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Difference between revisions of "Nodular fasciitis"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Nodular_fasciitis_-_intermed_mag.jpg | | Image = Nodular_fasciitis_-_intermed_mag.jpg | ||
| Width = | | Width = | ||
| Caption = Nodular fasciitis. [[H&E stain]]. | | 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. | | Micro = usu. well-circumscribed, clusters of (non-pleomorphic) spindle cells, inflammation (lymphocytes), microcysts in cellular regions - uncommon, mitoses - common, [[extravasated RBC]]s. | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = | | LMDDx = myxoid [[dermatofibrosarcoma protuberans]], cellular [[dermatofibroma]], [[desmoid-type fibromatosis]], other [[spindle cell lesions of the skin]] | ||
| Stains = | | Stains = | ||
| IHC = CD34 -ve, desmin -ve, SMA -ve, S-100 -ve, AE1/AE3 -ve. | | IHC = CD34 -ve, desmin -ve, SMA -ve, S-100 -ve, AE1/AE3 -ve. | ||
| Line 12: | Line 12: | ||
| Molecular = t(15;15) ? | | Molecular = t(15;15) ? | ||
| IF = | | IF = | ||
| Gross = | | Gross = usu. upper extremity ~45% of cases | ||
| Grossing = | | Grossing = | ||
| Site = [[soft tissue lesions|soft tissue]] - [[fibroblastic/myofibroblastic tumours]] | | Site = [[soft tissue lesions|soft tissue]] - [[fibroblastic/myofibroblastic tumours]] | ||
| Line 20: | Line 20: | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = | | Prevalence = common soft tissue lesion | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = | ||
| Line 28: | Line 28: | ||
| ClinDDx = | | ClinDDx = | ||
}} | }} | ||
'''Nodular fasciitis''' is | '''Nodular fasciitis''' is a benign [[soft tissue lesion]]. | ||
It should '''not''' to be confused with [[necrotizing fasciitis]]. | |||
==General== | ==General== | ||
*Benign. | *Benign. | ||
*All age groups. | *All age groups - though typically 20-40 years old. | ||
*Associated with trauma. | *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== | ==Microscopic== | ||
| Line 56: | Line 71: | ||
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> | 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 [[ | *Myxoid [[dermatofibrosarcoma protuberans]]. | ||
*Cellular [[dermatofibroma]]. | *Cellular [[dermatofibroma]]. | ||
*[[Desmoid-type fibromatosis]]. | *[[Desmoid-type fibromatosis]]. | ||
*Other [[spindle cell lesions of the skin]]. | |||
===Images=== | ===Images=== | ||
| Line 77: | Line 93: | ||
*CD34 -ve. | *CD34 -ve. | ||
*Desmin -ve. | *Desmin -ve. | ||
*SMA - | *SMA +ve -- strong.{{fact}} | ||
*S-100 -ve. | *S-100 -ve. | ||
*AE1/AE3 -ve. | *AE1/AE3 -ve. | ||