Mimickers of cysts

Ossifying fibromyxoid tumor of soft parts presenting as a scalp cyst

BACKGROUND

Ossifying fibromyxoid tumor of soft parts (OFMT) is a rare mesenchymal neoplasm of intermediate malignant potential. The tumor most commonly occurs on the extremities with a male predominance. We present an unusual case of OFMT occurring as a cystic lesion on the scalp of a female.

CASE HISTORY

A 67-year-old woman presented with a 6-year history of a well demarcated cystic scalp mass. Physical examination revealed a slightly movable, multilobular mass of the left parietal scalp which was subsequently excised. Histological evaluation revealed an OFMT comprised of bland, small cells and a thick collagenous capsule containing an incomplete rim of lamellar bone.

CONCLUSION

OFMT is an unusual tumor which can usually be considered as having an intermediate risk of malignancy. It generally occurs in the extremities with a male predominance. The clinical differential for a cystic mass on the scalp is broadened by this unusual case of an OFMT.

Intradermal nodular fasciitis presenting as an eyelid mass

BACKGROUND

Nodular fasciitis is a fibroblastic proliferation in which nodules, most commonly appearing on the extremities, develop suddenly and rapidly. Although excisional biopsy is curative, the nodules will often resolve spontaneously; however, the histologic appearance of a pleomorphic spindle cell neoplasm with frequent mitotic figures may raise concern of a more malignant neoplasm and lead to unnecessary and overly aggressive therapy.

METHODS

A case of nodular fasciitis presenting in an unusual location, intradermally at the lateral canthus, is discussed.

RESULTS

Review of the recent literature from other disciplines reveals new insights into the etiology and diagnostic options (fine needle aspiration, tomography, other imaging techniques) for this puzzling disease.

CONCLUSIONS

When nodular fasciitis occurs in an unusual location, such as on the head and neck or at an intradermal location, it will not present as the deep, mobile, nontender nodule described in the dermatologic literature. Fine-needle aspiration and modern imaging techniques may help in the diagnosis and prevent unnecessary surgery for a self-limited condition.