Nodular Fasciitis

Áine O’Brien
Introduction
Nodular fasciitis is a rare soft tissue tumor that occurs
in the fascia of muscles. It is composed of
myofibroblasts. The fascia is the connective tissue that
connects muscles. This tumour is non-cancerous and
does not spread.
The most common sites for this tumor to occur is on the
head, neck, arms, legs or torso.

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Characteristics of nodular fasciitis
 NF occurs predominantly in young to middle-aged adults.
 It
typically presents as a fast-growing nodule that reaches 2 to 3
cm in size within a few weeks.
 Themost common site is the upper extremities, followed by the
trunk, head and neck region.
 However, the lesion can occur in unusual locations such as in a
salivary gland, the breast, the mesentery, and the vulva.
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Characteristics of nodular fasciitis
Cranial fasciitis, which is a
distinctive form of nodular
In children, the head and neck Nodular fasciitis can occur in
fasciitis, can occur in infants.
are common locations for suprafascial, intrafascial, and
This involves the soft tissue of
nodular fasciitis. subfascial locations.
the scalp and may invade the
underlying bone.

Nodular fasciitis can

This can reoccur in some
spontaneously regress.
patients, and it is unknown
However, it does not always
why. One reason may be due to
regress on its own and some
incomplete excision following
tumours may need surgical
surgery.
intervention.

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Relatively well-circumscribed fascia-based nodule
of the anterior aspect of the right thigh measuring A large well encapsulated mass lesion
28 x 26 x 20 mm. It elicits an isosignal to muscle is seen subcutaneously in upper arm.
on T1, heterogeneous high signal on T2 with vivid
homogeneous enhancement on postcontrast
sequences. Moderate infiltration of the
surrounding fatty tissue with no extension to the
adjacent muscles.

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 Symptoms
 A fast-growing lump
 Firm to touch
 Usually painless but can be tender
 Solid mass
 Mobility can be affected depending on location
 Can cause pain if lump presses against a nerve

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  Aetiology has been associated with previous
trauma in 5–10% of the cases. It has also been
associated with a hyper-response mechanism
which triggers an increase in mitotic activity in
certain predisposed individuals.
 It is not usually known why nodular Fasciitis
occurs but is can be mistaken for:

Aetiology  Fibromatosis
 Schwannoma
 Harmless nerve sheath tumor
 Synovial sarcoma
 Dermatofibrosarcoma protuberans
 Myxofibrosarcoma

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Imaging - MRI

Sarcoma
Nodular Fasciitis

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 Biopsy
 A biopsy is imperative in order to grade the sarcoma
if that is the case or make sure it is not confused with
a condition such as nodular fasciitis so the patient
will not be irradiated for no reason as this can cause
harm.
 A core needle biopsy is usually carried out on a
patient presenting with symptoms of these tumours.
 This type of needle biopsy uses a wide needle. The
needle used during a core needle biopsy is a hollow
tube that allows the doctor to extract a sample of
tissue for testing.
 A histological sample of sarcoma cells and nodular
fasciitis are quite different, which is key to
distinguishing between the two.

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Histology
 NF presents as a proliferation of spindle cells which are arranged in short S-shaped assortments within a
myxoid stroma that have small capillaries and extravasated erythrocytes.
 Histologically, nodular fasciitis is classified into three subtypes: myxoid or reactive (type I), cellular (type
II), and fibrous (type III); however, the lesions may present characteristics of different subtypes,
corresponding to progressive phases of the same disease.

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Biopsy results
Nodular Fasciitis Sarcoma

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Treatment
 Surgical Removal
 Corticosteroid injection
 When spontaneous regression occurs, regular check-ups
should be carried out.

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Nodular fasciitis: a retrospective study of 272 cases from China
with clinicopathologic and radiologic correlation
Clinical findings
 In this study there was a total of 272
cases diagnosed with nodular fasciitis.
 There were 160 males and 112 females
with ages ranging from new born to 77
years. The mean being 36 years.
 The upper extremity was the most
common location in this study.
 The newborn patient presented with a
mass in the ulnar side of his left hand.
 The 77-year-old male had a mass in his
left shoulder.
Histological findings
 The spindle cells showed diffuse
expression of smooth muscle actin.
 The spindle cells were also positive
for calponin, muscle specific actin,
and CD10.
 Intralesional histiocytes and small
multinucleated giant cells were
positive for CD68 .
Pathological Features
 All lesions were solitary except for 1
intradermal case, 1 periosteal case,
and 16 intramuscular cases , all the
remaining cases were subcutaneous.
 They were described as well-
circumscribed soft, ranged from
rubbery to firm nodules or masses
with glistening appearance on cut
section.
 Lesions in 238 cases were smaller
than 4 cm. Tumours with dimensions
larger than 4 cm were deeply seated
or intramuscular lesions.
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Breast Nodular fasciitis
 The WHO categorised nodular fasciitis of the breast as a
benign mesenchymal breast tumour.
 This tumour is often painless, palpable and can mimic a
malignant neoplasm.
 Clinical manifestations, poor specificity of imaging and
cyto-histological features can hinder the differential
diagnosis. This negatively impacts the therapeutic strategy.
 Nodular fasciitis in this location is very rare.
 The appearance of breast fasciitis on a mammogram is a
dense, irregular or spiculated nodule, that has poorly
defined margins.
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 It can also be regular, oval or round with well-
defined margins.
 On an ultrasound scan, the margins are most often
irregular, and the vascularity is generally minimal or
completely absent.
 Breast nodular fasciitis may resemble several other
breast lesions. These can present similar radiological
or even pathological features. Examples include:
fibromatosis, myofibroblastoma, inflammatory
myofibroblastic tumour, metaplastic carcinoma and
sarcoma.
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Paediatric head and
neck nodular
fasciitis
 Patients usually present with a firm,
enlarging soft-tissue mass mostly.
 The most common locations are the
maxillofacial, scalp, forehead, neck, and
mandible.

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Thank you

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References
• https://my.clevelandclinic.org/health/diseases/23510-nodular-fasciitis
Zuber TJ, Finley JL. Nodular fasciitis. South Med J. 1994 Aug;87(8):842-4. doi: 10.1097/00007611-199408000-
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https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/nodular-fasciitis

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 Jun;19(3):180-5. doi:
10.1016/j.anndiagpath.2015.03.013. Epub 2015 Apr 6. PMID: 25890487.
https://radiopaedia.org/search?lang=us&q=nodular+fasciitis

Paliogiannis
P, Cossu A, Palmieri G, Scognamillo F, Pala C, Nonnis R, Sotgiu G, Fois A, Palomba G, Attene F.
Breast Nodular Fasciitis: A Comprehensive Review. Breast Care (Basel). 2016 Aug;11(4):270-274. doi:
10.1159/000448185. Epub 2016 Aug 11. PMID: 27721715; PMCID: PMC5040882.
Hseu A, Watters K, Perez-Atayde A, Silvera VM, Rahbar R. Pediatric nodular fasciitis in the head and neck:
evaluation and management. JAMA Otolaryngol Head Neck Surg. 2015 Jan;141(1):54-9. doi:
10.1001/jamaoto.2014.2797. PMID: 25375993.
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