Intra-articular nodular fasciitis of the proximal interphalangeal joint of a finger: A case report

Intra-Articular Nodular Fasciitis of the Knee, A Rare Clinical Presentation and Histological Diagnosis: A Case Report

Introduction

Nodular fasciitis is a rare, benign soft tissue lesion that can prove to be difficult to diagnose, especially when intra-articular.

Case presentation

A 17-year-old female softball player presents with several year history of right knee pain and swelling initially attributed to patellar maltracking refractory to non-operative and operative management.

Management and Outcomes

Initial pathology suggested tenosynovial giant cell tumor; however, further tissue diagnosis revealed nodular fasciitis, which was eventually resected.

Conclusion

Intra-articular nodular fasciitis of the knee is rare and may easily be misdiagnosed due to its nonspecific clinical presentation. Careful histological examination can aid in diagnosis. Nodular fasciitis should be considered in the differential diagnoses for intra-articular lesions of the knee joint.

A case report of an unusual temporomandibular joint mass: Nodular fasciitis

Nodular fasciitis (NF) is a benign myofibroblastic proliferation that grows very rapidly, mimicking a sarcoma on imaging. It is treated by local excision, and recurrence has been reported in only a few cases, even when excised incompletely. The most prevalent diagnoses of temporomandibular joint (TMJ) masses include synovial chondromatosis, pigmented villonodular synovitis, and sarcomas. Cases of NF in the TMJ are extremely rare, and only 3 cases have been reported to date. Due to its destructive features and rarity, NF has often been misdiagnosed as a more aggressive lesion, which could expose patients to unnecessary and invasive treatment approaches beyond repair. This report presents a case of NF in the TMJ, focusing on various imaging features, along with a literature review aiming to determine the hallmark features of NF in the TMJ and highlight the diagnostic challenges.

Intraarticular nodular fasciitis-detection of USP6 gene fusions in three cases by targeted RNA sequencing

Intraarticular nodular fasciitis arising in the joint synovium is an uncommon lesion. Most cases have been reported in the knee and rarely in other joints. A USP6 gene fusion has so far been documented in only four cases of intraarticular nodular fasciitis, three were located in the knee and one in the proximal interphalangeal joint. In all three cases located in the knee, MYH9 was detected as a USP6 fusion partner. We analysed three cases of intraarticular nodular fasciitis for the presence of USP6 fusion by targeted RNA sequencing. Two cases were located in the hip (a 25-year-old female and 48-year-old male) and one in the shoulder (a 38-year-old male). We detected a MYH9-USP6 fusion in the two hip cases and a COL1A1-USP6 fusion in the shoulder case. Our findings provide additional evidence that intraarticular nodular fasciitis is a form of nodular fasciitis arising in the joint synovium, harbouring a USP6 fusion. Although a MYH9-USP6 fusion seems to predominate in intraarticular nodular fasciitis, other fusion partners of the USP6 gene may also be involved. Detection of a USP6 fusion by targeted RNA sequencing may assist in confirming the diagnosis in selected cases.

A Juxta-Articular Myxoma of the Thumb

Juxta-articular myxomata are benign tumors that are mostly encountered in the vicinity of larger joints. Few cases in the hand have been reported. We present a case of a juxta-articular myxoma at the metacarpophalangeal joint of the thumb in a 40-year-old man. The preoperative diagnostic work-up included 4-dimensional magnetic resonance angiography and ultrasound. The histochemical examination of the resected tumor established the diagnosis definitively. Follow-up magnetic resonance imaging scheduled with no clinical suspicion of tumor recurrence 9 months after surgery revealed no obvious recurrence. At 14 months, the patient had full motion without pain and declined further imaging.

A case of intra-articular fasciitis in the elbow joint

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Intra-nodular fasciitis is very rare and there are only two reported cases of intra-articular nodular fasciitis in the elbow joint.

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It is difficult to diagnose preoperatively, so a clear diagnosis can be obtained only after excisional biopsy.

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As local recurrence has not occurred in previously reported cases, we think that arthroscopic resection is suitable for treatment of this disease.

Introduction

Nodular fasciitis is a benign myofibroblastic proliferation arising from the fascia. Until now, there have been only two reported cases of intra-articular nodular fasciitis in the elbow joint.

Presentation of case

We report a case of a 19-year-old woman with a 3-month history of pain in the left elbow. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) showed an intra-articular lobulated mass on the anterior portion of the elbow joint, with accompanying effusion. The patient subsequently underwent arthroscopic excision of the mass. Histologically, intra-articular nodular fasciitis was the final diagnosis. At the most recent follow-up, 20 months after surgery, the patient had no subjective symptoms, including pain. The final MRI findings showed no tumor recurrence.

Discussion

As nodular fasciitis is not generally known to arise within a joint, the occurrence at such anatomical locations may lead to a misdiagnosis. Intra-articular nodular fasciitis is rarely encountered, and therefore, is not usually considered during the clinical investigation of joint symptoms.

Conclusion

Preoperative diagnosis was difficult in this case because of nonspecific preoperative clinical findings. Although histological examination is necessary to establish a diagnosis, we recommend that intra-articular nodular fasciitis should be included in the differential diagnosis of intra-articular mass lesions.