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Domazet I, Njiric N, Jakovcevic A, Bitunjac A, Domazet K, Pašalić I, Mrak G. Intraneural Nodular Fasciitis of the Dorsal Scapular Nerve: Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2023; 84:404-407. [PMID: 34897609 DOI: 10.1055/s-0041-1739218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nodular fasciitis is a benign neoplasm occurring predominantly in the subcutaneous tissue. There have been nine intraneural occurrences described in the literature. CASE REPORT A 37-year-old woman presented with numbness and tenderness in her left shoulder and scapula and a slightly dropped left shoulder, without history of trauma. A magnetic resonance imaging (MRI) of the cervical spine showed a well-circumscribed oval mass deep to the levator scapula muscle. Due to persisting symptoms and an unknown nature of the process, surgical excision was performed, and histopathologic analysis confirmed diagnosis of a benign fibroblastic/myofibroblastic neoplasm, nodular fasciitis. The postoperative course was uneventful and the patient was without symptoms at 4 months of follow-up. METHODS We reviewed the available literature (PubMed, Google Scholar), with nine published cases of intraneural nodular fasciitis. The reported clinical, radiologic, and histopathologic parameters were evaluated and compared. DISCUSSION Most of the cases reported in the literature were symptomatic, with tenderness and palpability being the main symptoms. Six of the reported cases occurred in the forearm, whereas three were in the leg. To the best of our knowledge, ours is the first reported case of nodular fasciitis occurring in the trunk. Ours is the only case to display desmin positivity, which supports the reactive hypothesis of nodular fasciitis. CONCLUSION Intraneural nodular fasciitis is an extremely rare diagnosis. Due to its benign natural course, a multidisciplinary approach with this extremely rare diagnosis in mind is needed to avoid overtreatment.
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Affiliation(s)
- Ivan Domazet
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Niko Njiric
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Antonia Jakovcevic
- Department of Pathology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Andrija Bitunjac
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Krešimir Domazet
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Pašalić
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Goran Mrak
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
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Parkinson B, Patton A, Rogers A, Farhadi HF, Oghumu S, Iwenofu OH. Intraneural Nodular Fasciitis of the Femoral Nerve with A Unique CTNNB1::USP6 Gene Fusion: Apropos of a Case and Review of Literature. Int J Surg Pathol 2022; 30:673-681. [PMID: 35175167 DOI: 10.1177/10668969221080064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nodular fasciitis (NF) is a benign proliferation of fibroblasts and myofibroblasts occurring most commonly in the upper extremities that can mimic a variety of mesenchymal tumors including sarcoma. Although reported in almost all anatomic locations, only 7 cases of intraneural nodular fasciitis have been reported in English literature. The CTNNB1::USP6 gene fusion has not been previously reported in intraneural nodular fasciitis, although it has been reported in three entities including aneurysmal bone cyst, nodular fasciitis, and intravascular fasciitis. We report a case of a 29-year-old female with a 6-month history of left leg weakness, myalgia, and paresthesia of the left foot prompting a clinical diagnosis of a peripheral nerve sheath tumor. Surgical resection was performed, and histologic sections revealed a circumscribed lesion composed of banal spindle cells with variable interstitial collagen and occasional mitotic figures. By immunohistochemistry, the lesional cells were positive for smooth muscle actin, smooth muscle heavy chain myosin, p16, and H-caldesmon and negative for desmin, S-100, SOX10, HMB45, CD34, and beta-catenin. Fluorescence in Situ Hybridization for USP6 gene rearrangement was positive and consistent with the diagnosis of nodular fasciitis. Next-generation sequencing uncovered the presence of a CTNNB1::USP6 gene fusion involving CTNNB1 gene in exon 1 at the genomic position chr3:41241161 and the USP6 gene in exon 1 at the genomic position chr17:5033231. This gene fusion was confirmed by Sanger sequencing. Herein, we report a case that underscores the rare incidence of intraneural nodular fasciitis and highlights the pitfalls associated with the clinical differential diagnoses of intraneural tumors.
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Affiliation(s)
- Bryce Parkinson
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashley Patton
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alan Rogers
- The James Cancer Hospital and Solove Research Institute, 2647The Ohio State University, Wexner Medical Center, Columbus, USA
| | - H Francis Farhadi
- 12306The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,12252University of Kentucky, Lexington, Kentucky, USA
| | - Steve Oghumu
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - O Hans Iwenofu
- 12306The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Chu CL, Lu YJ, Lee TH, Jung SM, Chu YC, Wong HF. Concomitant spinal dural arteriovenous fistula and nodular fasciitis in an adolescent: case report. BMC Pediatr 2022; 22:30. [PMID: 34998361 PMCID: PMC8742378 DOI: 10.1186/s12887-021-03032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Spinal dural arteriovenous fistula (SDAVF) usually occurs during the 4th to 6th decades of life, and adolescent SDAVF is rarely reported. SDAVF arising around a tumor is also rare, and reported tumors are mostly schwannoma and lipoma. Case presentation We reported a 16-year-old male presented with progressive weakness and numbness of lower limbs for 3 months. A SDAVF was found, which was fed by right radicular arteries from segmental artery at L2 level and drained retrogradely into perimedullary veins. A concomitant spinal extradural nodular fasciitis at right L1/L2 intervertebral foramen was also noted. The SDAVF was completely obliterated by endovascular treatment and the tumor was debulked. The patient recovered well after the procedures. Conclusions Our case report suggests SDAVF can occur in adolescent. The concomitant presence with a nodular fasciitis indicates that although it usually arises in subcutaneous tissue but can rarely form on the dura of spine.
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Affiliation(s)
- Chan-Lin Chu
- Department of Neurology, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Jung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pathology, Linkou Chang-Gung Children Hospital, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Cheng Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Critical Care, Far-Eastern Hospital, New Taipei City, Taiwan
| | - Ho-Fai Wong
- Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang-Gung Memorial Hospital, No.5, Fuxing Street, Guishan Township, Taoyuan, Taiwan.
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Miyama A, Kuratsu S, Takenaka S, Yoshimura M, Yoneda G, Yamada Y, Oda Y. Two case reports of intra-articular nodular fasciitis of the knee confirmed by MYH9-USP6 gene fusion expression. J Orthop Sci 2021; 26:1138-1142. [PMID: 30611632 DOI: 10.1016/j.jos.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 02/09/2023]
Abstract
AIM To describe two cases of intra-articular nodular fasciitis (NF) which developed within the knee joint and were associated with the expression of the MYH9-USP6 gene fusion. PATIENTS AND METHODS Two women, 30 and 56 years of age, with no history of joint disease or knee joint trauma, are presented in our cases. We report these cases describing the clinical presentation, assessment, histopathological examination, gene expression, and clinical management. RESULTS Both patients presented with knee pain and limitation in the range of flexion. We diagnosed our two cases as intraarticular nodular fasciitis based on histological findings and by the detection of the MYH9-USP6 gene fusion. The transcript of MYH9-USP6 gene fusion was identified by RT-PCR and direct sequencing in both cases. CONCLUSION We report the first cases of intra-articular NF involving the knee joint, with identification of a MYH9-USP6 gene fusion by RT-PCR. NF should be considered in the differential diagnosis of intra-articular lesions.
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Affiliation(s)
- Akira Miyama
- Department of Orthopaedic Surgery, Bellland General Hospital, Japan; Osaka University Graduate School of Medicine Orthopaedic Surgery, Japan.
| | | | - Satoshi Takenaka
- Osaka University Graduate School of Medicine Orthopaedic Surgery, Japan
| | | | | | - Yuichi Yamada
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Japan
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Chouhan D, Ansari MT, Goyal D, Mridha AR. Unilateral carpal tunnel syndrome: an unusual presentation of nodular fasciitis. BMJ Case Rep 2020; 13:13/11/e236142. [PMID: 33257360 PMCID: PMC7705373 DOI: 10.1136/bcr-2020-236142] [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] [Indexed: 11/04/2022] Open
Abstract
Nodular fasciitis is a benign, self-limiting proliferative disorder of fibroblast of uncertain aetiology, occurs frequently in the forearm. Nodular fasciitis in hand inducing carpal tunnel syndrome is exceptional. There are four cases of non-intraneural nodular fasciitis causing peripheral neuropathy that has been reported previously. We present the case of a 38-year-old man with features of unilateral carpal tunnel syndrome. Decompression of the median nerve performed subsequently along with excision of the lesion in a piecemeal fashion. Histopathological and immunohistochemical findings were consistent with nodular fasciitis. There were complete resolution of symptoms and no sign of recurrence at the end of 1 year after surgery.
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Affiliation(s)
- Deepak Chouhan
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Devansh Goyal
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Rani D, Gupta A. Cytological Diagnosis and Misdiagnosis of Nodular Fasciitis. J Cytol 2019; 36:196-199. [PMID: 31741577 PMCID: PMC6844020 DOI: 10.4103/joc.joc_112_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/04/2022] Open
Abstract
Background Nodular fasciitis (NF) is a rapidly growing, self-limiting, subcutaneous nodular cytologic exuberant fibroblastic/myofibroblastic proliferation prone to cytological misdiagnosis. Aims This study aimed at finding out the utility of fine needle aspiration cytology (FNAC) from NF patients and to validate the diagnostic features. Materials and Methods The study group comprised 11 cases diagnosed as NF on cytology or subsequent histology. Results Out of 11 cases, 9 were cytologically diagnosed as NF. Two cases were misdiagnosed as sarcoma as proven histologically. Of the 9 cases of NF, spontaneous resolution occurred in 7 cases in 2-16 weeks; excisional biopsy was undertaken in the other 2 cases. Conclusion On cytology, NF reveals hypercellular, polymorphic, dispersed cell population, which is most commonly misdiagnosed as sarcoma. For this reason, FNAC has to be correlated with clinical data and followed up for the anticipated spontaneous regression.
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Affiliation(s)
- Deepa Rani
- Department of Pathology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - Arsh Gupta
- Department of Pathology, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Lao IW, Liu X, Yu L, Wang J. Infantile nodular fasciitis of the hand: A case report and literature review. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kanaya K, Iba K, Yamashita T, Wada T, Hasegawa T. Intraneural Nodular Fasciitis in a Child: A Case Report and Review of the Literature. J Hand Surg Am 2016; 41:e299-302. [PMID: 27469937 DOI: 10.1016/j.jhsa.2016.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 02/02/2023]
Abstract
We present the case of an 11-year-old boy with intraneural nodular fasciitis of the median nerve at the distal part of the carpal tunnel. Complete excision of the involved median nerve and cable grafting using 4 fascicular segments of the sural nerve was performed for persistent pain and numbness after initial resection of the tumor in piecemeal fashion. Pain and numbness were completely resolved and there was no evidence of recurrence 24 months after the final surgery.
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Affiliation(s)
- Kohei Kanaya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kousuke Iba
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takuro Wada
- Department of Orthopedic Surgery, Hokkaido Saiseikai Otaru Hospital, Hokkaido, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Sundar SJ, Healy AT, Shook SJ, Kamian K. Intraneural nodular fasciitis of the radial nerve with rapidly progressive motor symptoms. Surg Neurol Int 2016; 7:28. [PMID: 27114852 PMCID: PMC4822346 DOI: 10.4103/2152-7806.178776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Nodular fasciitis is a benign mesenchymal tumor arising from fascia that typically presents as a rapidly growing, subcutaneous mass. Intraneural cases are very rare and can present with neurological symptoms, requiring surgical resection. Case Description: A 31-year-old woman presented to us with painful paresthesias in her elbow and progressive motor deficits, for which she underwent surgery. Conclusion: The authors report the first case of intraneural nodular fasciitis occurring in the radial nerve and highlight the possibility of rapidly progressive motor deficit in patients presenting with this rare clinical entity.
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Affiliation(s)
- Swetha J Sundar
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Andrew T Healy
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Steven J Shook
- Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kambiz Kamian
- Department of Neurosurgery, Dayton Children Hospital, Dayton, Ohio
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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; 19:180-5. [DOI: 10.1016/j.anndiagpath.2015.03.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/29/2015] [Indexed: 11/24/2022]
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Kim H, Baik MW, Kim J, Jo KW. Ulnar nerve compression in the cubital tunnel by a nodular fasciitis. Clin Neurol Neurosurg 2011; 113:803-5. [PMID: 21890263 DOI: 10.1016/j.clineuro.2011.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 07/26/2011] [Accepted: 08/06/2011] [Indexed: 11/15/2022]
Affiliation(s)
- Hoon Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea
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Yano K, Kazuki K, Yoneda M, Ikeda M, Fukushima H, Inoue T. Intraneural nodular fasciitis of the median nerve: case report and literature review. J Hand Surg Am 2011; 36:1347-51. [PMID: 21741773 DOI: 10.1016/j.jhsa.2011.05.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/14/2011] [Accepted: 05/23/2011] [Indexed: 02/02/2023]
Abstract
Nodular fasciitis, a benign soft tissue tumor, occurs most frequently in the forearm and is generally divided into subcutaneous, intramuscular, and fascial types. Intraneural nodular fasciitis has been reported in only 5 patients previously. We present the case of a 79-year-old woman with nodular fasciitis within the median nerve at the proximal forearm. Carpal tunnel syndrome was suspected at the initial visit, but high median nerve palsy and a mass at the proximal forearm were found a few months later. Subtotal resection of the tumor within the median nerve was performed and histological diagnosis indicated nodular fasciitis. There was no evidence of recurrence at follow-up 1 year and 3 months after surgery. Motor weakness had resolved but sensation was compromised.
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Affiliation(s)
- Koichi Yano
- Department of Orthopaedic Surgery, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan.
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Intractable sciatica due to intraneural nodular fasciitis detected by positron emission tomography. Spine (Phila Pa 1976) 2010; 35:E1137-40. [PMID: 20622746 DOI: 10.1097/brs.0b013e3181e028b6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a patient with nodular fasciitis in the sciatic nerve, detected by positron emission tomography (PET). SUMMARY OF BACKGROUND DATA Severe sciatic pain is commonly caused by lumbar disc herniation, lumbar spinal stenosis, or neoplastic lesion. These lesions are usually diagnosed by plain radiograph, myelography, computed tomography, and magnetic resonance imaging.Nodular fasciitis is a benign connective tissue tumor usually presenting as a firm, rapidly-growing lesion, occasionally arising in the forearm. Only 5 cases of intraneural nodular fasciitis have been reported in the published data, and although some have demonstrated mild neuropathy, none have shown nodular fasciitis with intractable sciatica. METHODS A 37-year old woman experienced severe sciatica after hitting her left buttock hard on the edge of a bathtub. Physical examination demonstrated intense radiating pain from the left buttock to the lateral calf. There was weakness in the sciatic nerve innervated musculature. She was diagnosed with piriformis syndrome in a local hospital. However, the symptoms remained unchanged after surgery, releasing the piriformis. Conventional imaging of the sciatica including plain radiograph, computed tomography, and magnetic resonance imaging of the spine showed a return of abnormal findings. RESULTS PET detected an abnormal lesion in the sciatic nerve in the posterior compartment of the patient's left thigh, indicating an intraneural tumor in the sciatic nerve. Subtotal resection was achieved and histologic evaluation of the specimen showed the typical features of nodular fasciitis. After surgery, the patient was relieved of all symptoms, with no evidence of recurrence at the recent 2-year follow-up. CONCLUSION This is the first reported case of intraneural nodular fasciitis presenting with severe radiculopathy. Nodular fasciitis should be considered in the differential diagnosis of severe sciatica. PET may be a useful tool for diagnosing sciatica of unknown origin that cannot be identified using conventional imaging tools.
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Nishida Y, Koh S, Fukuyama Y, Hirata H, Ishiguro N. Nodular fasciitis causing axillary nerve palsy: a case report. J Shoulder Elbow Surg 2010; 19:e1-4. [PMID: 20189836 DOI: 10.1016/j.jse.2009.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 10/26/2009] [Accepted: 10/27/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Showa, Nagoya, Japan.
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Grobmyer SR, Knapik JA, Foss RM, Copeland EM, Hochwald SN. Nodular Fasciitis: Differential Considerations and Current Management Strategies. Am Surg 2009. [DOI: 10.1177/000313480907500714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nodular fasciitis (NF) typically presents as an enlarging soft tissue mass with imaging characteristics that may be suggestive of soft tissue sarcoma or desmoid tumor. This presentation can make a correct diagnosis and management of patients with NF a challenge. We report our recent experience with two cases of NF that were both referred with a diagnoses of “soft tissue sarcoma.” Patient 1 was a 46-year-old woman who had undergone breast augmentation and was referred with a rapidly growing firm mass on the left chest wall beneath the breast implant. Computed tomography of the chest noted the mass to be 8 cm X 11 cm in size displacing the implant laterally with no radiological involvement of the bony structures of the chest. Core biopsy was suggestive of inflammation only. Given the clinical suspicion of malignancy, the patient underwent resection of the mass with implant removal. Final pathology showed NF. Patient 2 was a 65-year-old woman referred with an enlarging tender 3-cm infraclavicular mass and a clinical diagnosis of “soft tissue sarcoma.” Preoperative biopsy suggested NF. The patient underwent complete excision, which confirmed the diagnosis. These cases highlight the clinical issues associated with management of patients with NF. Current approaches to evaluation, diagnosis, and treatment of NF are discussed.
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Affiliation(s)
- Stephen R. Grobmyer
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Florida
| | | | - Robin M. Foss
- Department of Pathology, University of Florida, Gainesville, Florida
| | - Edward M. Copeland
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Florida
| | - Steven N. Hochwald
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Florida
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Abstract
Nodular fasciitis is a reactive proliferation of fibroblasts/myofibroblasts characterized by a rapidly growing non-tender subcutaneous mass and subsequently self-limited course. It is commonly found on the upper extremities, face, and shoulder, although it may occur in any superficial location. Its etiology is largely unknown, but associations have been made with local trauma, infection and inflammation. We report a case of an intraneural and intramuscular nodular fasciitis presenting in the obturator nerve and gracilis muscle, respectively. To our knowledge, this is the second reported case of this disease presenting in a nerve of the lower extremity, as well as the first reported case of it presenting within muscle and nerve simultaneously.
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Parrett BM, Orgill DP, Marsee DK, Freedman AS, Raut CP. Novel presentation of intraneural nodular fasciitis of the sciatic nerve. J Peripher Nerv Syst 2007; 12:61-3. [PMID: 17374106 DOI: 10.1111/j.1529-8027.2007.00121.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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