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Wen Y, Ye S, Liu C, Zhu Y. Laryngeal nodular fasciitis in a 75-year-old man: a rare case report and review of the literature. J Int Med Res 2024; 52:3000605241259764. [PMID: 39142703 PMCID: PMC11328270 DOI: 10.1177/03000605241259764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
Nodular fasciitis (NF) is a benign and self-limiting fibroblastic proliferation that originates from the superficial fascia and extends into the subcutaneous tissue or muscle. It typically manifests in individuals aged 20 to 35 years, with rare occurrences observed in patients over the age of 60 years. We herein report a case involving a 75-year-old man with NF in the right vocal cord. The patient sought medical attention at the Department of Otolaryngology of our hospital because of a 1-month history of hoarseness and breathlessness. The diagnosis was unable to be confirmed through preoperative pathological examination. After admission to our hospital, various examinations were completed and surgical treatment was performed, and the postoperative histopathological findings revealed the presence of NF in the right vocal cord. NF of the vocal cord is a rare clinical entity. Given its rapid progression and propensity for marked infiltration, it often poses diagnostic challenges because it can mimic various malignant soft tissue tumors. Therefore, thorough exclusion of other neoplastic lesions is imperative prior to confirming the diagnosis of NF through pathological examination. Local surgical resection remains the primary treatment modality.
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Affiliation(s)
- Yu Wen
- Department of Otolaryngology Surgery, The Second People's Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
| | - Shufeng Ye
- Department of Otolaryngology Surgery, The Second People's Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
| | - Cuiping Liu
- Department of Otolaryngology Surgery, The Second People's Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
| | - Yiming Zhu
- Department of Otolaryngology Surgery, The Second People's Hospital of Gansu Province (Affiliated Hospital of Northwest University for Nationalities), China
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Diagnosis and Treatment of Nodular Fasciitis of Ear Region in Children: A Case Report and Review of Literature. Healthcare (Basel) 2022; 10:healthcare10101962. [PMID: 36292409 PMCID: PMC9601438 DOI: 10.3390/healthcare10101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
Nodular fasciitis (NF) is a benign fibroblastic and myofibroblastic proliferation of subcutaneous tissues. Rarely, it has been identified in the ear and more rarely in children. We describe a case in a four-year-old girl and the surgical management of it. The patient was referred to the otolaryngology unit of a tertiary referral center because she was affected by a painless and growing lesion in the left external auditory canal (EAC). The girl was treated by large-spectrum antibiotic therapy for one week without success. For this reason, we requested ultrasonography (US) of the left hemiface, maxillofacial and temporal bone computed tomography (CT) and magnetic resonance imaging (MRI) of the head with and without contrast. The imaging identified an irregular ovoid hypoechoic nodule with distinct margins indissociable from the cartilaginous planes and extending into the parotid loggia with local infiltration of the fascia. The lesion was surgically removed through preauricular access due its extension into the parotid area. The mass was excised in toto and sent to the pathologist for immunohistochemistry. The histopathologist based on the finding diagnosed a nodular fasciitis. In case of suspicion of malignancy, early investigations should be done to evaluate the lesion, then a traditional parotidectomy can be safely and successfully performed even in a very young child. The open technique allows the removal of NF with full control of the surgical area and facial nerve. In this article, we presented the management of a case in a 4-year-old female affected by NF of the external auditory canal (EAC), and we described clinical and surgical management of the case. We also reviewed literature of nodular fasciitis cases of ears in children.
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Bansal V, Bansal R, Thapliyal S, Mowar A, Dubey P. A Rare Lesion at Rare Location: A Surgeon's Enigma. J Maxillofac Oral Surg 2022; 21:73-77. [PMID: 35400894 PMCID: PMC8934827 DOI: 10.1007/s12663-020-01364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
Abstract
Leiomyosarcoma of palate is a rare malignant spindle cell tumour in oral cavity. It is often misdiagnosed with other benign lesions like nodular fasciitis, clinical and histological similarity of rapid growth, rich cellularity, as the pathogenesis is unknown, which can make diagnosis and management challenging. The non-specific clinical, radiologic and pathological presentation of spindle cell tumours causes diagnostic difficulty due to similarities to granulation tissue, benign or malignant lesions in histologic and imaging features. Nevertheless, differentiation is important because the prognosis and treatment varies according to the type of tumor. NF is frequently evaluated by biopsy and also immunohistochemistry (IHC) which is very essential in cases of non-regressing lesions after biopsy. The present case report highlights the clinical and histopathologic challenges in a rare case of nodular fasciitis in the palate which initially diagnosed as granulation tissue and later confirmed as Grade l leiomyosarcoma on IHC.
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Affiliation(s)
- Vishal Bansal
- grid.416682.f0000 0004 1761 181XDepartment of Oral and Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar, Meerut Bypass Road, Meerut, Uttar Pradesh 250005 India
| | - Rani Bansal
- grid.416682.f0000 0004 1761 181XDepartment of General Pathology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India
| | - Sanchita Thapliyal
- grid.416682.f0000 0004 1761 181XDepartment of Oral and Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar, Meerut Bypass Road, Meerut, Uttar Pradesh 250005 India
| | - Apoorva Mowar
- grid.416682.f0000 0004 1761 181XDepartment of Oral and Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar, Meerut Bypass Road, Meerut, Uttar Pradesh 250005 India
| | - Prajesh Dubey
- grid.416682.f0000 0004 1761 181XDepartment of Oral and Maxillofacial Surgery, Subharti Dental College, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar, Meerut Bypass Road, Meerut, Uttar Pradesh 250005 India
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Wang X, Liu W, He L, Chen M, Shao J, Zhang X, Ma N, Li Y, Zhang J. Clinical characteristics of nodular fasciitis of the ear in children. Eur J Pediatr 2022; 181:833-840. [PMID: 34633518 DOI: 10.1007/s00431-021-04274-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
The rate of early misdiagnosis in patients with nodular fasciitis of the ear is high. To provide a basis for clinical diagnosis and treatment, we aimed to summarise the clinical manifestations, imaging results, pathological findings, treatment strategies, and postoperative follow-up results for three cases of paediatric nodular fasciitis (two girls, one boy) treated in the Department of Otorhinolaryngology, Head and Neck Surgery, at Beijing Children's Hospital of Capital Medical University from 2018 to 2020. The average age at diagnosis was 24 months. Lesions occurred in the left ear in two cases and right ear in one case. All patients had a history of biopsy before surgery. Rapid growth was observed following biopsy in two patients, and anti-inflammatory treatment was ineffective in all three cases. Fluorescence in situ hybridisation analysis of ubiquitin-specific peptidase 6 (USP6) was performed in two of the three cases, with positive results. The lesions exhibited hypo-intensity or iso-intensity on T1-weighted magnetic resonance imaging (MRI) and heterogeneous hyper-intensity on T2-weighted MRI. "Fascial tail" signs were observed on imaging in all cases. Surgical resection was performed in all cases. Intact ear appearance was observed at follow-up, and there were no cases of recurrence.Conclusion: Combining clinical features with imaging findings may improve the accuracy of preoperative diagnosis in patients with nodular fasciitis. In addition to pathological findings, genetic testing for USP6 may aid in diagnosis. The final diagnosis should be based on comprehensive assessment. Complete surgical resection can prevent recurrence. What is Known: • Paediatric NF around the ear is rare and is easily misdiagnosed as other inflammatory masses that have a higher incidence in children. • Most previous reports of NF were case reports. What is New: • Combining clinical and imaging findings with genetic testing for USP6 rearrangement may improve the accuracy of preoperative diagnosis in patients with NF. Nonetheless, the final diagnosis should be based on comprehensive assessment. • The present paper is significant in that it represents the only report of three cases of ear NF in children with a complete medical history and prognosis.
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Affiliation(s)
- Xiaoxu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Wei Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Lejian He
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Jianbo Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Xiao Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Ning Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Yanhong Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China.
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Mella M, Khoury J, Fata F. Unusual presentation of a clinically isolated temporal region mass: Non-Hodgkin lymphoma. Clin Case Rep 2021; 9:e04938. [PMID: 34667609 PMCID: PMC8512182 DOI: 10.1002/ccr3.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/01/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Non-hodgkins lymphoma is a systemic disease that may present in multiple sites, rarely does it present primarily as a temporal fossa swelling. Only four cases have been reported in the English literature. We report a case of a patient who presented with a rapidly progressive swelling of the temporal fossa.
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Affiliation(s)
- Mariam Mella
- Department of OtolaryngologySaint George Hospital University Medical CenterBeirutLebanon
| | - Jihad Khoury
- Department of OtolaryngologySaint George Hospital University Medical CenterBeirutLebanon
| | - Fouad Fata
- Department of OtolaryngologySaint George Hospital University Medical CenterBeirutLebanon
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Liu X, Li X. Nodular Fasciitis in the Cavity of Auricular Concha: A Case Report. EAR, NOSE & THROAT JOURNAL 2021; 102:409-411. [PMID: 33829880 DOI: 10.1177/01455613211006006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nodular fasciitis (NF) has a low incidence, many classification subtypes and large histological variations. We describe a 17-month-old child who presented with a mass in the right cavity of auricular concha that was successfully cured by 2 procedures. In pediatric patients with fibroproliferative lesions, the possibility of NF should be excluded to avoid misdiagnosis and overtreatment.
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Affiliation(s)
- Xiaojun Liu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, 12474Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, 12474Shanghai Jiao Tong University, Shanghai, China
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Friedrich RE, Heiland M, Burchard G, Racz P, Zustin J, Hagel C. Human Dirofilaria repens infection of the zygomatico-temporal region. J Craniomaxillofac Surg 2014; 42:612-5. [DOI: 10.1016/j.jcms.2013.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/14/2013] [Accepted: 08/28/2013] [Indexed: 12/29/2022] Open
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The chameleon in the neck: Nodular fasciitis mimicking malignant neck mass of unknown primary. Int J Surg Case Rep 2012; 3:501-3. [PMID: 22858790 DOI: 10.1016/j.ijscr.2012.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/03/2012] [Accepted: 05/22/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Difficulties with the correct diagnosis and treatment of nodular fasciitis in head and neck region has been reported in the literature. Nodular fasciitis was mistaken for sarcoma, papillary thyroid carcinoma, Burkitt's lymphoma, pleomorphic adenoma, or as a vascular lesion. PRESENTATION OF CASE We present a patient with a single node in the neck with accelerated growth, which clinically appeared as a malignant epithelial tumor with unknown primary. The en bloc removal of the tumor and selective neck dissection was performed with bilateral tonsillectomy and biopsy of the tongue base. The histopathology revealed the tumor to be nodular fasciitis. No malignant cells were detected. DISCUSSION Due to very rapid growth, its rich cellularity and high mitotic activity, nodular fasciitis can be mistaken as a malignant tumor. Trauma and/or infection is advocated to be a trigger for the formation of nodular fasciitis, although the exact aetiopathogenesis still remains unknown. Our patient admitted to regularly practicing martial arts with his opponent performing a specific combat maneuver applying pressure into the neck and submental region, which might have triggered the formation of the nodular fasciitis. CONCLUSION Nodular fasciitis is a benign and often overlooked diagnosis in the head and neck region, that can be misinterpreted as a malignant tumor both clinically and histologically. A comprehensive medical history may help to avoid unnecessary radical treatment. If a malignancy cannot be confidently ruled out, the en bloc resection of the tumor with selective neck dissection may offer a safe option with low morbidity.
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