Nodular fasciitis

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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

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.