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Watson AL, Winters R. Nonsyndromic Craniofacial Disorders. Facial Plast Surg Clin North Am 2024; 32:127-139. [PMID: 37981408 DOI: 10.1016/j.fsc.2023.06.004] [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: 11/21/2023]
Abstract
We describe the investigation and management of select pediatric craniofacial disorders their recent advances. Positional plagiocephaly: The incidence of positional plagiocephaly has increased since the institution of the "safe to sleep" campaign to reduce sudden infant death syndrome. Positional plagiocephaly may be associated with underlying developmental delay. Nonsyndromic craniosynostosis: Treatment of nonsyndromic craniosynostosis depends on the age of the patient and the suture involved. Pediatric skull lesions: Management of skull lesions depends on histologic diagnosis. Some benign skull lesions are managed conservatively, whereas erosive and malignant lesions may require surgical excision, radiotherapy, chemotherapy, or multimodality treatment.
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Affiliation(s)
- Antonia L Watson
- Department of Otolaryngology - Head & Neck Surgery, John Hunter Hospital, Lookout Road, New Lambton Heights, New South Wales 2035, Australia
| | - Ryan Winters
- Department of Otolaryngology - Head & Neck Surgery, John Hunter Hospital, Lookout Road, New Lambton Heights, New South Wales 2035, Australia; Department of Otolaryngology-Head & Neck Surgery, Tulane University, New Orleans, LA, USA; Division of Plastic & Reconstructive Surgery, Tulane University, New Orleans, LA, USA.
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McDermott T, Amarneh M, Sato Y, Watal P, Charmi V, Fuortes M, Faruqui S, Sato TS. Pediatric focal calvarial lesions: an illustrated review. Pediatr Radiol 2023; 53:2699-2711. [PMID: 37964037 DOI: 10.1007/s00247-023-05795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Focal skull lesions in children can be diagnostically challenging with a wide variety of potential etiologies. Understanding the diverse pathologies and recognizing their associated clinical and imaging characteristics is crucial for accurate diagnosis and appropriate treatment planning. We review pertinent anatomy of the scalp and calvarium and review different pathologies that can present with focal skull lesions in pediatric patients. These include neoplastic, non-neoplastic tumor-like, congenital, post traumatic, and vascular-associated etiologies. We review the key clinical and imaging features associated with these pathologies and present teaching points to help make the correct diagnosis. It is important for radiologists to be aware of the common and rare etiologies of skull lesions as well as the clinical and imaging characteristics which can be used to develop an accurate differential to ensure a timely diagnosis and initiate appropriate management.
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Affiliation(s)
- Tyler McDermott
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohammad Amarneh
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Yutaka Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pankaj Watal
- Department of Radiology, Nemours Children's Health, Orlando, FL, USA
| | - Vijapura Charmi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michaelangelo Fuortes
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sami Faruqui
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - T Shawn Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Cao J, Yang G, Chen Y, Wang Y, Shan Y, Xu S, Liu Y, Feng X, Liu S. Infantile Cranial Fasciitis: A Clinicopathologic Evaluation. J Craniofac Surg 2023; 34:1226-1230. [PMID: 36872515 PMCID: PMC10205113 DOI: 10.1097/scs.0000000000009234] [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] [Received: 08/15/2022] [Accepted: 11/05/2022] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE To investigate the clinicopathologic features, immunophenotype, molecular genetic changes, and differential diagnosis of cranial fasciitis (CF). METHODS The clinical manifestations, imaging, surgical technique, pathologic characteristics, special staining, and immunophenotype, as well as break-apart fluorescence in situ hybridization assay for USP6 of 19 CF cases were analyzed, retrospectively. RESULTS The patients were 11 boys and 8 girls, aged 5 to 144 months, with a median age of 29 months. There were 5 cases (26.31%) in the temporal bone, 4 cases (21.05%) in the parietal bone, 3 cases (15.78%) in the occipital bone, 3 cases (15.78%) in the frontotemporal bone, 2 cases (10.52%) in the frontal bone, 1 case (5.26%) in the mastoid of middle ear, and 1 case (5.26%) in the external auditory canal. The main clinical manifestations were painless, with the presentation of masses that grew rapidly and frequently eroded the skull. There was no recurrence and no metastasis after the operation. Histologically, the lesion consists of spindle fibroblasts/myofibroblasts arranged in bundles, braided or atypical spokes. Mitotic figures could be seen, but not atypical forms. Immunohistochemical studies showed diffuse strong positive SMA and Vimentin in all CFs. These cells were negative for Calponin, Desmin, β-catenin, S-100, and CD34. The ki-67 proliferation index was 5% to 10%. Ocin blue-PH2.5 staining showed blue-stained mucinous features in the stroma. The positive rate of USP6 gene rearrangement detected by fluorescence in situ hybridization assay was about 10.52%, and the positive rate was not related to age. All patients were observed for 2 to 124 months and showed no signs of recurrence or metastasis. CONCLUSIONS In summary, CF was a benign pseudosarcomatous fasciitis that occurs in the skull of infants. Preoperative diagnosis and differential diagnosis were difficult. Computed tomography typing might be beneficial for imaging diagnosis, and pathologic examination might be the most reliable way to diagnose CF.
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Affiliation(s)
- Juan Cao
- Department of Pathology, Shenzhen Children’s Hospital
| | - Guocheng Yang
- Department of Pathology, Shenzhen Children’s Hospital
| | - Yongxian Chen
- Department of Pathology, Shenzhen Children’s Hospital
| | - Yue Wang
- Department of Pathology, Shenzhen Children’s Hospital
| | - Yingying Shan
- Department of Pathology, Shenzhen Children’s Hospital
| | - Shoujun Xu
- Department of Radiology, Shenzhen Children’s Hospital
| | - Yuecheng Liu
- Department of Neurosurgery, Shenzhen Children’s Hospital
| | - Xia Feng
- Department of ultrasound, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, China
| | - Shuguang Liu
- Department of Pathology, The Eighth Affiliated Hospital, Sun Yat-sen University
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Yaprak Bayrak B, Sen HE, Eruyar AT, Etus V. Extremely rare occurrence of multiple cranial fasciitis: A case report. Neuropathology 2023; 43:95-99. [PMID: 35872600 DOI: 10.1111/neup.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
Cranial fasciitis (CF) is a rare, rapidly growing, benign fibroproliferative lesion of the skull in the pediatric population. It is characterized by benign mesenchymal proliferation of spindle cells arranged as short, intersecting loose fascicles within a fibromyxoid stroma, and mostly appears as a single mass. A surgical excision with clear surgical margins is definitively curative for CF. Up to date only two cases with multiple CF have been reported in the literature. In this report, we describe a 1-year-old girl with multiple locations of CF, as the first case to be reported in the Turkish population. The radiological and morphological findings of our case were comparable with the observations of the two previous reports in the literature. Histopathological examination remains to be the gold-standard for differential diagnosis of CF, as the treatment of this lesion differs from other malignancies of the skull in the pediatric population.
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Affiliation(s)
- Busra Yaprak Bayrak
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Harun Emre Sen
- Department of Neurosurgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ahmet Tugrul Eruyar
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Volkan Etus
- Department of Neurosurgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Xiang Y, He S, Zhou Z, Gan Q, Jin K. Cranial fasciitis in children: clinicoradiology features and management. BMC Pediatr 2022; 22:551. [PMID: 36114476 PMCID: PMC9482288 DOI: 10.1186/s12887-022-03610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cranial fasciitis (CF) is a rare benign fibroproliferative lesion of the skull. To date, the summarized radiologic characteristics and the subtype of the disease have not been reported. our purpose was to summarize the characteristic clinicoradiology features and management of CF and to improve the knowledge of radiologists and clinicians. Methods We searched our institution’s database and retrieved the clinical and radiologic data of CF patients confirmed by histopathological examination. The clinicoradiology features and management of CF were analysed retrospectively. Results A total of 14 CF patients were included. A total of 85.7% of the patients presented with a painless, firm, nonmobile and single mass. Tenderness and multiple masses were found in 14.3% of the patients. The mass was clearly increased in 2 patients and gradually increased in 5 patients in the short term. We divided these patients into three types based on the CT characteristics. The characteristic features of type I (9 patients) presented as an expansive and osteolytic bone destruction with a soft tissue mass. Type II (2 patients) presented as a scalp mass with mild erosion of the outer skull plate. Type III (3 patients) presented as a scalp mass without skull destruction. All patients underwent surgical resection. For type I patients, craniectomy and cranioplasty were performed. For type II patients, complete excision of the scalp mass with local skull curettage was performed. For type III patients, complete excision of the scalp mass was performed. There were no cases of recurrence after follow-up. Conclusions CF usually presents as a painless, firm, nonmobile and single mass with a clear boundary. There are generally three types of MSCT findings: bone destruction with a soft tissue mass, a scalp mass with erosion of the skull and a scalp mass. Different management strategies should be utilized for the various types of CF.
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Malik F, Bernieh A, El Jamal SM, Saad AG. Cranial Fasciitis in Children: Expanding the Spectrum of USP6-Associated Clonal Transient Neoplasms. Pediatr Dev Pathol 2022; 25:304-315. [PMID: 35686345 DOI: 10.1177/10935266211063989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cranial fasciitis (CF) is a benign (myo)fibroblastic proliferation of children. Typical presentation consists of a rapidly growing solitary mass on the temporal or parietal cranium in the first 2 years of age. CF is characterized by a rapid growth followed by a relative slowdown and even growth arrest. The finding of somatic USP6 gene rearrangements demonstrating clonality in CF together with its clinical behavior places it in the category of diseases recently termed "transient neoplasia."Methods: Histological, immunohistochemical, and molecular findings of 18 patients with CF were retrospectively studied.Results: The tumor typically presented as a painless rapidly enlarging mass in the temporal region. Sixty-six percent of the cases harbored USP6 gene rearrangement. Nine patients were treated with gross total resection (GTR) and 9 with subtotal tumor resection (STR). Two patients treated with GTR had recurrence. Five patients treated with STR had progression-free disease for at least 10 months after surgery and in four patients the tumor regressed spontaneously a median 16 months after surgery.Conclusions: In this largest series to date, we reported the clinicopathological, immunohistochemical, and molecular findings of 18 pediatric cases of CF with emphasis on the clinical growth pattern of these tumors.
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Affiliation(s)
- Faizan Malik
- Department of Pathology and Laboratory Medicine, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anas Bernieh
- Division of Pathology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Siraj M El Jamal
- Department of Pathology, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali G Saad
- Department of Pathology, 12235University of Miami Miller School of Medicine, Miami, FL, USA
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Morimoto A, Shioda Y, Sakamoto K, Imamura T, Imashuku S. Bone lesions of Langerhans cell histiocytosis triggered by trauma in children. Pediatr Int 2022; 64:e15199. [PMID: 35770832 DOI: 10.1111/ped.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone lesions of Langerhans cell histiocytosis (LCH) may be triggered by trauma. METHODS The characteristics of pediatric patients in the JLSG-02 study cohort who developed a bone lesion at the trauma site at diagnosis of LCH were analyzed retrospectively. RESULTS Of the 261 pediatric patients with LCH, 12 (4.6%), of median age 4.9 years, had trauma-triggered bone LCH lesions at diagnosis, making them significantly older than the remaining patients (P = 0.006). Trauma sites included the craniofacial regions in 10 patients and the lumbar spine and pelvis in one patient each. At the time of trauma, six patients had a bump at the site, whereas none had extradural hematomas or bone fractures. The median time from trauma to onset was 4 weeks. Of these 12 patients, three had isolated bone (IB) disease; four had multifocal bone (MFB) disease, including the bone lesion at the trauma site; and five had multisystem disease, including four with lesions in neighboring tissue and one with polyuria (posterior pituitary lesion) more than 1 year before the trauma-triggered bone lesion. Treatment responses were good in all 12 patients and none died, but relapses were observed in two patients, one each with IB and MFB disease. CONCLUSIONS About 5% of pediatric patients with LCH developed new trauma-triggered bone lesions at a relatively old age. These lesions can manifest as IB, or, in patients with underlying LCH diseases, as MFB or multisystem. Good clinical outcomes were observed in these patients.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Showa Innan General Hospital, Komagane, Japan.,Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsaku Imashuku
- Department of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
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Nodular fasciitis occurring at the anterior abdominal wall in a 12-year-old female. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Craniofacial fasciitis of the face: Case report and review of the recent literature. Int J Pediatr Otorhinolaryngol 2020; 138:110389. [PMID: 33152980 DOI: 10.1016/j.ijporl.2020.110389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Craniofacial fasciitis (CFFF) an uncommon, benign pseudosarcomatous proliferation of unknown etiology that occurs almost exclusively in children less than 6 years old. CFF lesions occur most frequently in the deep fascial layers and the periosteal layer of the calvarium, resulting in a rapidly enlarging scalp mass with potential underlying bony erosion. Presentation of CFF on the midface is rare. OBJECTIVE The objective of this report is to describe a case of paranasal CFF involving the nasolacrimal duct in an infant and perform a literature review of cases of CFF of the midface in children. METHODS A literature review of children ≤18 years old who were diagnosed with CFF of the midface was performed. A single case report is presented. RESULTS A 7-month-old girl presented with a rapidly enlarging facial mass with edema, epiphora, difficulty breathing, and issues with feeding. She underwent urgent biopsy which revealed spindle cells with fibrous background. Patient was diagnosed with paranasal CFF based on clinical presentation and pathology report. She subsequently underwent near complete surgical excision. Patient is doing well with no progression of disease with follow up MRI revealing minimal residual disease in the nasal cavity. Review of the literature identified 4 additional cases of CFF of the midface which presented on sites including the mandible, frontonasal region, nasal process of the maxilla, and orbit/maxilla. The patient in this case is the first presentation of CFF involving the nasolacrimal duct. Lesions presented anywhere from 2 days to 3 months prior to treatment, and immunohistochemistry was positive for either vimentin or beta-catenin. Interestingly, all cases in this series occurred within the first year of life and were treated with complete or near complete resection with no evidence of recurrence. CONCLUSION Although CFF is a rare diagnosis, it should be considered in the evaluation and treatment of soft-tissue masses of the midface in children. Surgical excision is curative and there appears to be a low rate of recurrence based on the small series presented in literature.
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Villamil V, Riba Martínez M, Bejarano Serrano M, Parri Ferrandis FJ. [Cranial fasciitis. Report of a clinical case]. An Pediatr (Barc) 2020; 96:S1695-4033(20)30432-X. [PMID: 33127341 DOI: 10.1016/j.anpedi.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Vanesa Villamil
- Sección de Cirugía Plástica, Servicio de Cirugía Pedíatrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - Mireia Riba Martínez
- Sección de Cirugía Plástica, Servicio de Cirugía Pedíatrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Miguel Bejarano Serrano
- Sección de Cirugía Plástica, Servicio de Cirugía Pedíatrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Francisco José Parri Ferrandis
- Sección de Cirugía Plástica, Servicio de Cirugía Pedíatrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Soft Tissue Special Issue: Fibroblastic and Myofibroblastic Neoplasms of the Head and Neck. Head Neck Pathol 2020; 14:43-58. [PMID: 31950474 PMCID: PMC7021862 DOI: 10.1007/s12105-019-01104-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/18/2019] [Indexed: 12/17/2022]
Abstract
Fibroblastic and myofibroblastic neoplasms of the head and neck encompass a group of rare tumor types with often overlapping clinicopathologic features that range in biologic potential from benign to overtly malignant. Even neoplasms with no metastatic potential may provide significant therapeutic challenges in this region due to the unique anatomy of the head and neck. This review will cover the following entities, highlighting important clinical aspects of each neoplasm and then focusing on their characteristic histomorphology, immunophenotype, and molecular alterations: nodular and cranial fasciitis, fibrous hamartoma of infancy, nasopharyngeal angiofibroma, nuchal-type and Gardner fibromas, desmoid fibromatosis, dermatofibrosarcoma protuberans and giant cell fibroblastoma, solitary fibrous tumor, inflammatory myofibroblastic tumor, low-grade myofibroblastic sarcoma, infantile fibrosarcoma, low-grade fibromyxoid sarcoma, and sclerosing epithelioid fibrosarcoma. While some of these neoplasms characteristically arise in the head and neck, others are rarely described in this anatomic region and may therefore be particularly difficult to recognize. Distinction between these entities, however, is crucial, particularly as the molecular pathogenetic basis for these neoplasms are being rapidly elucidated, in some instances allowing for targeted therapeutic approaches.
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