Nodular fasciitis of the oral cavity with partial spontaneous regression (nodular fasciitis)

Oral Nodular Fasciitis: A Case Report in an Uncommon Location and Review of the Literature

Nodular fasciitis (NF) is a benign, self-limiting condition that is often misdiagnosed due to its resemblance to other lesions. Although NF is common, its occurrence in the oral cavity is rare and particularly challenging for both clinicians and pathologists. To date, no case has been reported in the retromolar area of the oral cavity. A 49-year-old male patient presented with a painless, rapidly growing, firm nodule in the right retromolar area. Histopathological examination revealed spindle cell proliferation with characteristics of NF and immunohistochemical analysis confirmed the diagnosis. The lesion was treated by conservative surgical excision, without recurrence at a one-year follow-up. In the current case, 54 cases of oral nodular fasciitis (ONF) have been documented. The majority of ONF-affected individuals are in their 40s, with a 1:1 male-to-female ratio. The buccal mucosa was the most commonly involved site followed by the tongue and labial mucosa. Histopathologically, the most prominent features were the proliferation of uniform spindle-shaped cells within a myxomatous and/or fibrotic background. A positive smooth muscle actin (SMA) stain was a consistent finding. Complete local excision remains the preferred treatment method, and no recurrences have been reported. This report underscores the importance of considering NF in the differential diagnosis of oral spindle cell lesions and emphasizes the need for a comprehensive evaluation to guide appropriate management.

Aggressive fibromatosis near the incision after cervical spinal cord ependymoma: A case report

Aggressive fibromatosis (AF), also known as ligamentoid fibromatosis and desmoid tumor, is a fibroblast clonoproliferative lesion located in the deep soft tissue. The present study reports the case of a 36-year-old female with AF who underwent cervical spinal cord ependymoma surgery. AF developed in the soft tissue of the neck adjacent to the incision site. The size of the neck AF increased rapidly over 2 years, and due to discomfort, the patient underwent initial surgical resection without any other combined treatment methods. When the patient was routinely reviewed at 6 months post-surgery, a recurrence of AF of the neck was found. The patient was recommended surgical resection and radiotherapy. This case report should improve the understanding of clinicians with regard to AF, and help the diagnostic process and treatment plan.

Oral nodular fasciitis – A case report with a diagnostic schema

Introduction: The spectrum of myofibroblastic lesions of the oral cavity ranges from reactive to benign to malignant lesions with overlapping histopathologic and immunohistologic characteristics posing a diagnostic dilemma. Observation: A 30-year-old male presented with a spontaneous swelling over the right lower buccal gingiva giving a clinical suspicion of a benign mesenchymal tumor. The lesion presented with a varied biphasic microscopic appearance that posed as a challenge for diagnosis. Commentaries: The incisional biopsy of the lesion showed a highly collagenous stroma with spindle-shaped cells, while the excision biopsy revealed myxoid and hyalinized stroma. A panel of markers comprising of SMA (smooth muscle actin). CD-34, β-Catenin, and Alcian blue stain was employed to arrive at a diagnosis. Conclusion: Most myofibroblastic lesions present with diverse histological appearance which warrants a thorough assessment of the cellular and stromal components for an accurate diagnosis.

Description of a Rare Case of Nodular Fasciitis of the Apical Aspect of the Upper Buccal Sulcus

This report describes a rare case of nodular fasciitis (NF) of the oral cavity, discussing the clinical, histological, and immunohistochemical characteristics. Histopathologic diagnosis of this type of lesion can be challenging due to its differential diagnosis, which principally includes sarcoma. The patient presented with a painless, well-defined nodule, reported as increasing in size, located at the apical aspect of the upper left buccal sulcus. Histologically, the lesion revealed spindle cell proliferation arranged in fascicles, while immunohistochemistry demonstrated positivity for smooth muscle actin. Eight months after complete surgical excision, no signs of local recurrence have been observed.

Nodular fasciitis of the masseter

A 73-year-old man presented to ENT clinic with a painless, smooth lump overlying his right cheek. Fine needle aspiration wrongly diagnosed necrotising malignancy with squamous differentiation. MRI showed a lesion overlying the right masseter, and positron emission tomography scanning incorrectly suggested this was a metabolically active lymph node. After surgical excision, immunohistochemical analysis showed this was in fact nodular fasciitis of the masseter. Nodular fasciitis is a rare, benign, proliferative lesion whose clinical and histological features make it difficult to distinguish from malignancies such as sarcoma. Immunohistochemical analysis for markers including vimentin and actin is crucial for diagnosis. Without this, misdiagnoses are common and patients are at risk of unnecessarily aggressive treatment. This case report summarises the epidemiological, aetiological and clinical features of nodular fasciitis, explores the pitfalls of investigation modalities and describes its management.

Nodular fasciitis of the lip mucosa: a rare but clinically important entity

Oral nodular fasciitis (NF) is a rare benign entity of significant clinical importance, which presents as a rapidly growing soft tissue mass. Awareness of this entity is essential, because histologically it resembles a malignancy at first glance, owing to its spindled histological nature and numerous typical mitoses. Thus, it is often misdiagnosed as an aggressive sarcoma, resulting in unnecessary radical surgery. In total, 45 cases of oral NF have been reported since 1966, of which only 2 were reported in the dermatological literature. Patients with NF of the lip mucosa will frequently present to a dermatologist. Therefore, it is critical that dermatologists recognize this benign neoplasm to correctly manage it and avoid potentially catastrophic unnecessary surgery, as these lesions typically spontaneously resolve. We describe the clinical, histological and immunohistochemistry findings of NF in a 51-year-old woman, and discuss its differential diagnosis.

The Spindle Cell Neoplasms of the Oral Cavity

Spindle cell neoplasms are defined as neoplasms that consist of spindle-shaped cells in the histopathology. Spindle cell neoplasms can affect the oral cavity. In the oral cavity, the origin of the spindle cell neoplasms may be traced to epithelial, mesenchymal and odontogenic components. This article aims to review the spindle cell neoplasms of the oral cavity with emphasis on histopathology.

A huge nodular fasciitis in parapharygneal space in a 7-year-old girl: a case report and review of literature

Nodular fasciitis (NF) is a benign and reactive fibroblastic growth extending from the superficial fascia into the subcutaneous tissue or muscle, with a morbidity of less than 20% in children. We report a case of a 7-year-old girl presented with a 3-month history of snore and mouth breathing. Image findings demonstrated a large soft-tissue mass in the right parapharyngeal space. The lesion was successfully eradicated by surgical removal. Pathological analysis established NF as the final diagnosis. Histopathological findings were notable for a reactive spindle-cell process composed of proliferative fibroblasts with extravasated red blood cells and interstitial edema. Immunohistochemical stains showed that the lesional cells were positive for smooth muscle actin (SMA), muscle-specific actin (HHF35), and epithelial membrane antigen (EMA), and negative for S100 protein. No clinical evidence of recurrence was noticed after 2 months of follow-up. Being the first report of NF in the parapharyngeal space of a child, this rare pediatric case points out the importance for otolaryngologists to keep NF in mind for differential diagnosis to avoid unnecessary wide resection.

Nodular fasciitis in the buccal region with rapid growth after incisional biopsy mimicking sarcoma

Nodular fasciitis (NF) is a reactive and proliferative fibroblastic lesion that occurs predominantly in the upper limbs but rarely develops in the oral cavity. This lesion can be misdiagnosed as malignant owing to its frequent display of rapid growth, rich cellularity, and high mitotic activity. Unlike a sarcoma, NF can resolve spontaneously or after an incisional biopsy. We describe a challenging case involving a lesion in the buccal region that rapidly enlarged after incisional biopsy. This variation of clinical behavior illustrates the difficulty in predicting whether NF will continue to grow or regress. Clinicians dealing with cases of an enlarging fibrous lesion of short duration should remain aware of this disease entity and its potential diagnostic dilemma.

A rare case of intraoral nodular fasciitis: diagnosis and immunohistochemical profile

Nodular fasciitis is a benign, idiopathic, reactive proliferation of myofibroblasts found in the subcutaneous fascia; intraoral occurrence is very rare. An 18-year-old woman was referred to the oral diagnosis service with a 1-month history of a nodular mass in the gingiva. Clinical examination disclosed a well-circumscribed, mobile, pedunculated mass in the left mandibular gingiva. The clinical diagnoses included pyogenic granuloma. She underwent an excisional biopsy under local anesthesia through an intraoral approach. Microscopic examination showed a proliferation of spindle cells arranged in intersecting fascicles. The spindle cells exhibited plump, vesicular nuclei without significant pleomorphism. Scattered multinucleated giant cells also were present. Immunohistochemical stains showed that the lesional cells were positive for smooth muscle actin and vimentin and negative for S-100 protein. The features were those of an inflammatory, benign myofibroblastic lesion, consistent with intraoral nodular fasciitis.