Nodular fascitis of the maxilla in a child

Maxillary Sinus Myxofibrosarcoma Mimicking Nodular Fasciitis: A Rare Case Report

Myxofibrosarcoma (MFS) is a fibroblastic soft tissue sarcoma that is extremely rare in the maxillofacial region. Due to its non-specific clinicoradiographic findings and challenging histopathological features, the diagnosis is difficult. Here, we present a case of MFS which was first diagnosed as nodular fasciitis. The initial examination of the incisional biopsy showed a benign-appearing proliferation of fibroblasts without features of malignancy. The patient returned with recurrence four months after surgical excision of the primary lesion. The second histologic study revealed a high-grade spindle cell sarcoma with myxoid features most compatible with MFS. Definitive diagnosis of MFS was confirmed by these histopathologic features and supportive immunohistochemical stains. Unfortunately, the patient died of disease 3 months later.

Fibroma of tendon sheath in planta

PURPOSE

Fibroma of tendon sheath in planta is comparatively rare, and its differentiate diagnose, tumour features, treatment and complications were lack of retrospective study in clinics.

METHODS

This was a retrospective study of 13 patients (seven women, six men) operated between July 2001 and May 2013 for FTS in planta. The average age at the time of the procedure was 49.8 ± 8.3 years old (range 31-64). The female-to-male ratio was 9:4. Before the surgery, anteroposterior, lateral and oblique position of foot X-rays were performed in all patients. Ultrasonography (n = 11) and magnetic resonance imaging (n = 11) were performed selectively. The tumor located on the metatarsal par (n = 6), the central part of plantar (n = 4), the lateral part (n = 2) and the medial part (n = 1). Eight patients presented with painless mass (62 % of cases), while five patients presented with pain mass (38 % of cases). No patient had bony erosion. This paper studies the different features of FTS and classifies them into two types-superficial type that tumour grows at planter fascia; deep type that breaks through the planter fascia growing around tendon and joint capsule. Eight and five patients were diagnosed as superficial type and deep type respectively.

RESULTS

In all cases, the tumor was excised, pathological results was FTS. The mean follow-up period was 3.2 ± 1.1 years (range 2-7) years. Five patients had neurovascular bundle involvement (38 % of cases). Two patients had a recurrence (15 % of cases), they undergone another operation. Four patients had a pain (31 % of cases), two patients had numbness (15 % of cases), and one patient had pain and numbness (8 % of cases). They recovered after conservative treatment.

CONCLUSION

For the FTS that grows in the plantar, we should select differential diagnosis and the corresponding therapy according to the features of two types, also the prognosis is different.

LEVEL OF EVIDENCE

IV.

Oral intravascular fasciitis: a rare maxillofacial lesion

Nodular fasciitis is a benign non-neoplastic myofibroblastic proliferation, involving the head in 7% to 20% of cases. Intravascular fasciitis (IVF) is a rare variant, with a unique intravascular growth pattern. Only 4 maxillofacial cases have been previously reported. We describe a 58-year-old woman with a rapidly growing, hard, mobile buccal submucosal swelling. CT scans identified a well-defined, 1.7-cm isodense lesion, located between the mental foramen and masseter muscle, which was excised under general anesthesia. A well-defined cellular nodular mass was composed of bland spindle cells, in a densely vascularized, focally myxoid matrix, involving an arterial lumen, and extending into adjacent tissues. Mitoses were rare. Immunohistochemistry was positive for smooth muscle actin, negative for keratins, S-100, epithelial membrane antigen, caldesmon, p53 and Alk. CD31 and CD34 were positive only in the vascular component, supporting the diagnosis of intravascular fasciitis.

Nodular fasciitis of the face: aesthetic considerations

Nodular fasciitis is an uncommon tumor-like fibroblastic proliferation that occurs rarely in the head and neck region. A new case of nodular fasciitis occurring in the cheek of a 56-year-old woman is reported. The case was characterized by dental trauma preceding the appearance of the lesion (extraction of tooth 35). Histologically, the lesion consisted of proliferating fibroblasts and myofibroblasts presenting clinically as a rapidly growing subcutaneous nodule. A conservative surgical excision with curettage is the treatment of choice, and the lesion usually does not exhibit a tendency to recur. The clinical relevance of this condition relies on the fact that both the disorder and its surgical treatment may cause tissue distortion resulting in aesthetic compromise. Furthermore, it needs to be differentiated from malignancy due to its very rapid growth, its rich cellularity, and its high mitotic activity. Both of these aspects, i.e. aesthetic implications and differential diagnosis, have been discussed.

Nodular fasciitis in the orofacial region

Nodular fasciitis (NF) is a benign, reactive proliferation of fibroblasts in subcutaneous tissues which commonly occurs in the deep fascia. It can only be diagnosed by histopathological examination of a biopsy. A total of 23 orofacial NF patients was analysed, including those reported in the English language literature and six new patients from the files of this hospital. All patients were treated between 1994 and 2005. The reported lesions were located in cheek masseter muscle, parotid gland, upper neck, upper gingiva and body of mandibular. The clinical and histological features and differential diagnoses are discussed. All lesions were removed under general or local anaesthesia and no recurrence of the lesions was found.

Extracranial fasciitis in childhood: a sheep in wolf's clothing

Soft tissue tumours in children are rare, and the differentiation between pseudosarcomatous tumours and sarcomas is difficult. Rapidly-enlarging masses within the head and neck region in infants require rapid diagnosis and prompt definitive treatment to lessen psychological burden on the parents and the surgical team. We present a case of a 17-month-old girl who had a large, rapidly-enlarging soft tissue mass within the maxilla which was excised. The diagnosis of childhood extracranial fasciitis was confirmed histopathologically. We emphasise the importance of conservative excision once the diagnosis has been confirmed.