|Micrograph of nodular fasciitis showing the haphazard arrangement of cells (tissue culture-like pattern). H&E stain.|
Nodular fasciitis, also known as nodular pseudosarcomatous fasciitis, pseudosarcomatous fasciitis, and subcutaneous pseudosarcomatous fibromatosis,:992 is a benign soft tissue lesion most commonly found in the superficial fascia. The lesion commonly occurs in the first three decades of life. Upper extremities and trunk are the most common affected anatomical areas. Previous history of trauma may be present. Clinically and histologically, nodular fasciitis may be mistaken for a sarcoma.
Cause and clinical course
Until recently, nodular fasciitis have been considered a reactive process of uncertain cause. However, recent findings indicate that nodular fasciitis is a self-limited clonal neoplastic process (see below). Clinically, nodular fasciitis presents as a subcutaneous "growth" over a period of 3–6 weeks that eventually regresses. The lesion usually reaches a size of 2–3 cm. Larger lesions are unusual. Local recurrence has been described after simple surgical excision but it is rare.
- Histologically vast array of patterns.
- Short S-shaped fascicles, inflammation, accelerated mitotic index with normal mitoses.
- Essentially spindle cell proliferation.
- Stroma is rich in collagen and/or myxoid ground substance.
Surgical excision is usually curative. Intralesional application of steroids has been used to induce regression. Because recurrence is rare, even when there is incomplete excision, in case of recurrence initial diagnosis of nodular fasciitis should be revisited.
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