis]. Accessed on: 11 November 2011.</ref>
*Tissue culture-like/CNS-like morphology.
*Thick (keloid-like) collagen bundles - '''key feature'''.
*[[Extravasated RBCs]].
*Inflammation.
*+/-[[Giant cell]]s.
 
Notes:
*No significant nuclear atypia.
*No atypical mitoses.
*May be cellular.
 
DDx:<ref>URL: [http://www.mckeedermpath.com/SPOT%20DIAGNOSIS%20CASE%20268.html http://www.mckeedermpath.com/SPOT%20DIAGNOSIS%20CASE%20268.html]. Accessed on: 11 November 2011.</ref>
*Myxoid [[dermatofibrosarcoma protuberans]].
*Cellular [[dermatofibroma]].
*[[Desmoid-type fibromatosis]].
*Other [[spindle cell lesions of the skin]].
 
===Images===
<gallery>
Image:Nodular_fasciitis_-_intermed_mag.jpg | NF - case 1 - intermed. mag. (WC)
Image:Nodular_fasciitis_-_high_mag.jpg | NF - case 1 - high mag. (WC)
Image:Nodular_fasciitis_-2-_intermed_mag.jpg | NF - case 2 - intermed. mag. (WC)
Image:Nodular_fasciitis_-2-_high_mag.jpg | NF - case 2 - high mag. (WC)
</gallery>
<gallery>
Image:Nodular_fasciitis_%281%29.JPG | NF - low mag. (WC)
Image:Nodular_fasciitis_%282%29.JPG | NF - high mag. (WC)
</gallery>
www:
*[http://www.humpath.com/nodular-fasciitis NF (humpath.com)].
==IHC==
Routine spindle cell panel:
*CD34 -ve.
*Desmin -ve.
*SMA +ve -- strong.{{fact}}
*S-100 -ve.
*AE1/AE3 -ve.
 
Others:
*H-caldesmon -ve.
*EMA -ve.
*Vimentin +ve.
 
==Molecular==
*Evolving - case reports.
**t(15;15)(q13;q25).<ref name=pmid12606136>{{cite journal |author=Velagaleti GV, Tapper JK, Panova NE, Miettinen M, Gatalica Z |title=Cytogenetic findings in a case of nodular fasciitis of subclavicular region |journal=Cancer Genet. Cytogenet. |volume=141 |issue=2 |pages=160–3 |year=2003 |month=March |pmid=12606136 |doi= |url=}}</ref>
 
==See also==
*[[Fibroblastic/myofibroblastic tumours]].
 
==References==
{{Reflist|2}}
 
[[Category:Fibroblastic/myofibroblastic tumours]]
[[Category:Diagnosis]]

Latest revision as of 16:17, 18 June 2017

Nodular fasciitis
Diagnosis in short

Nodular fasciitis. H&E stain.
LM usu. well-circumscribed, clusters of (non-pleomorphic) spindle cells, inflammation (lymphocytes), microcysts in cellular regions - uncommon, mitoses - common, extravasated RBCs.
LM DDx myxoid dermatofibrosarcoma protuberans, cellular dermatofibroma, desmoid-type fibromatosis, other spindle cell lesions of the skin
IHC CD34 -ve, desmin -ve, SMA -ve, S-100 -ve, AE1/AE3 -ve.
Molecular t(15;15) ?
Gross usu. upper extremity ~45% of cases
Site soft tissue - fibroblastic/myofibroblastic tumours
Clinical history associated with trauma
Prevalence common soft tissue lesion
Prognosis benign

Nodular fasciitis is a benign soft tissue lesion.

It should not to be confused with necrotizing fasciitis.

General

  • Benign.
  • All age groups - though typically 20-40 years old.
  • Associated with trauma.
  • Often rapidily growing - clinically concerning for malignancy.[1]
  • Commonly misdiagnosed as malignant.[2]

Subtypes - location:[2]

  • Subcutaneous.
  • Intramuscular.
  • Fascial
  • Dermal - rare.
  • Intravascular - rare.

Gross

  • Usually upper extremity ~45% of cases.[2]
    • Other locations in order: trunk (~20%), head and neck (~20%), and lower extremities (~15%).

Microscopic

Features:[3][4]

  • Usu. well-circumscribed.
  • Clusters of (non-pleomorphic) spindle cells.
  • Inflammation (lymphocytes).
  • Microcysts in cellular regions - uncommon - discriminatory.
  • Mitoses - common.
  • Extravasated RBCs.

The BD feature list:[5][6]

  • Tissue culture-like/CNS-like morphology.
  • Thick (keloid-like) collagen bundles - key feature.
  • Extravasated RBCs.
  • Inflammation.
  • +/-Giant cells.

Notes:

  • No significant nuclear atypia.
  • No atypical mitoses.
  • May be cellular.

DDx:[7]

Images

  • NF - case 1 - intermed. mag. (WC)

  • NF - case 1 - high mag. (WC)

  • NF - case 2 - intermed. mag. (WC)

  • NF - case 2 - high mag. (WC)

  • NF - low mag. (WC)

  • NF - high mag. (WC)

www:

IHC

Routine spindle cell panel:

  • CD34 -ve.
  • Desmin -ve.
  • SMA +ve -- strong.[citation needed]
  • S-100 -ve.
  • AE1/AE3 -ve.

Others:

  • H-caldesmon -ve.
  • EMA -ve.
  • Vimentin +ve.

Molecular

  • Evolving - case reports.
    • t(15;15)(q13;q25).[8]

See also

References

  1. ↑ Chi, CC.; Kuo, TT.; Wang, SH. (Aug 2003). "Nodular fasciitis: clinical characteristics and preoperative diagnosis.". J Formos Med Assoc 102 (8): 586-9. PMID 14569327.
  2. ↑ 2.0 2.1 2.2 Dinauer, PA.; Brixey, CJ.; Moncur, JT.; Fanburg-Smith, JC.; Murphey, MD.. "Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults.". Radiographics 27 (1): 173-87. doi:10.1148/rg.271065065. PMID 17235006.
  3. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 606. ISBN 978-0781765275.
  4. ↑ de Feraudy S, Fletcher CD (September 2010). "Intradermal nodular fasciitis: a rare lesion analyzed in a series of 24 cases". Am. J. Surg. Pathol. 34 (9): 1377–81. doi:10.1097/PAS.0b013e3181ed7374. PMID 20716998.
  5. ↑ Dickson, B. 26 April 2011.
  6. ↑ URL: http://anvita.info/wiki/Nodular_Fasciitis. Accessed on: 11 November 2011.
  7. ↑ URL: http://www.mckeedermpath.com/SPOT%20DIAGNOSIS%20CASE%20268.html. Accessed on: 11 November 2011.
  8. ↑ Velagaleti GV, Tapper JK, Panova NE, Miettinen M, Gatalica Z (March 2003). "Cytogenetic findings in a case of nodular fasciitis of subclavicular region". Cancer Genet. Cytogenet. 141 (2): 160–3. PMID 12606136.
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