Nodular fasciitis in the parotid region of a child

Posterior Ethmoid Nodular Fasciitis

Nodular fasciitis (NF) is an uncommon and benign tumour-like fibroblastic proliferation that is difficult to distinguish from sarcoma both clinically and histologically. In addition, it is a type of lesion characterised by having a potential for spontaneous regression. NF is frequently misdiagnosed due to its rapid growth, rich cellularity, and mitotic figure. Although NF is only rarely diagnosed in children, the head and neck represent the most common locations for NF among this population. The cause of NF remains unknown, however trauma is believed to be an important triggering factor. We describe an unusual case of NF in the posterior ethmoid sinus in a six-year-old boy with no history of trauma. The NF was incidentally noted on a computed tomography scan after the patient complained of a squint. The diagnosis of NF was also supported by histopathology and specific immunohistological staining. A surgical biopsy was performed, and no recurrence was observed after one year.

Benign Temporomandibular Joint Lesions Presenting as Masses in the External Auditory Canal

OBJECTIVE

Describe benign lesions arising from the temporomandibular joint (TMJ) that presented as masses in the external auditory canal (EAC).

STUDY DESIGN

Retrospective case series of two academic medical centers.

PATIENTS

Six patients with lesions emanating from the TMJ that presented as EAC masses. Lesions included pigmented villonodular synovitis (PVNS), nodular fasciitis, foramen of Huschke herniation with salivary fistula, fibroepithelial polyp, superficial angiomyxoma, and giant cell tumor (GCT).

INTERVENTION

Surgical resection.

MAIN OUTCOME MEASURES

Tumor control, TMJ function, and hearing.

RESULTS

All patients presented with hearing loss, TMJ pain, and otalgia. Three patients with EAC occluding masses developed entrapment cholesteatoma between the mass and tympanic membrane. Following surgical resection, four patients were free of disease. The patient with PVNS has a stable remnant at 3 years follow up and the patient with giant cell tumor is under active surveillance. Hearing improved in three patients, remained stable in one patient, and worsened in two patients. All had resolution of their TMJ and ear pain.

CONCLUSIONS

EAC masses of uncertain origin should be imaged preoperatively to exclude lesions best not biopsied (e.g., encephalocele, facial nerve schwannoma, paraganglioma). In the differential of EAC masses, lesions emanating from the TMJ need to be considered, especially for those based anteriorly. Understanding the extent of TMJ involvement is crucial for surgical planning which optimizes outcome. Goals for therapy are to control the underlying disease process, restore patency of the EAC, improve hearing, and preserve function of TMJ.

Nodular fasciitis of the tongue

BACKGROUND

Nodular fasciitis is a non-neoplastic proliferation within the subcutaneous tissue and the deep fascia of the fibroblasts, probably of a reactive nature characterized by apparent infiltration of the connective tissues by a mitotically active spindle cell lesion. Nodular fasciitis in the head/neck region is rarely found and only 2 previous cases affecting the tongue have been reported.

METHODS AND RESULTS

The purpose of this study was for us to report a very rare case of a 67-year-old man with a history of a 3-month subepithelial asymptomatic nodule of the tongue tip with an ulcerated surface. An excisional biopsy of the mass was performed with 0.5-mm surgical margins.

CONCLUSION

The clinical and histological features of nodular fasciitis may mimic a head and neck malignancy, but it is often misdiagnosed as a malignant mesenchymal neoplasm. Even if it is a rare entity, nodular fasciitis should be considered in cases of rapidly growing masses of the head and neck region.

Parotid Gland Nodular Fasciitis: A Clinicopathologic Series of 12 Cases with a Review of 18 Cases from the Literature

Nodular fasciitis (NF), very uncommon in the parotid gland, is a benign myofibroblastic proliferation that may be mistaken for other neoplastic proliferations. The mass-like clinical presentation and histologic features result in frequent misclassification, resulting in inappropriate clinical management. There are only a few reported cases in the English literature. Cases within the files of the authors' institutions (retrospective) confined to the parotid gland were compared to cases reported in the English literature (Medline 1966-2014). The patients included five females and seven males, aged 11-70 years (mean 45.2 years). All patients presented with a mass lesion, present on average 1.9 months, without a documented history of trauma. The lesions were 0.7-5.2 cm (mean 2.2 cm). Seven patients had fine needle aspiration. The majority of the lesions were circumscribed (n = 9), composed of spindle-shaped to stellate myofibroblasts (MF) arranged in a storiform growth pattern, juxtaposed to hypocellular myxoid tissue-culture-like areas with extravasation of erythrocytes. Dense, keloid-like collagen (n = 7) and occasional giant cells were seen (n = 6). Mitotic figures (without atypical forms) were readily identifiable (mean 4/10 HPFs). By immunohistochemical staining, the MF were reactive with vimentin, actins, and calponin, while the histiocytes were reactive with CD68. All patients had surgical excision. One patient developed local recurrence (12 months later). All were alive and disease free at last follow-up, with a mean 133 months of follow-up. The principle differential diagnoses include fibrosarcoma, fibromatosis, pleomorphic adenoma, myoepithelioma, neurofibroma, schwannoma, solitary fibrous tumor, leiomyoma, fibrous histiocytoma and myxoma. NF of the parotid gland occurs in middle-aged patients who present with a mass (mean 2.2 cm) in the parotid gland of short duration (1.9 months). FNA misinterpretation frequently leads to excision. Separation from myoepithelial and mesenchymal lesions affecting the parotid gland results in appropriate management.

Cervical nodular fasciitis in a 17-month-old child

Nodular fasciitis (NF) is an uncommon fibroblastic proliferation that usually arises in the extremities or trunk, less frequently in the head and neck region. It is frequently mistaken for a malignant tumour owing to its rapid growth, but it is ultimately a benign condition with spontaneous regression. We describe a case of a 17-month-old African girl with cervical NF in which spontaneous and complete regression of the lesion occurred following the diagnosis by fine needle aspiration cytology. We emphasise the importance of making an accurate and timely diagnosis, and the imperative role of fine needle aspiration cytology in this process, potentially avoiding further unnecessary surgical procedures.

The chameleon in the neck: Nodular fasciitis mimicking malignant neck mass of unknown primary

INTRODUCTION

Difficulties with the correct diagnosis and treatment of nodular fasciitis in head and neck region has been reported in the literature. Nodular fasciitis was mistaken for sarcoma, papillary thyroid carcinoma, Burkitt's lymphoma, pleomorphic adenoma, or as a vascular lesion.

PRESENTATION OF CASE

We present a patient with a single node in the neck with accelerated growth, which clinically appeared as a malignant epithelial tumor with unknown primary. The en bloc removal of the tumor and selective neck dissection was performed with bilateral tonsillectomy and biopsy of the tongue base. The histopathology revealed the tumor to be nodular fasciitis. No malignant cells were detected.

DISCUSSION

Due to very rapid growth, its rich cellularity and high mitotic activity, nodular fasciitis can be mistaken as a malignant tumor. Trauma and/or infection is advocated to be a trigger for the formation of nodular fasciitis, although the exact aetiopathogenesis still remains unknown. Our patient admitted to regularly practicing martial arts with his opponent performing a specific combat maneuver applying pressure into the neck and submental region, which might have triggered the formation of the nodular fasciitis.

CONCLUSION

Nodular fasciitis is a benign and often overlooked diagnosis in the head and neck region, that can be misinterpreted as a malignant tumor both clinically and histologically. A comprehensive medical history may help to avoid unnecessary radical treatment. If a malignancy cannot be confidently ruled out, the en bloc resection of the tumor with selective neck dissection may offer a safe option with low morbidity.

Nodular fasciitis of the oro-facial region

Nodular fasciitis is a benign proliferative spindle-cell lesion that presents as a rapidly growing mass frequently being mistaken for a sarcoma. A rare presentation and treatment of nodular fasciitis in the cheek of an 8-year-old boy is described here. He came with a chief complaint of swelling in the left cheek since 1 month which rapidly increased to the size of a marble, over a period of 1 month. Surgical excision of the lesion was planned under general anesthesia following which the surgical site was closed with resorbable sutures. Based on the history, clinical picture, and histopathological examination, the lesion was diagnosed as nodular fasciitis. Although infrequent in both children and the oral mucosa, nodular fasciitis should be considered in the differential diagnosis of facial tumors in infants and young children.

Nodular fasciitis of the external auditory canal in six Egyptian children

OBJECTIVE

Nodular fasciitis of external auditory canal may mimic a malignant tumor due to its progressive course, so it was the aim of this study to focus on a new etiology for aural masses to avoid unnecessary aggressive treatment.

STUDY DESIGN

Retrospective study on six children presented with aural masses that were diagnosed pathologically to have nodular fasciitis.

METHODS

Presentation of the cases clinically, radiologically and pathologically was carried out. Surgical excision of the lesions was done through the external canal with follow up of the cases for 1 year.

RESULTS

Recurrence was detected in two cases, one after 2 months and the other after 4 months. Re-excision was carried out without recurrence till the end of the follow up period.

CONCLUSIONS

Proper diagnosis of this lesion is mandatory to avoid aggressive treatment (radical surgery and/or radiotherapy) as the disease has favorable prognosis with local excision.

Parotid neoplasms in children: experience of diagnosis and management in a district general hospital

Parotid neoplasms are uncommon in children and the available literature is predominantly from specialized centres. This paper highlights our experience at a district general hospital, in the diagnosis and management of parotid neoplasms in children. The case records of all parotidectomies performed in a 26-year period between 1974-1999 were scrutinized and patients aged 18 years and below identified. The demographic data, histology, presentation, investigations, treatment, outcomes and complications were analysed. 545 parotidectomies were performed in 536 patients, in whom 569 neoplasms were diagnosed. Only 12 patients aged 18 and under were identified (2.2%). The relative frequency of individual tumours differed markedly from that in adults. 75% of the tumours were benign. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common tumours. A painless mass was the most frequent clinical presentation and CT sialogram was the most common investigation. Parotidectomy with preservation of the facial nerve was performed in all cases, and adjuvant radiotherapy employed in the case of malignant tumours. All patients were alive and well at the time of last follow up. Transient facial nerve palsy and hypertrophic scars were the most common complications.

Nodular fasciitis of the forehead in a pediatric patient

BACKGROUND

Nodular fasciitis is a benign fibroblastic proliferation in soft tissue that is frequently misdiagnosed as a sarcoma. Most patients are middle aged, and the upper extremity is the most common localization. Nodular fasciitis is rarely diagnosed in childhood but appears in the head and neck region more commonly in children than in adults.

OBJECTIVE

To describe a rare case of nodular fasciitis of the forehead in a pediatric patient.

RESULTS

A 15-year-old female had been aware of a subcutaneous nodule with subtle tenderness on the forehead for 4 months. The patient had no history of trauma. The nodule was totally excised with a narrow margin and was histopathologically diagnosed as nodular fasciitis. No recurrence was observed for 22 months.

CONCLUSION

When we encounter subcutaneous nodules of the face and neck region in children, it is important for dermatologists to keep nodular fasciitis in mind for differential diagnosis to avoid unnecessary wide resection.