48,466
edits
Difference between revisions of "Nodular fasciitis"
Jump to navigation
Jump to search
no edit summary
(+cat.) |
|||
| (12 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
{{ 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]] | [[Category:Diagnosis]] | ||