Difference between revisions of "Nodular fasciitis"

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| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
| Prevalence = uncommon
| Prevalence = common soft tissue lesion
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
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*All age groups - though typically 20-40 years old.
*All age groups - though typically 20-40 years old.
*Associated with trauma.
*Associated with trauma.
*Rapid growth - 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>
*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>
*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>


Revision as of 03:20, 29 September 2013

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.
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 an uncommon 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.
  • 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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