Nodular fasciitis of the upper lip mimicking a sarcoma

Nodular fasciitis of the lip mucosa: a rare but clinically important entity

Oral nodular fasciitis (NF) is a rare benign entity of significant clinical importance, which presents as a rapidly growing soft tissue mass. Awareness of this entity is essential, because histologically it resembles a malignancy at first glance, owing to its spindled histological nature and numerous typical mitoses. Thus, it is often misdiagnosed as an aggressive sarcoma, resulting in unnecessary radical surgery. In total, 45 cases of oral NF have been reported since 1966, of which only 2 were reported in the dermatological literature. Patients with NF of the lip mucosa will frequently present to a dermatologist. Therefore, it is critical that dermatologists recognize this benign neoplasm to correctly manage it and avoid potentially catastrophic unnecessary surgery, as these lesions typically spontaneously resolve. We describe the clinical, histological and immunohistochemistry findings of NF in a 51-year-old woman, and discuss its differential diagnosis.

Nodular Fasciitis of the Periorbital Area

Nodular fasciitis is a reactive, non-neoplastic lesion that is most commonly found in the subcutaneous or superficial fascia of the extremities and trunk. Head and neck lesions are relatively uncommon and reports vary from 7% to 15% depending on the authors. Nodular fasciitis grows quickly, and shows a pleomorphic spindle cell pattern with increased mitotic activity. Such factors lead to cases where the lesion is mistaken for a malignancy such as fibrosarcoma and the case may end up with unnecessarily aggressive treatments. The intent of this paper is to report a relatively rare case of nodular fasciitis occurring in the periorbital area and also to highlight the importance of accurate diagnosis and non-aggressive management of this benign lesion.

Intraneural nodular fasciitis of the median nerve: case report and literature review

Nodular fasciitis, a benign soft tissue tumor, occurs most frequently in the forearm and is generally divided into subcutaneous, intramuscular, and fascial types. Intraneural nodular fasciitis has been reported in only 5 patients previously. We present the case of a 79-year-old woman with nodular fasciitis within the median nerve at the proximal forearm. Carpal tunnel syndrome was suspected at the initial visit, but high median nerve palsy and a mass at the proximal forearm were found a few months later. Subtotal resection of the tumor within the median nerve was performed and histological diagnosis indicated nodular fasciitis. There was no evidence of recurrence at follow-up 1 year and 3 months after surgery. Motor weakness had resolved but sensation was compromised.

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.

Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity: 1. Nodular fasciitis

BACKGROUND

Nodular fasciitis (NF), a soft tissue lesion mainly composed of myofibroblastic cells, is well documented in various body locations however, in the oral cavity it is rare. The NF has non-specific histologic characteristics that might result in misdiagnosis and mistreatment. The aim of the study was to analyze clinico-pathologic correlations of NF occurring in the oral cavity.

METHODS

A total of 36 cases of oral NF were analyzed including review of the English language literature and five new cases from our files.

RESULTS

Oral mucosa NF was found to peak in the fourth and fifth decades, which is a decade later than NF occurring in other sites of the body. The most common locations were the buccal mucosa (52.8%) and the lips (16.7%). Duration of lesions ranged from 3 days to 2 years, with approximately 61% being present for more than a month, which is longer than the duration of NF from other body locations. Histologically, oral NF showed varying degrees of cellularity and frequently contained myxomatous areas, and often demonstrated local infiltration into adjacent tissues. However, the myofibroblastic, spindle-shaped lesional cells were uniform and lacked any major signs of atypia. Mitotic figures, characteristically abundant in NF lesions throughout the body, ranged from absent to moderately high in oral NF cases. Treatment modality of choice was complete surgical excision. Recurrence was reported for only one case. Extensive, mutilating surgical procedures for oral mucosa NF are unnecessary, since lesions resolve even when surgical margins are partly involved.

CONCLUSIONS

The NF should be included in the clinical differential diagnosis of superficial and deep soft tissue masses of the oral cavity, especially of the buccal mucosa. Histopathologically, NF should be differentiated from other spindle cell lesions, mainly myofibroma, neurofibroma, fibrosarcoma, solitary fibrous tumor, fibromatosis and fibrous histiocytoma.

Nodular fasciitis and solitary fibrous tumor of the oral region: tumors of fibroblast heterogeneity

OBJECTIVE

Fibroblastic proliferations of the oral cavity are extremely varied, yet they share certain features-spindle cell morphology, collagen synthesis, and fasciculation. Nodular fasciitis is a cellular fibroblastic lesion, uncommonly located in the oral submucosa, that shows smooth muscle actin (SMA) immunoreactivity. Solitary fibrous tumor expresses a CD34 fibroblast phenotype. The aim of this study is to report instances of nodular fasciitis and solitary fibrous tumor in the orofacial region and investigate immunohistochemical markers to compare and contrast fibroblastic phenotypic heterogeneity in these tumors.

STUDY DESIGN

Seven benign cellular fibrogenic tumors initially diagnosed as nodular fasciitis over a 10-year period were examined. Immunohistochemical markers, including S-100 protein, SMA, CD68, CD34, and vimentin, were used to further characterize these lesions.

RESULTS

All tumors occurred in adults, and the buccal mucosa was found to be the favored site. The spindle cells in these tumors showed phenotypic heterogeneity both within and between tumors. All were vimentin-reactive and harbored small populations of CD68-positive macrophage/dendrocytes. Five tumors were SMA-positive and CD34-negative; the tumor in one case was SMA-negative and CD34-positive, and that in another was SMA-positive and CD34-positive.

CONCLUSION

Although rare, nodular fasciitis and solitary fibrous tumor arise in oral submucosa, usually in the cheek. The histopathologic features and immunomarkers indicative of myofibroblastic differentiation are seen in nodular fasciitis, whereas solitary fibrous tumor is CD34-positive; however, one instance was found to be positive for both markers. All of these cases harbored subpopulations of CD68-positive cells. Immunomarkers are a valuable adjunct in differentiating nodular fasciitis from solitary fibrous tumor, yet some tumors may harbor heterogeneous fibroblast phenotypes.

Nodular fasciitis: response to intralesional corticosteroids

Nodular fasciitis is one of the more common soft-tissue lesions, frequently presenting as a rapidly enlarging subcutaneous mass on the arm. Management is usually surgical excision; however, large infiltrative lesions may be difficult to manage. We describe a patient in whom intralesional corticosteroid injections provided rapid resolution.