Ischemic fasciitis

Histopathology of ischemic fasciitis

Ischemic Fasciitis

Ischemic fasciitis, also known as atypical decubital fibroplasia, is a rare, benign, reactive process that occurs in soft tissue, often associated with prolonged immobilization or pressure points in elderly or debilitated patients. This condition primarily affects the deep subcutaneous tissue and fascia, leading to the development of a pseudosarcomatous fibroblastic proliferation. It was first described in the medical literature in 1992, highlighting its distinct pathological features from other soft tissue lesions.

Etiology and Pathogenesis

The exact cause of ischemic fasciitis is not fully understood, but it is believed to be a response to localized ischemia. This ischemic event may result from pressure-induced vascular compromise in patients who are immobilized or bedridden for extended periods. The condition is characterized by the presence of a zonal phenomenon in the tissue, with a central area of fibrinoid necrosis surrounded by granulation tissue and a peripheral zone of fibroblastic proliferation.

Clinical Presentation

Patients with ischemic fasciitis typically present with a painless, firm mass that may be mistaken for a soft tissue sarcoma. The lesions are most commonly found over bony prominences subject to pressure, such as the sacrum, hips, and elbows. Although the condition can occur at any age, it predominantly affects the elderly and those with significant comorbidities leading to prolonged immobilization.

Diagnosis

The diagnosis of ischemic fasciitis is primarily based on histopathological examination of the lesion. Imaging studies, such as MRI, can be helpful in delineating the extent of the lesion but are not diagnostic. Biopsy of the lesion reveals a characteristic appearance with areas of necrosis, granulation tissue, and fibroblastic proliferation. Immunohistochemical staining can help differentiate ischemic fasciitis from malignant soft tissue tumors.

Treatment and Prognosis

The treatment of ischemic fasciitis involves surgical excision of the lesion. Complete removal is usually curative, and recurrence is rare. The prognosis for patients with ischemic fasciitis is generally excellent, with no known cases of malignant transformation. However, the underlying condition that predisposed the patient to develop ischemic fasciitis, such as prolonged immobilization, needs to be addressed to prevent recurrence.

Conclusion

Ischemic fasciitis is a rare, benign condition that requires histopathological examination for diagnosis. It is important for clinicians to be aware of this entity to differentiate it from malignant soft tissue tumors and to provide appropriate treatment. With surgical excision, the prognosis for patients with ischemic fasciitis is favorable.