Nodular fasciitis of the periorbital soft tissue in an adolescent confirmed by USP6 gene rearrangement

Mid-thoracic Nodular Fasciitis: A Diagnostic Dilemma

Nodular fasciitis (NF) is a rare, benign, yet rapidly proliferative myofibroblastic soft tissue tumor that often mimics malignant lesions and presents significant diagnostic challenges. This case report describes a 16-year-old female whose mid-thoracic mass was initially mismanaged in an emergency setting as a sebaceous cyst. The misdiagnosis and subsequent inappropriate incision and drainage led to an iatrogenic flare-up, exacerbating the patient's condition and complicating her management course. The complexities encountered in this case underscore the critical need for stringent diagnostic protocols and multidisciplinary management to avoid iatrogenic complications and improve clinical outcomes in patients presenting with unusual soft tissue lesions. This report highlights the importance of adhering to established protocols for soft tissue lump evaluation and the potential pitfalls of misdiagnosis.

Nodular fasciitis of the orbit: rapid growth phase post iatrogenic incisional trauma

Nodular fasciitis (NF) is a benign, reactive, myofibroblastic proliferative solitary lesion that commonly develops in the subcutaneous or superficial fascia. We present a case of a 35-year-old male with a rapidly enlarging upper eyelid mass postiatrogenic incisional trauma. Subsequent en toto excisional biopsy demonstrated NF. Given the rapid clinical course of this patient and the reactive nature of NF, we hypothesize that the initial incisional trauma likely incited an inflammatory response resulting in rapid proliferation and growth of the lesion. NF accounts for <1% of all orbital lesions, and is often a clinically and pathologically difficult diagnosis to make given its propensity to mimic other benign and malignant conditions. Therefore, we recommend that en toto biopsies of orbital lesions in this anatomical area be performed rather than incisional biopsies.