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Ariyaratne S, Abudu A, Sumathi V, Botchu R, Azzopardi C. An unusual case of nodular fasciitis presenting as an intra-tendinous mass. Skeletal Radiol 2025; 54:367-371. [PMID: 38888624 DOI: 10.1007/s00256-024-04728-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
Nodular fasciitis is a benign soft tissue pseudotumour typically occurring in the upper extremities, head and neck, thigh and trunk. It is most commonly seen in subcutaneous locations but also can be present in intramuscular and intermuscular (fascial) locations. Its occurrence in the hand is rare, and while it can occur in close proximity to tendons, its presentation as an intra-tendinous mass has not been previously described. We present a unique and rare case of nodular fasciitis arising within the flexor digitorum profundus (FDP) tendon of the hand in a 16-year-old female. The patient presented with a painful swelling in the volar aspect of the base of her left middle finger, with progressive flexion deformity of the finger. Ultrasound and magnetic resonance imaging revealed a mass within the FDP tendon of the middle finger. An ultrasound-guided biopsy revealed a diagnosis of nodular fasciitis. Given the self-limiting nature of the condition, she was managed conservatively with close clinical and imaging follow-up. This case highlights the importance of considering nodular fasciitis in the differential diagnosis of an intra-tendinous lesion in the hand, even though it is a rare occurrence in this location. The clinical presentation, diagnostic workup, and management of this unique case are discussed, emphasising the potential for its misdiagnosis as a malignancy which can have important implications in management.
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Affiliation(s)
- Sisith Ariyaratne
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - Adesegun Abudu
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Vaiyapuri Sumathi
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Klontzas ME, Vassalou EE, Spanakis K, Alpantaki K, Karantanas AH. Musculoskeletal Infection: The Great Mimickers on Imaging. J Clin Med 2024; 13:5424. [PMID: 39336911 PMCID: PMC11432558 DOI: 10.3390/jcm13185424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
A series of conditions can mimic musculoskeletal infections on imaging, complicating their diagnosis and affecting the treatment. Depending on the anatomical location, different conditions can manifest with clinical and imaging findings that mimic infections. Herein we present a wide spectrum of the musculoskeletal disorders of the axial skeleton, long bones, peripheral joints, and soft tissue that may manifest as infectious processes, and we focus on the potential mimics of osteomyelitis, septic arthritis, and infectious spondylodiscitis that are common in clinical practice. We present the typical imaging characteristics of each musculoskeletal infection, followed by mimicking conditions.
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Affiliation(s)
- Michail E. Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Evangelia E. Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Crete, Greece
| | - Konstantinos Spanakis
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Crete, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma Surgery, “Venizeleion” General Hospital of Heraklion, 71409 Crete, Greece
| | - Apostolos H. Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Crete, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Wen Y, Ye S, Liu C, Zhu Y. Laryngeal nodular fasciitis in a 75-year-old man: a rare case report and review of the literature. J Int Med Res 2024; 52:3000605241259764. [PMID: 39142703 PMCID: PMC11328270 DOI: 10.1177/03000605241259764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/20/2024] [Indexed: 08/16/2024] Open
Abstract
Nodular fasciitis (NF) is a benign and self-limiting fibroblastic proliferation that originates from the superficial fascia and extends into the subcutaneous tissue or muscle. It typically manifests in individuals aged 20 to 35 years, with rare occurrences observed in patients over the age of 60 years. We herein report a case involving a 75-year-old man with NF in the right vocal cord. The patient sought medical attention at the Department of Otolaryngology of our hospital because of a 1-month history of hoarseness and breathlessness. The diagnosis was unable to be confirmed through preoperative pathological examination. After admission to our hospital, various examinations were completed and surgical treatment was performed, and the postoperative histopathological findings revealed the presence of NF in the right vocal cord. NF of the vocal cord is a rare clinical entity. Given its rapid progression and propensity for marked infiltration, it often poses diagnostic challenges because it can mimic various malignant soft tissue tumors. Therefore, thorough exclusion of other neoplastic lesions is imperative prior to confirming the diagnosis of NF through pathological examination. Local surgical resection remains the primary treatment modality.
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Affiliation(s)
- Yu Wen
- Department of Otolaryngology Surgery, The Second People’s Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
| | - Shufeng Ye
- Department of Otolaryngology Surgery, The Second People’s Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
| | - Cuiping Liu
- Department of Otolaryngology Surgery, The Second People’s Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
| | - Yiming Zhu
- Department of Otolaryngology Surgery, The Second People’s Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
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Montreuil J, Campano D, Montoya-Cerrillo D, Subhawong T, Geiger EJ, Rosenberg AE, Temple TH. Large Nodular Fasciitis of the Shoulder Presenting as Soft Tissue Sarcoma: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00048. [PMID: 39241104 DOI: 10.2106/jbjs.cc.24.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
CASE This case report describes a patient who presented with clinical and radiographic features of a soft tissue sarcoma of the shoulder. Despite having a painless and relatively large mass, a biopsy and resection revealed nodular fasciitis (NF). CONCLUSION This is an unusual case of a painless 10 cm mass that histopathologically was diagnosed as NF in the upper extremity with proximity to the axillary nerve and posterior humeral circumflex vessels. The USP6 rearrangement was helpful in confirming the diagnosis. Careful clinical, radiographic, and pathologic correlation is necessary in diagnosing these relatively rare tumors. In cases where there are discordant findings, molecular markers can be very helpful.
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Affiliation(s)
- Julien Montreuil
- Division of Orthopedic Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Dominic Campano
- Division of Orthopedic Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Diego Montoya-Cerrillo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Erik J Geiger
- Division of Orthopedic Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Thomas H Temple
- Division of Orthopedic Oncology, University of Miami Miller School of Medicine, Miami, FL
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Philippart A, Degols JC, Vilain J. Nodular fasciitis of the external auditory canal: Clinical case report and review of the literature. J Otol 2023; 18:240-245. [PMID: 37877075 PMCID: PMC10593568 DOI: 10.1016/j.joto.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023] Open
Abstract
Nodular fasciitis is a benign reactive soft tissue tumor arising from fibroblasts and myofibroblasts. Its incidence is low and misdiagnosis is frequent especially for malignant lesions. This can lead to inappropriate and unnecessary invasive treatment. Nodular fasciitis of the external auditory canal is extremely rare. So far, around fifteen cases have been reported. We present here the case of a 90-year-old patient with nodular fasciitis of the right external auditory canal. The lesion extends anteriorly for 6.5 cm and reaches the posterior wall of the maxillary sinus. To our knowledge, this is the first case in the literature of an external auditory canal nodular fasciitis presenting as an inflammatory ear polyp with such a wide extension.
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Affiliation(s)
- Adrien Philippart
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Saint-Luc University Hospital, Catholic University of Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Jean-Christophe Degols
- Chief of Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Saint-Pierre Clinic Ottignies, Avenue Reine Fabiola 9, 1340, Ottignies-Louvain-la-Neuve, Belgium
| | - Jacques Vilain
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery Saint-Pierre Clinic Ottignies, Avenue Reine Fabiola 9, 1340, Ottignies-Louvain-la-Neuve, Belgium
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Wang C, Zhang Z, Dou Y, Liu Y, Chen B, Liu Q, Wang S. Development of clinical and magnetic resonance imaging-based radiomics nomograms for the differentiation of nodular fasciitis from soft tissue sarcoma. Acta Radiol 2023; 64:2578-2589. [PMID: 37593946 DOI: 10.1177/02841851231188473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Accurate differentiation of nodular fasciitis (NF) from soft tissue sarcoma (STS) before surgery is essential for the subsequent diagnosis and treatment of patients. PURPOSE To develop and evaluate radiomics nomograms based on clinical factors and magnetic resonance imaging (MRI) for the preoperative differentiation of NF from STS. MATERIAL AND METHODS This retrospective study analyzed the MRI data of 27 patients with pathologically diagnosed NF and 58 patients with STS who were randomly divided into training (n = 62) and validation (n = 23) groups. Univariate and multivariate analyses were performed to identify the clinical factors and semantic features of MRI. Radiomics analysis was applied to fat-suppressed T1-weighted (T1W-FS) images, fat-suppressed T2-weighted (T2W-FS) images, and contrast-enhanced T1-weighted (CE-T1W) images. The radiomics nomograms incorporating the radiomics signatures, clinical factors, and semantic features of MRI were developed. ROC curves and AUCs were carried out to compare the performance of the clinical factors, radiomics signatures, and clinical radiomics nomograms. RESULTS Tumor location, size, heterogeneous signal intensity on T2W-FS imaging, heterogeneous signal intensity on CE-T1W imaging, margin definitions on CE-T1W imaging, and septa were independent predictors for differentiating NF from STS (P < 0.05). The performance of the radiomics signatures based on T2W-FS imaging (AUC = 0.961) and CE-T1W imaging (AUC = 0.938) was better than that based on T1W-FS imaging (AUC = 0.833). The radiomics nomograms had AUCs of 0.949, which demonstrated good clinical utility and calibration. CONCLUSION The non-invasive clinical radiomics nomograms exhibited good performance in the differentiation of NF from STS, and they have clinical application in the preoperative diagnosis of diseases.
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Affiliation(s)
- Chunjie Wang
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Zhengyang Zhang
- Department of Radiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, PR China
| | - Yanping Dou
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Yajie Liu
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Bo Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Qing Liu
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
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Haseli S, Mansoori B, Christensen D, Abadi A, Pooyan A, Shomal Zadeh F, Mau B, Khalili N, Murphey M, Chalian M. Fibroblastic and Myofibroblastic Soft-Tissue Tumors: Imaging Spectrum and Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230005. [PMID: 37440448 DOI: 10.1148/rg.230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Fibroblastic and myofibroblastic tumors are a variable group of neoplasms ranging from benign to malignant. These lesions may affect patients of any age group but are more frequently encountered in the pediatric population. Patient clinical presentation depends on the location, growth pattern, adjacent soft-tissue involvement, and pathologic behavior of these neoplasms. In the 2020 update to the World Health Organization (WHO) classification system, these tumors are classified on the basis of their distinct biologic behavior, histomorphologic characteristics, and molecular profiles into four tumor categories: (a) benign (eg, fibrous hamartoma of infancy, nodular fasciitis, proliferative fasciitis, fibroma of the tendon sheath, calcifying aponeurotic fibroma); (b) intermediate, locally aggressive (eg, desmoid fibromatosis); (c) intermediate, rarely metastasizing (eg, dermatofibrosarcoma protuberans, myxoinflammatory fibroblastic sarcoma, low-grade myofibroblastic sarcoma, infantile fibrosarcoma); and (d) malignant (eg, sclerosing epithelioid fibrosarcomas; low-grade fibromyxoid sarcoma; myxofibrosarcoma; fibrosarcoma, not otherwise specified). Detection of various components of solid tumors at imaging can help in prediction of the presence of corresponding histopathologic variations, thus influencing diagnosis, prognosis, and treatment planning. For example, lesions with a greater myxoid matrix or necrotic components tend to show higher signal intensity on T2-weighted MR images, whereas lesions with hypercellularity and dense internal collagen content display low signal intensity. In addition, understanding the radiologic-pathologic correlation of soft-tissue tumors can help to increase the accuracy of percutaneous biopsy and allow unnecessary interventions to be avoided. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Sara Haseli
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Bahar Mansoori
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Diana Christensen
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Alireza Abadi
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Atefe Pooyan
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Firoozeh Shomal Zadeh
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Brian Mau
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Nastaran Khalili
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Mark Murphey
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
| | - Majid Chalian
- From the Department of Radiology, Division of Musculoskeletal Imaging and Intervention (S.H., A.P., F.S.Z., M.C.), Department of Radiology, Division of Abdominal Imaging (B.M., D.C., A.A.), and Department of Laboratory Medicine and Pathology (B.M.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Cancer Immunology Project, Universal Scientific Education and Research Network, Philadelphia, Pa (N.K.); and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.M.)
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Broski SM, Wenger DE. Multimodality imaging features of USP6-associated neoplasms. Skeletal Radiol 2023; 52:297-313. [PMID: 35962835 DOI: 10.1007/s00256-022-04146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
Since the discovery of USP6 gene rearrangements in aneurysmal bone cysts nearly 20 years ago, we have come to recognize that there is a family of USP6-driven mesenchymal neoplasms with overlapping clinical, morphologic, and imaging features. This family of neoplasms now includes myositis ossificans, aneurysmal bone cyst, nodular fasciitis, fibroma of tendon sheath, fibro-osseous pseudotumor of digits, and their associated variants. While generally benign and in many cases self-limiting, these lesions may undergo rapid growth, and be confused with malignant bone and soft tissue lesions, both clinically and on imaging. The purpose of this article is to review the imaging characteristics of the spectrum of USP6-driven neoplasms, highlight key features that allow distinction from malignant bone or soft tissue lesions, and discuss the role of imaging and molecular analysis in diagnosis.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA.
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA
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Lee HS, Oh KY, Kang JH, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS. A case report of an unusual temporomandibular joint mass: Nodular fasciitis. Imaging Sci Dent 2023; 53:83-89. [PMID: 37006787 PMCID: PMC10060757 DOI: 10.5624/isd.20220175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 11/25/2022] [Indexed: 01/13/2023] Open
Abstract
Nodular fasciitis (NF) is a benign myofibroblastic proliferation that grows very rapidly, mimicking a sarcoma on imaging. It is treated by local excision, and recurrence has been reported in only a few cases, even when excised incompletely. The most prevalent diagnoses of temporomandibular joint (TMJ) masses include synovial chondromatosis, pigmented villonodular synovitis, and sarcomas. Cases of NF in the TMJ are extremely rare, and only 3 cases have been reported to date. Due to its destructive features and rarity, NF has often been misdiagnosed as a more aggressive lesion, which could expose patients to unnecessary and invasive treatment approaches beyond repair. This report presents a case of NF in the TMJ, focusing on various imaging features, along with a literature review aiming to determine the hallmark features of NF in the TMJ and highlight the diagnostic challenges.
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Affiliation(s)
- Han-Sol Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyu-Young Oh
- Department of Oral Pathology, College of Dentistry, Dankook University, Cheonan, Korea
| | - Ju-Hee Kang
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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10
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Kang JY, Zhang K, Liu AL, Wang HL, Zhang LN, Liu WV. Characteristics of primary giant cell tumor in soft tissue on magnetic resonance imaging: A case report. World J Clin Cases 2021; 9:9564-9570. [PMID: 34877291 PMCID: PMC8610883 DOI: 10.12998/wjcc.v9.i31.9564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary soft tissue giant cell tumor (GCT-ST) is rare and has relatively low malignant potential. Most reports are pathological and clinical studies, while imaging studies have only been reported in cases of adjacent bone or with atypical cystic degeneration. With regard to the findings on magnetic resonance imaging (MRI) or ultrasonography, superficial masses can be further identified based on facial edema, skin thickening, skin contact, internal hemorrhage or necrosis and lobulation of the mass. Unlike deep-seated masses, MRI features do not always provide an accurate diagnosis for benign and malignant patients with superficial soft-tissue lesions. Thus, the application of diffusion-weighted imaging (DWI) to evaluate superficial soft tissue tumors is necessary.
CASE SUMMARY A 36-year-old woman who had a suspected malignant tumor in the upper limb on ultrasound and computed tomography is reported. The signal intensity of the suspected tumor was heterogeneous on plain MRI; nodular and heterogeneous enhancement was observed in the tumor with irregular shapes and blurred margins on dynamic contrast-enhanced MRI. The lesion on DWI was hyperintense with a higher mean apparent diffusion coefficient (ADC) value. Finally, a GCT-ST was confirmed by pathology. This case suggests that GCT-ST should be distinguished as a benign soft tissue mass from giant cell-rich soft tissue neoplasms or malignant tumors.
CONCLUSION The MRI features of the superficial GCT-ST in the upper limb included heterogeneous signal intensity within the lesion on T2-weighted image (T2WI) and T1-weighted fat-saturation spoiled gradient recalled echo (T1 FSPGR), nodular enhancement with blurred margins, irregular shapes, and a slow-increased enhancement. DWI could be used to differentiate a benign soft tissue mass from a malignant mass by the mean ADC value and provide more radiologic-pathologic information for the diagnosis of GCT-ST. Comprehensive imaging of primary GCT-ST could help complete tumor resection, and in turn likely prolong survival after surgery.
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Affiliation(s)
- Jian-Yun Kang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Kai Zhang
- Department of Radiology, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Ai-Lian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Hua-Li Wang
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Li-Na Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Al-Qassab S, Lalam R, Botchu R, Bazzocchi A. Imaging of Pediatric Soft Tissue Tumors and Tumor-like Conditions. Semin Musculoskelet Radiol 2021; 25:39-56. [PMID: 34020467 DOI: 10.1055/s-0041-1723966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lumps and bumps are frequently seen in children, and the vast majority are a result of trauma, infection, or inflammation. True soft tissue neoplastic lesions are rare; however, their wide and complex classifications make these lesions challenging to manage. Imaging features are usually nonspecific, and a reasonable list of differential diagnoses can be generated following consideration of the clinical presentation, age, and anatomical location of the lesion. In this article, we offer a practical approach to diagnosing such lesions by discussing the most common three benign and malignant lesions in different anatomical regions stratified by age with emphasis on certain features that might aid in the diagnosis such as depth, multiplicity, calcification, or other specific imaging feature.
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Affiliation(s)
- Sinan Al-Qassab
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Radhesh Lalam
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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12
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Boriani F, Raposio E, Errani C. Imaging Features of Primary Tumors of the Hand. Curr Med Imaging 2021; 17:179-196. [PMID: 32811403 DOI: 10.2174/1573405616999200817173154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues, ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences, data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis, prognosis and therapy. The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.
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Affiliation(s)
- Filippo Boriani
- Department of Plastic and Hand Surgery, Sanremo Hospital, Sanremo, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences and Integrated Methodologies (DISC), University of Genova, Genova, Italy
| | - Costantino Errani
- Department of Musculo-Skeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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13
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Paixao C, Lustig JP, Causeret S, Chaigneau L, Danner A, Aubry S. Tumors and pseudotumors of the soft tissues: Imaging semiology and strategy. J Clin Imaging Sci 2021; 11:13. [PMID: 33767905 PMCID: PMC7981940 DOI: 10.25259/jcis_135_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
The aims of this educational review are to learn the semiological basis of soft-tissue lesions and, with the help of diagnostic algorithms, to apply the current recommendations for the management of soft-tissue tumors. Pseudotumors must first be identified and excluded. Among primary tumors, the search for macroscopic fat content on MRI is decisive; since it restricts the diagnostic range to adipocytic tumors. Key imaging features of non-adipocytic tumors are highlighted. When a deep soft-tissue mass is found, therapeutic abstention or simple monitoring is only appropriate when there is diagnostic certainty: This is only the case for typical pseudotumors, typical benign tumors, and fat tumors without atypical criteria. In all other cases, histological evidence is required. If there is any suspicion of soft-tissue sarcoma or any undetermined lesion, the patient should be referred to a sarcoma referral center before biopsy.
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Affiliation(s)
- Charlinne Paixao
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Jean-Philippe Lustig
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Sylvain Causeret
- Department of Surgery, CHU Dijon, Centre Georges-François Leclerc, Dijon, France
| | - Loic Chaigneau
- Department of Oncology, CHU Besancon, CHU de Besancon, Besancon, France
| | - Alexis Danner
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Sebastien Aubry
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
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14
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Massarelli M, Paparo F, Benedetti S. A rare case of maxillary nodular fasciitis: Case report and short literature review. Clin Case Rep 2021; 9:31-33. [PMID: 33505683 PMCID: PMC7813115 DOI: 10.1002/ccr3.3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/08/2022] Open
Abstract
Nodular fasciitis has to be considered as an option in the presence of a solitary, rapidly growing mass even in older adults. When possible, direct surgery should be preferred to FNAC, particularly in the older adults because of high misdiagnostic risk.
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Affiliation(s)
- Mauro Massarelli
- Department of Maxillo‐Facial SurgeryAzienda Ospedaliera S.MariaTerniItaly
| | - Francesco Paparo
- Department of Maxillo‐Facial SurgeryAzienda Ospedaliera S.MariaTerniItaly
| | - Simone Benedetti
- Department of Maxillo‐Facial SurgeryAzienda Ospedaliera S.MariaTerniItaly
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15
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Wang T, Tang GC, Yang H, Fan JK. Occipital nodular fasciitis easily misdiagnosed as neoplastic lesions: A rare case report. World J Clin Cases 2020; 8:6144-6149. [PMID: 33344616 PMCID: PMC7723723 DOI: 10.12998/wjcc.v8.i23.6144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nodular fasciitis (NF) is a benign disease originating from fascial tissue and most commonly occurs in the extremities, followed by the trunk, head, and neck. NF of the head and neck occurs mainly in the face and neck, and it has not been reported in the occipital region.
CASE SUMMARY A 30-year-old man was admitted because of a mass in the left occipital region. Imaging examination revealed a soft tissue nodule in the left occipital area. An enhanced magnetic resonance imaging scan showed characteristic inverted target and fascial tail signs. Histopathological analysis showed a large amount of spindle cell proliferation, and immunohistochemistry showed positive expression of SMA in the spindle cells in the lesion. Finally, nodular fasciitis was diagnosed.
CONCLUSION NF of the head and neck is rare, but the possibility of NF should be considered when nodules or masses with rapid subcutaneous growth are found and tenderness in the head and neck is present. Imaging examination, in combination with clinical manifestations and histopathological examination, can improve the diagnostic accuracy for the disease. After diagnosis, local surgical resection is the first choice of treatment.
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Affiliation(s)
- Teng Wang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Guang-Cai Tang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Han Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jian-Kun Fan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Wang T, Tang GC, Yang H, Fan JK. Occipital nodular fasciitis easily misdiagnosed as neoplastic lesions: A rare case report. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Chouhan D, Ansari MT, Goyal D, Mridha AR. Unilateral carpal tunnel syndrome: an unusual presentation of nodular fasciitis. BMJ Case Rep 2020; 13:13/11/e236142. [PMID: 33257360 PMCID: PMC7705373 DOI: 10.1136/bcr-2020-236142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nodular fasciitis is a benign, self-limiting proliferative disorder of fibroblast of uncertain aetiology, occurs frequently in the forearm. Nodular fasciitis in hand inducing carpal tunnel syndrome is exceptional. There are four cases of non-intraneural nodular fasciitis causing peripheral neuropathy that has been reported previously. We present the case of a 38-year-old man with features of unilateral carpal tunnel syndrome. Decompression of the median nerve performed subsequently along with excision of the lesion in a piecemeal fashion. Histopathological and immunohistochemical findings were consistent with nodular fasciitis. There were complete resolution of symptoms and no sign of recurrence at the end of 1 year after surgery.
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Affiliation(s)
- Deepak Chouhan
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Devansh Goyal
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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18
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Wu SY, Zhao J, Chen HY, Hu MM, Zheng YY, Min JK, Yu RS. MR imaging features and a redefinition of the classification system for nodular fasciitis. Medicine (Baltimore) 2020; 99:e22906. [PMID: 33157932 PMCID: PMC7647516 DOI: 10.1097/md.0000000000022906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To analyze magnetic resonance imaging features of nodular fasciitis and redefine the system for classifying this class of lesions.Twenty-seven patients with nodular fasciitis and 71 patients with other soft tissue lesions who underwent surgery or biopsy were retrospectively analysed. Demographic information, medical history, and magnetic resonance imaging features were collected. Classification of nodular fasciitis was performed based on a redefined system. Comparison between 2 groups was performed with Chi-square or Fisher exact test.For nodular fasciitis, the longest average lesion diameter was 1.87 cm (range, 0.52-5.46 cm), and 40.7% of lesions were located in the upper extremities, while 29.6% were located in the head and neck. Compared with skeletal muscle, most lesions exhibited isointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging, and 45.5% of the lesions exhibited rim enhancement, 40.9% showed obvious homogenous enhancement, while 13.6% showed no enhancement or slight enhancement. The subcutaneous type accounted for 25.9% of cases, the fascial type 25.9%, the intramuscular type 29.6%, and the unclassified type 18.5%. The "fascia tail sign" was more frequently observed in nodular fasciitis than in other soft tissue lesions (P < .001). Nodular fasciitis was slightly more likely to present with the "inverted target sign" and "solar halo sign" than other soft tissue lesions (P > .05). The "cloud sign" only appeared in nodular fasciitis (P < .05).The "fascia tail sign" and "cloud sign" could help differentiate nodular fasciitis from other soft tissue lesions. A new classification may improve understanding about nodular fasciitis.
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Affiliation(s)
- Shi-Yong Wu
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou
| | - Jin Zhao
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Hai-Yan Chen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Miao-Miao Hu
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou
| | - Yin-Yuan Zheng
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou
| | - Ji-Kang Min
- Department of Orthopedics, The First Affiliated Hospital of Huzhou University, Huzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
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19
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Aoki T, Fujisaki A, Terasawa T, Hayashida Y, Todoroki Y, Hirano N, Hisaoka M, Sakai A, Korogi Y. Primary Site Identification of Soft-Tissue Mass: Things to Know in MRI Assessment. J Magn Reson Imaging 2020; 55:37-47. [PMID: 32949073 DOI: 10.1002/jmri.27368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
The spectrum of soft-tissue mass is varied, including neoplastic and nonneoplastic/inflammatory lesions. However, soft-tissue tumors have similar imaging findings and, therefore, the diagnosis of soft-tissue mass is challenging. Although careful assessment of the internal characteristics on imaging can often narrow the differential diagnoses, the differential diagnosis may be out of the question if identification of the soft-tissue mass origin is missed. The purpose of this article is to review the imaging findings and the essential anatomy to identify the primary site of the soft-tissue mass, and discuss the associated potential pitfalls. In order not to fall into a pitfall, recognition of characteristic imaging findings indicating the origin of the soft-tissue mass and anatomical knowledge of the normal tissue distribution are necessary. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akitaka Fujisaki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Takashi Terasawa
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yo Todoroki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Natsumi Hirano
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
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Chen Y, Lv W, Zhu Z. A rapidly progressing mass of nasal cavity in a child: Nodular fasciitis. EAR, NOSE & THROAT JOURNAL 2020; 100:1050S-1053S. [PMID: 32579384 DOI: 10.1177/0145561320932332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nodular fasciitis (NF) is a benign, self-limiting, reactive soft tissue tumor that is composed of fibroblasts and myofibroblasts and is often misdiagnosed as a malignant lesion. Nodular fasciitis is often reported in adults but rarely seen in children. We report the case of a 3-year-old girl with a rapidly growing NF in the left nasal cavity. The initial biopsy suggested the possibility of a spindle cell tumor or low-grade malignant tumor, respectively. The child underwent complete excision of the tumor. With the help of immunohistochemistry and pathological consultation, the final diagnosis was confirmed as NF. There was no recurrence during an 18-month follow-up period.
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Affiliation(s)
- Yujie Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Lv
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhenzhen Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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21
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Nepal P, Songmen S, Alam SI, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci 2019; 9:15. [PMID: 31448166 PMCID: PMC6702939 DOI: 10.25259/jcis-6-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 01/14/2023] Open
Abstract
Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | | | | | - Darshan Gandhi
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Neeta Ghimire
- Department of Pediatric Dentistry, Kathmandu University, Nepal
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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Abstract
BACKGROUND Nodular fasciitis rarely occurs in young adults and children; it usually resembles other tumors, even malignancy. PURPOSE To review the imaging findings of six cases of nodular fasciitis misdiagnosed radiologically. MATERIAL AND METHODS The clinical and radiologic features of six cases of histologically proven but radiologically misdiagnosed nodular fasciitis were reviewed retrospectively. Two cases underwent both plain and enhanced computed tomography (CT) scans and the other four had both regular and enhanced magnetic resonance (MR) scans. RESULTS All six patients were young (five children and one young adult). A rapid growing mass, pain or painless, was the most frequent presentation. Most masses were oval, well-defined, and homogeneous, with an average diameter of 2.2 cm. Five were found in superficial fascia with a broad base. Two cyst-like masses showed hypodensity relative to muscle on plain CT and without enhancement. Compared to muscle, these masses showed isointensity (n = 3) or slight hyperintensity (n = 1) on T1-weighted imaging, hyperintensity on T2-weighted imaging (n = 4), with homogeneous notable enhancement (n = 3) or mild enhancement (n = 1). Five (83.3%) were found with a "fascial tail" sign characterized as thickening of adjacent fascial layer with notable enhancement. One mass showed an "inverted target" sign. CONCLUSION Nodular fasciitis in young adults and children is usually superficial, rapid growing, well-defined, and homogeneous, frequently with a "fascial tail" sign. Radiologically, it can resemble a benign cyst and might be easily misdiagnosed. Therefore, nodular fasciitis should be remembered in the differential diagnosis for superficial soft tissue tumor found in young adult and children.
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Affiliation(s)
- Pei-an Hu
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, PR China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College; Fudan University, Shanghai, PR China
- Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Zheng-rong Zhou
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, PR China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, PR China
- Department of Oncology, Shanghai Medical College; Fudan University, Shanghai, PR China
- Shanghai Institute of Medical Imaging, Shanghai, PR China
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Wang W, Huang Y, Wang C, Hong J, Ma C, Lin N, Ye Z, Yan S, Wu H. Intra-articular nodular fasciitis: a rare lesion case report and an updated review of the literature. BMC Musculoskelet Disord 2019; 20:5. [PMID: 30611237 PMCID: PMC6320623 DOI: 10.1186/s12891-018-2375-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/07/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nodular fasciitis is a benign proliferation of myofibroblasts that usually arises in subcutaneous tissues of the trunk, neck, head, and upper extremities of young adults. It is not reported to arise in the joints. CASE PRESENTATION In this report, we describe a rare case where nodular fasciitis occurred in an intra-articular location in the right knee of a 20-year-old man. The patient presented with 3-months' duration of knee pain without history of trauma to the extremity. Physical examination revealed pain, joint effusion, and limited range of motion (ROM) of the affected knee. Magnetic resonance imaging (MRI) showed a 2.5 × 2 × 1 cm lesion in front of the posterior cruciate ligament. Arthroscopically, the soft tissue mass was removed and pathologically diagnosed as a rare, benign, intra-articular nodular fasciitis. Symptoms resolved 1 month after the operation and no recurrence was found at the 6 months follow-up. CONCLUSION The present paper describes detailed characteristics of intra-articular nodular fasciitis and provides an updated comprehensive summary of 21 prior case reports.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Yiting Huang
- Division of Reproductive Medicine & Infertility, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88#, Jiefang Rd., Hangzhou, Zhejiang, 310009, China
| | - Changxing Wang
- Department of Pathology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88#, Jiefang Rd., Hangzhou, Zhejiang, 310009, China
| | - Jianqiao Hong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Chiyuan Ma
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Nong Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Zhaoming Ye
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Shiyuan Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
| | - Haobo Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
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24
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Nodular fasciitis of the temporomandibular joint: a case report. Br J Oral Maxillofac Surg 2018; 56:70-73. [DOI: 10.1016/j.bjoms.2017.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022]
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25
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Park SY, Kim GY, Chun YS. Sonographic appearance of proliferative fasciitis---A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:445-449. [PMID: 28426131 DOI: 10.1002/jcu.22422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/29/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
Proliferative fasciitis is a benign entity involving the subcutaneous tissues and fascias, characterized by the proliferation of fibroblast-like spindle cells and ganglion-like cells. However, proliferative fasciitis may be easily confused with sarcoma clinically and pathologically, because it appears as a rapidly growing painful mass and has histologic features such as high cellularity, bizarre morphologic patterns, mitotic figures, and diffuse infiltrative proliferation. Imaging findings of proliferative fasciitis have been very rarely reported. We report the sonographic findings in a case of proliferative fasciitis in a 43-year-old woman with histopathological correlation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:445-449, 2017.
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Affiliation(s)
- So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea
| | - Gou Young Kim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea
| | - Young Soo Chun
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea
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26
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Agarwal MD, Resnick EL, Mhuircheartaigh JN, Mortele KJ. MR Imaging of the Female Perineum. Magn Reson Imaging Clin N Am 2017; 25:435-455. [DOI: 10.1016/j.mric.2017.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Chemmanam JJ. Nodular Fasciitis in the Tongue-a Mimicker of Malignancy: Case Report and Review of Literature. Indian J Surg Oncol 2016; 8:214-216. [PMID: 28546724 DOI: 10.1007/s13193-016-0567-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022] Open
Abstract
Tongue cancer surgery involves wide excision of tumors with negative margins. It can cause significant morbidity if adequate function is not restored with the use of grafts or flaps if the defect is large. Nodular fasciitis is an uncommon entity in the tongue and a mimicker of malignancy. Preoperative diagnosis avoids mutilating radical surgery. The lesion is benign and the recurrence potential is very low with marginal excision.
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Affiliation(s)
- Jency Joy Chemmanam
- Division of Surgical Oncology, Pushpagiri Medical College, Tiruvalla, Kerala India
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Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics 2016; 36:1888-1910. [DOI: 10.1148/rg.2016160068] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kanaya K, Iba K, Yamashita T, Wada T, Hasegawa T. Intraneural Nodular Fasciitis in a Child: A Case Report and Review of the Literature. J Hand Surg Am 2016; 41:e299-302. [PMID: 27469937 DOI: 10.1016/j.jhsa.2016.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 02/02/2023]
Abstract
We present the case of an 11-year-old boy with intraneural nodular fasciitis of the median nerve at the distal part of the carpal tunnel. Complete excision of the involved median nerve and cable grafting using 4 fascicular segments of the sural nerve was performed for persistent pain and numbness after initial resection of the tumor in piecemeal fashion. Pain and numbness were completely resolved and there was no evidence of recurrence 24 months after the final surgery.
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Affiliation(s)
- Kohei Kanaya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kousuke Iba
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takuro Wada
- Department of Orthopedic Surgery, Hokkaido Saiseikai Otaru Hospital, Hokkaido, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Sargar KM, Sheybani EF, Shenoy A, Aranake-Chrisinger J, Khanna G. Pediatric Fibroblastic and Myofibroblastic Tumors: A Pictorial Review. Radiographics 2016; 36:1195-214. [DOI: 10.1148/rg.2016150191] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Certain soft-tissue tumors seem to be specific to the upper extremity; most are benign. Knowledge of key magnetic resonance features, with clinical history and epidemiologic knowledge, can assist the radiologist in establishing optimal diagnosis. Indeterminate lesions require biopsy to exclude malignancy.
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Affiliation(s)
- Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Hiroshi Nishimura
- Department of Radiology, Saiseikai Futsukaichi Hospital, 3-13-1 Yu-machi, Chikushino, Fukuoka 818-0058, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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32
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Ng E, Tandon A, Ho B, Chong B. Characterising benign fibrous soft-tissue tumours in adults: why is it so difficult and what do we need to know? Clin Radiol 2015; 70:684-97. [DOI: 10.1016/j.crad.2015.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/28/2015] [Accepted: 02/05/2015] [Indexed: 01/06/2023]
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Lu L, Lao IW, Liu X, Yu L, Wang J. Nodular fasciitis: a retrospective study of 272 cases from China with clinicopathologic and radiologic correlation. Ann Diagn Pathol 2015; 19:180-5. [DOI: 10.1016/j.anndiagpath.2015.03.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/29/2015] [Indexed: 11/24/2022]
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34
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Hino S, Masuda I, Fukai S, Kaneko T, Horie N, Shimoyama T. A case of nodular fasciitis involving the tongue. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE The purpose of this article is to review the imaging features of necrotizing fasciitis and its potential mimics. Key imaging features are emphasized to enable accurate and efficient interpretation of variables that are essential in appropriate management. CONCLUSION Necrotizing fasciitis is a medical emergency with potential lethal outcome. Dissecting gas along fascial planes in the absence of penetrating trauma (including iatrogenic) is essentially pathognomonic. However, the lack of soft-tissue emphysema does not exclude the diagnosis. Mimics of necrotizing fasciitis include nonnecrotizing fasciitis (eosinophilic, paraneoplastic, inflammatory (lupus myofasciitis, Churg-Strauss, nodular, or proliferative), myositis, neoplasm, myonecrosis, inflammatory myopathy, and compartment syndrome. Necrotizing fasciitis is a clinical diagnosis, and imaging can reveal nonspecific or negative findings (particularly during the early course of disease). One should be familiar with salient clinical and imaging findings of necrotizing fasciitis to facilitate a more rapid and accurate diagnosis and be aware that its diagnosis necessitates immediate discussion with the referring physician.
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36
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Jarraya M, Parva P, Stone M, Klein MJ, Guermazi A. Atypical proliferative myositis: original MR description with pathologic correlation: case report. Skeletal Radiol 2014; 43:1155-9. [PMID: 24609811 DOI: 10.1007/s00256-014-1849-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/27/2014] [Accepted: 02/10/2014] [Indexed: 02/02/2023]
Abstract
Proliferative myositis (PM) along with proliferative fasciitis and nodular fasciitis are a group of pseudosarcomatous myofibroblastic proliferations. Although the histologic presentation of each is almost identical, the magnetic resonance imaging (MRI) appearance of proliferative myositis is closer to that of inflammatory myopathies. We report a case of PM in which the imaging and histologic features combine typical findings of PM with unusual imaging features, suggesting of reactive (or nodular) fasciitis.
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Affiliation(s)
- Mohamed Jarraya
- Department of Radiology, Musculoskeletal Section, Boston University School of Medicine, Boston, MA, USA,
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37
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Abstract
Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass.
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Affiliation(s)
- Dejan Samardzic
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alison Chetlen
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jozef Malysz
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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38
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Rhee SJ, Ryu JK, Kim JH, Lim SJ. Nodular fasciitis of the breast: two cases with a review of imaging findings. Clin Imaging 2014; 38:730-3. [PMID: 24849197 DOI: 10.1016/j.clinimag.2014.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/07/2014] [Accepted: 04/13/2014] [Indexed: 11/20/2022]
Abstract
Nodular fasciitis of the breast is a rare, benign, proliferative disease characterized by sudden onset and rapid growth. It can clinically and radiologically mimic breast cancer. We present imaging findings from two cases of nodular fasciitis that initially manifested as palpable masses. Sonographically, they appeared as irregular, not-circumscribed hypoechoic nodules. The diagnosis of nodular fasciitis was made by US-guided core needle biopsies. US-guided vacuum-assisted excision was subsequently performed in the first case, while the second resolved via spontaneous regression.
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Affiliation(s)
- Sun Jung Rhee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Sangil-dong, Gangdong-gu, Seoul, Korea
| | - Jung Kyu Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Sangil-dong, Gangdong-gu, Seoul, Korea.
| | - Jeoung Hyun Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sung-Jig Lim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Sangil-dong, Gangdong-gu, Seoul, Korea
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Khuu A, Yablon CM, Jacobson JA, Inyang A, Lucas DR, Biermann JS. Nodular fasciitis: characteristic imaging features on sonography and magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:565-573. [PMID: 24658936 DOI: 10.7863/ultra.33.4.565] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the imaging features of nodular fasciitis on sonography and magnetic resonance imaging (MRI). METHODS A retrospective search of the radiologic and pathologic databases over the past 10 years for the diagnosis of nodular fasciitis was performed. Sonographic and MRI features were described. Pathologic specimens were reviewed. RESULTS Six pathologically confirmed cases of nodular fasciitis were found. The mean patient age was 19.5 years (range, 8-33 years); 3 patients were male and 3 were female. Four patients had sonography only; 1 patient had both sonography and MRI; and 1 patient had MRI only. Three masses were located in the subcutaneous tissue adjacent to fascia; 2 were at the subcutaneous/muscular border; and 1 was intramuscular; however, all were in contact with fascia and showed a fascial tail on sonography and MRI. On sonography and MRI, masses were oval with poorly defined lobulated borders, averaging 2.6 cm (range, 1.8-3.5 cm). On sonography, all masses were hypoechoic. On MRI, the masses were isointense to muscle on T1-weighted sequences, hyperintense to muscle on fluid-sensitive sequences, and enhanced avidly but heterogeneously. The masses were surrounded by fat. CONCLUSIONS When a rapidly growing oval mass in contiguity with a fascial plane is recognized, the diagnosis of nodular fasciitis should be entertained. More importantly, the possibility of an inaccurate diagnosis by core biopsy exists, which may warrant gross resection.
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Affiliation(s)
- Anthony Khuu
- Department of Radiology, University of Michigan, Taubman Center, Room 2910Q, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5326 USA.
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40
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Fasciíte nodular em quirodáctilo que simula neoplasia maligna de partes moles. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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41
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Song YS, Lee IS, Choi KU, Cho KH, Lee SM, Lee YH, Kim JI. Soft Tissue Masses Showing Low Signal Intensity on T2-weighted Images: Correlation with Pathologic Findings. ACTA ACUST UNITED AC 2014. [DOI: 10.13104/jksmrm.2014.18.4.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- You Seon Song
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Kyung Un Choi
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - Kil Ho Cho
- Department of Radiology, Yeungnam University Hospital, Daegu, Korea
| | - Sung Moon Lee
- Department of Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Young Hwan Lee
- Department of Radiology, Catholic Universiry of Daegu Hospital, Daegu, Korea
| | - Jeung Il Kim
- Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Korea
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42
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Monteiro SS, Ribeiro DH, Rodrigues TC, Junior GFG, Arruda K, Fernandes EDA. Nodular fasciitis in finger simulating soft tissue malignancy. Rev Bras Ortop 2014; 49:89-93. [PMID: 26229780 PMCID: PMC4511758 DOI: 10.1016/j.rboe.2014.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/09/2013] [Indexed: 12/02/2022] Open
Abstract
Nodular fasciitis (NF) is a rare fibroblastic proliferative lesion, characterized clinically as a solitary mass of hardened and slightly painful on palpation, fast growing and no gender preference. The objective of this study is to report the case of a patient with NF in third finger of left hand, describe the findings of plain radiography, computed tomography and magnetic resonance imaging and correlate with the literature. Since the diagnosis of NF is a challenge, being necessary to conciliate the clinical, radiological and pathological.
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43
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Coyle J, White LM, Dickson B, Ferguson P, Wunder J, Naraghi A. MRI characteristics of nodular fasciitis of the musculoskeletal system. Skeletal Radiol 2013; 42:975-82. [PMID: 23624727 DOI: 10.1007/s00256-013-1620-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/28/2013] [Accepted: 04/04/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate MRI imaging appearances of nodular fasciitis in a pathologic-proven series of 29 patients. MATERIALS AND METHODS Review of the orthopedic oncology and pathology databases yielded 51 cases of histologically proven nodular fasciitis. MR imaging was available in 29 patients. Three musculoskeletal radiologists retrospectively reviewed all cases in consensus. Imaging features evaluated included location in the body, size, compartmental localization, relationship to fascia, signal characteristics, enhancement pattern, transcompartmental extension, and osseous and intra-articular involvement. RESULTS There were 15 male and 14 female patients. Mean age was 33 years (range, 16-59 years). Lesions ranged in size from 1.6 to 9 cm with 84 % of lesions measuring less than 4 cm. Twenty-three lesions were located in the upper arm or shoulder girdle. Nine lesions were subcutaneous in location, nine were intra-muscular, and 11 were inter-muscular. Lesions were consistently ovoid in shape with broad fascial contact. They exhibited internal homogenous low T1 and heterogeneous intermediate T2 signal with surrounding edema and slightly inhomogeneous enhancement. Twelve lesions exhibited central non-enhancing areas. Trans-compartmental spread was demonstrated in nine lesions. Osseous changes were seen in five cases and included extrinsic cortical saucerization, medullary edema, and transcortical osseous invasion. Two lesions demonstrated intra-articular extension. CONCLUSIONS MR imaging features of nodular fasciitis are generally non-specific and can be mistaken for a soft tissue sarcoma. This series, the largest MRI series of musculoskeletal cases in the literature, confirms the predilection of nodular fasciitis for the upper extremity in young adults but also demonstrates that aggressive imaging features such as transcompartmental spread, and osseous and intra-articular involvement may be seen in association with this benign soft tissue lesion.
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Affiliation(s)
- J Coyle
- Division of Musculoskeletal Radiology, Joint Department of Medical Imaging, University of Toronto and Mt. Sinai Hospital, Toronto, Canada.
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44
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GRAHAM R, OSTLERE S. Imaging of soft-tissue masses. IMAGING 2013. [DOI: 10.1259/imaging/79953227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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45
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Mazura JC, Matrai C, Spigland N, Brill PW, Kovanlikaya A. Intramuscular nodular fasciitis of the rectus abdominis muscle in an 11-year-old girl. Skeletal Radiol 2013; 42:147-50. [PMID: 22915210 DOI: 10.1007/s00256-012-1498-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 02/02/2023]
Abstract
Nodular fasciitis is a benign rapidly proliferating fibrous tumor that is common in adults but relatively uncommon in children. When present in children, nodular fasciitis is typically subcutaneous in location and involves the head and neck. We present a case of intramuscular nodular fasciitis involving the rectus abdominis muscle in an 11-year-old girl and discuss the importance of distinguishing this rare but benign lesion from a more aggressive sarcomatous process.
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Affiliation(s)
- Jan C Mazura
- Department of Radiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA.
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46
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Park JS, Park HB, Lee JS, Na JB. Nodular fasciitis with cortical erosion of the hand. Clin Orthop Surg 2012; 4:98-101. [PMID: 22379562 PMCID: PMC3288501 DOI: 10.4055/cios.2012.4.1.98] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 12/23/2009] [Indexed: 11/18/2022] Open
Abstract
Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.
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Affiliation(s)
- Jin Sung Park
- Department of Orthopaedic Surgery, Gyeongsang National University Hosptial, Gyeongsang National University School of Medicine, Jinju, Korea
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a patient with nodular fasciitis arising in the lumbar extradural space. SUMMARY OF BACKGROUND DATA Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It commonly occurs in the subcutaneous tissue of an upper extremity, trunk, head, and neck, but rarely arises in the spinal canal. METHODS A 7-year-old boy experienced gradually increasing intense radiating pain from the bilateral buttocks to the lower extremities after a bruise on his lower back. Computed tomography and magnetic resonance imaging demonstrated a relatively circumscribed mass in the dorsal epidural space from the first lumbar vertebra (L1) to L2. The presumptive diagnosis based on the radiologic findings included aggressive neoplasm such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor or malignant lymphoma. RESULTS The patient underwent L1-L2 laminectomy and resection of the tumor. Histologically, the tumor was mainly composed of a proliferation of spindle cells without atypia, positive for vimentin and smooth muscle actin, and myxoid areas with a loosely textured feathery pattern. These findings are the typical features of nodular fasciitis. Surgery relieved the patient's pain, with no evidence of recurrence at a recent 4-year follow-up. CONCLUSION This report presents a very rare case of extradural nodular fasciitis arising in the lumbar spinal canal, which could have been misinterpreted as a malignant tumor such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor because of its rapid growth and absence of distinguishing radiologic features. A detailed histopathologic examination including immunohistochemistry is important for the correct diagnosis.
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48
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Walker EA, Fenton ME, Salesky JS, Murphey MD. Magnetic Resonance Imaging of Benign Soft Tissue Neoplasms in Adults. Radiol Clin North Am 2011; 49:1197-217, vi. [DOI: 10.1016/j.rcl.2011.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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49
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Intra-articular nodular fasciitis of the shoulder: a case report and review of the literature. Skeletal Radiol 2011; 40:1383-6. [PMID: 21603874 DOI: 10.1007/s00256-011-1182-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/12/2011] [Accepted: 04/14/2011] [Indexed: 02/02/2023]
Abstract
Nodular fasciitis is a benign proliferation of myofibroblasts usually arising adjacent to the fascia. In this report, we describe a rare case in which nodular fasciitis occurred in an intra-articular location in the shoulder of a 26-year-old man. The mass developed in the subscapularis recess of the shoulder and histological evaluation showed a myofibroblastic proliferation. MRI findings of intra-articular nodular fasciitis are discussed along with a review of previous reports.
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50
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Case report: nodular fasciitis of the parotid region. The Journal of Laryngology & Otology 2011; 125:1312-4. [DOI: 10.1017/s0022215111002210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To demonstrate the clinical and histopathological features of nodular fasciitis in the parotid region.Case report:A 24-year-old man presented with a palpable mass in the superior border of the parotid gland. The mass was firm and immobile, with a smooth surface. Fine needle aspiration cytology revealed proliferating fibroblasts, macrophages and adipocytes among the blood cells. Although a superficial parotidectomy was initially planned, a total excision was performed, as the mass was observed to be located in the periphery of the parotid tissue. Nodular fasciitis was diagnosed, based on the results of immunohistochemical analysis.Conclusion:Nodular fasciitis very rarely occurs in the parotid region. These lesions grow quickly, and may be misdiagnosed as sarcoma. Trauma may play a role in their aetiology. Total excision is adequate as treatment.
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