Nodular fasciitis

A benign soft tissue tumor

Classification
External resources

Nodular fasciitis is a benign, rapidly growing soft tissue tumor that often presents as a solitary, painless mass. It is most commonly found in the subcutaneous tissues of the upper extremities, trunk, and head and neck region. Despite its alarming growth rate, nodular fasciitis is non-cancerous and typically resolves spontaneously or after surgical excision.

Pathophysiology

Nodular fasciitis is characterized by a proliferation of fibroblasts and myofibroblasts. It is thought to arise from a reactive process, possibly due to trauma or inflammation, although the exact etiology remains unclear. The lesion is composed of spindle-shaped cells in a myxoid stroma, often with a prominent vascular component.

Nodular fasciitis - low magnification

Clinical Presentation

Patients with nodular fasciitis typically present with a rapidly enlarging mass that may be mistaken for a malignant tumor due to its growth rate. The lesion is usually well-circumscribed, firm, and mobile. It is most frequently found in young adults, although it can occur at any age.

Histopathology

Histologically, nodular fasciitis is characterized by a proliferation of spindle cells arranged in short fascicles. The stroma is myxoid and contains scattered inflammatory cells, including lymphocytes and macrophages. Mitotic figures may be present, but atypical mitoses are rare.

Nodular fasciitis - intermediate magnification

Diagnosis

The diagnosis of nodular fasciitis is primarily based on histological examination. Imaging studies such as ultrasound or MRI may be used to assess the extent of the lesion, but they are not diagnostic. Fine needle aspiration or core needle biopsy can provide tissue for histological analysis.

Treatment

The treatment of choice for nodular fasciitis is surgical excision. Complete removal of the lesion is usually curative, and recurrence is rare. In some cases, the lesion may regress spontaneously without intervention.

Nodular fasciitis - high magnification

Prognosis

The prognosis for patients with nodular fasciitis is excellent. The lesion is benign and does not metastasize. Recurrence after surgical excision is uncommon, and spontaneous resolution has been reported.

Related pages

• Fibromatosis
• Myofibroblast
• Soft tissue tumor

Fasciitis nodularis (Goldner)