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A lump in an arm

Article  in  European Journal of Pediatrics · August 2013

DOI: 10.1007/s00431-013-2114-4 · Source: PubMed

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Federica Pederiva Edoardo Guida

Ospedale dei Bambini Vittore Buzzi IRCCS Ospedale Infantile Burlo Garofolo
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Giulio Zanazzo Jürgen Schleef

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Eur J Pediatr
DOI 10.1007/s00431-013-2114-4

IMAGES IN PEDIATRICS

A lump in an arm
Federica Pederiva & Edoardo Guida &
Giulio Andrea Zanazzo & Massimo Gregori &
Jurgen Schleef

Received: 11 July 2013 / Accepted: 18 July 2013

# Springer-Verlag Berlin Heidelberg 2013

Abstract The authors present a magnetic resonance image

showing a soft tissue mass misdiagnosed as sarcoma.

Keywords Nodular fasciitis . Soft tissue mass

A 12-year-old boy presented with a painless, rapidly growing

swelling mass in his right arm without any other accompany-
ing symptoms or history of trauma. A 4×2-cm solid fixed
mass with normal overlying skin was palpated. Laboratory
tests and tumor markers were unremarkable.
Magnetic resonance imaging showed an enhancing mass
inside the triceps brachii muscle reached by two vessels
(Fig. 1). Excisional biopsy was performed and histopathology
revealed nodular fasciitis.
Nodular fasciitis is a benign reactive fibroblastic and
myofibroblastic proliferation most commonly diagnosed in
adults. Ten percent of the lesions occur in children especially in Fig. 1 Axial enhanced MRI of the right arm showing a hyperintense
the extremities or trunk and also in the head and neck. It is well-circumscribed mass inside the triceps brachii muscle. Two vessels
usually subcutaneous in distribution but sometimes also in intra- reach the nodule
muscular and intermuscular locations involving skeletal muscle.
The etiology is still unknown and whether the reactive process is
triggered by local injury or inflammatory processes is not re- Conflict of interest There is no financial assistance or any potential
solved. It often develops rapidly, which may be concerning for conflict of interest, real or perceived.
malignancy, being the most common benign mesenchymal le-
sion misdiagnosed as sarcoma. Spontaneous regression is the
natural history and a proper diagnosis is essential to avoid References
unnecessarily aggressive treatment [1–3]. Although relatively
rare, nodular fasciitis should be considered in the differential 1. Hutter RV, Stewart FW, Foote FW Jr (1962) Fasciitis. A report of 70
diagnosis in any pediatric patient with a soft tissue mass. cases with follow-up proving the benignity of the lesion. Cancer
15:992–1003
2. Tomita S, Thompson K, Carver T, Vazquez WD (2009) Nodular
F. Pederiva (*) : E. Guida : G. A. Zanazzo : M. Gregori : J. Schleef fasciitis: a sarcomatous impersonator. J Pediatr Surg 44:e17–e19
Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, 3. Weinreb I, Shaw AJ, Perez-Ordonez B, Goldblum JR, Rubin BP
Via dell’Istria 65/1, 34137 Trieste, Italy (2009) Nodular fasciitis of the head and neck region: a clinicopatho-
e-mail: federica_pederiva@yahoo.it logic description in a series of 30 cases. J Cutan Pathol 36:1168–1173

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