Nodular fasciitis

From Libre Pathology
Revision as of 03:07, 29 September 2013 by Michael (talk | contribs) (→‎General)
Jump to navigation Jump to search
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) ?
Site soft tissue - fibroblastic/myofibroblastic tumours

Clinical history associated with trauma
Prevalence uncommon
Prognosis benign

Nodular fasciitis is an uncommon soft tissue lesion. It should not to be confused with necrotizing fasciitis.

General

  • Benign.
  • All age groups.
  • Associated with trauma.
  • Rapid growth - clinically concerning for malignancy.[1]

Microscopic

Features:[2][3]

  • 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:[4][5]

  • 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:[6]

Images

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).[7]

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. 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.
  3. 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.
  4. Dickson, B. 26 April 2011.
  5. URL: http://anvita.info/wiki/Nodular_Fasciitis. Accessed on: 11 November 2011.
  6. URL: http://www.mckeedermpath.com/SPOT%20DIAGNOSIS%20CASE%20268.html. Accessed on: 11 November 2011.
  7. 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.