Nodular Fasciitis: Definitive Diagnosis by Fine Needle Aspiration

Mind the Pitfall: Solitary Nodular Fasciitis Mimicking Extra-Nodal Manifestation of Hodgkin Lymphoma on [18F]FDG PET/CT

We report a [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scan of a 17-year-old male presenting increased focal glucose metabolism of a histologically proven solitary nodular fasciitis mimicking an extranodal manifestation of Hodgkin lymphoma. This interesting image should draw attention to considering nodular fasciitis as a possible pitfall in the staging of malignant diseases.

Nodular Fasciitis in the Preauricular Area in Pediatric Patients

Nodular fasciitis is a benign myofibroblastic and fibroblastic proliferative lesion that can be found in the subcutaneous tissue, muscle, and fascia. It is frequently observed in young adults aged 20 to 40 years and less commonly in pediatric patients. Rapid growth, high cellularity, and remarkable mitotic activity of this lesion could lead to misdiagnosis as a soft tissue sarcoma. Here, two cases of nodular fasciitis in the preauricular area in pediatric patients were reported. Nodular fasciitis in the preauricular area in a pediatric patient is rare. It could be confused with soft tissue sarcoma. However, nodular fasciitis should be suspected in a pediatric patient with a rapidly growing mass in the head and neck region. Surgical excision should be performed to confirm the histopathologic diagnosis when clinical diagnosis is uncertain and there is possibility of malignancy.

Approach to Fine Needle Aspiration of Giant Cell-rich Tumors of Soft Tissue

Giant cells may be found in a wide variety of reactive and neoplastic soft tissue lesions. Because of their distinct histomorphology, they often stand out in procured samples such as fine needle aspirates. The giant cells themselves may be benign or neoplastic. However, the presence, type, and quantity of giant cells are usually not specific and in some cases can even be misleading when making a diagnosis. The aim of this review is to guide the practicing cytopathologist in narrowing their differential diagnosis when encountering one of these challenging giant cell-rich lesions of the soft tissue.

Myxoid neoplasms of bone and soft tissue: a pattern-based approach

INTRODUCTION

The accurate diagnosis of musculoskeletal neoplasms is difficult but a pattern-based approach combined with ancillary testing has been shown to improve diagnostic accuracy. The pattern-based approach is particularly appropriate for myxoid lesions.

MATERIALS AND METHODS

The authors reviewed their personal experience of over 3 decades of diagnosing myxoid neoplasms of musculoskeletal lesions.

RESULTS

The authors found that myxoid lesions can be accurately classified based on cell type, nuclear atypia, presence of blood vessel fragments, as well as the results of immunohistochemical and molecular testing.

CONCLUSIONS

Musculoskeletal lesions with a prominence of myxoid or chondroid material in the background can be accurately diagnosed using pattern analysis and ancillary testing.

Nodular Fasciitis - Fine Needle Aspiration Cytology Diagnosis and Its Pitfalls, with Review of Literature

Background and Objective

Nodular fasciitis (NF) is a self-limiting, transient neo- plasm composed of fibroblasts and myofibroblasts. Since it regresses spontaneously, diagnosis by fine needle aspiration (FNA) cytology plays a major role in its management.

Methods

We present a series of 8 cases with either FNA or biopsy diagnosis ofNF, and study the major cytological features with a review of literature on diagnostic criteria and its pitfalls.

Results and Conclusion

The 8 cases occurred in patients between the age of 14 to 72 years, with equal sex distribution. FNA diagnosis concurred in 4 cases. Causes of wrong diagnosis included lack of clinical information and paucicellular smear. FNA cytology is an important tool in the diagnosis of nodular fasciitis, in appropriate clinico-radiologicalsetting.

Cytological Diagnosis and Misdiagnosis of Nodular Fasciitis

Background

Nodular fasciitis (NF) is a rapidly growing, self-limiting, subcutaneous nodular cytologic exuberant fibroblastic/myofibroblastic proliferation prone to cytological misdiagnosis.

Aims

This study aimed at finding out the utility of fine needle aspiration cytology (FNAC) from NF patients and to validate the diagnostic features.

Materials and Methods

The study group comprised 11 cases diagnosed as NF on cytology or subsequent histology.

Results

Out of 11 cases, 9 were cytologically diagnosed as NF. Two cases were misdiagnosed as sarcoma as proven histologically. Of the 9 cases of NF, spontaneous resolution occurred in 7 cases in 2-16 weeks; excisional biopsy was undertaken in the other 2 cases.

Conclusion

On cytology, NF reveals hypercellular, polymorphic, dispersed cell population, which is most commonly misdiagnosed as sarcoma. For this reason, FNAC has to be correlated with clinical data and followed up for the anticipated spontaneous regression.