Nodular fasciitis
Updates to Article Attributes
Nodular fasciitis is a rapidly growing non-neoplastic soft-tissue tissue lesion that is frequently located in the deep subcutaneous region or in the fascia. The most common locations for nodular fasciitis are the volar aspect of the forearm, the lower extremity, and the chest and back. It is It typically manifestedmanifests as a rapidly growing mass.
Epidemiology
-
mostMost often
itnodular fasciitis occursinin patients between 20 and 40 years of age - but children also may be affected
Clinical presentation
-
in most cases (46In most cases (~45%) it is
localizedlocalised to the upper extremity, particularly the volar aspect of the forearm -
other. Other common sitesof manifestationare:-
thetrunk- 20(20%) - head and neck
- 18(18%) - lower extremities
- 16(16%
-
Symptoms of tenderness and pain are frequently described at presentation.
Pathology
The pathogenesis of nodular fasciitis is poorly understood. Some describe it as a reactive lesion related to trauma, others have described chromosomal abnormalities that are suggestive of a neoplastic origin
The lesions tend to be small (<4 cm).
Three.Three general subtypes of nodular fasciitis may be identified on the basis of the lesion location:
- subcutaneous
- intramuscular
- fascial
Most occurrences of nodular fasciitis are subcutaneous, fascia based, and circumscribed; these lesions may be amenable to biopsy or excision without any need for imaging evaluation.
Pathology
Histology
Benign proliferation of fibro-blastsfibroblasts and myofibroblasts, typically mistaken for a sarcomatous lesion because of its rapid growth, abundant spindle-shaped cells, and mitotic activity.
Pathogenesis
The pathogenesis of nodular fasciitis is poorly understood. Some describe it as a reactive lesion related to trauma, others have described chromosomal abnormalities that are suggestive of a neoplastic origin
Radiographic features
Ultrasound
Sonography can show one or more well-defined isoechoic to hypoechoic nodules with mildly increased increased vascular flow in the deep portion of the subcutaneous fat layer, adjacent to or in the fascia.
MRI
Nodular fasciitis may be categorized as myxoid, cellular, or fibrous. This histologic diversity likely accounts for the variable MR imaging appearance of the lesions. :
-
hypercellular lesions appears nearly isointense to that in skeletal muscle on
T1-weighted imagesT1WI and hyperintense to that in adipose tissue onT2-weighted imagesT2WI - highly collagenous lesions have hypointense signal on all sequences
- contrast enhancement is typically diffuse but may be peripheral
Treatment and prognosis
The imaging-based diagnosis should be verified with an excisional biopsy.
Treatment and prognosis
-
treatmentTtreatment typically consists of marginal excision of the lesion(s)
-
several. Several weeks of observation (after a diagnosis based on the results of percutaneous fine-needle biopsy) also have been advocated given the self-limited course of the disease -
spontaneousSpontaneous
regression and involution of lesions in response to steroid injections have been reported
Differential diagnosis
Imaging differential considerations include
- Dupuytren's disease (palmar fibromatosis)
- extra-abdominal desmoid tumor
- neurofibroma
- fibrous histiocytoma
- soft
-tissuetissue sarcoma - if
intramuscular -intramuscular early myositis ossificans may be considered
-<p><strong>Nodular fasciitis</strong> is a rapidly growing non-neoplastic soft-tissue lesion that is frequently located in the deep subcutaneous region or in the fascia. The most common locations for nodular fasciitis are the volar aspect of the forearm, the lower extremity, and the chest and back. It is typically manifested as a rapidly growing mass.</p><h4>Epidemiology</h4><ul>-<li>most often it occurs in patients between 20 and 40 years of age</li>-<li>children also may be affected</li>-</ul><h4>Clinical presentation</h4><ul>-<li>in most cases (46%) it is localized to the upper extremity, particularly the volar aspect of the forearm</li>-<li>other sites of manifestation are:-<ul>-<li>the trunk - 20%</li>-<li>head and neck - 18%</li>-<li>lower extremities - 16%</li>-</ul>-</li>-</ul><p>Symptoms of tenderness and pain are frequently described at presentation. </p><p>The lesions tend to be small (<4 cm).</p><p>Three general subtypes of nodular fasciitis may be identified on the basis of the lesion location: </p><ul>- +<p><strong>Nodular fasciitis</strong> is a rapidly growing non-neoplastic soft tissue lesion that is frequently located in the deep subcutaneous region or in the fascia. The most common locations for nodular fasciitis are the volar aspect of the forearm, the lower extremity, and the chest and back. It typically manifests as a rapidly growing mass.</p><h4>Epidemiology</h4><p>Most often nodular fasciitis occurs in patients between 20 and 40 years of age but children also may be affected.</p><h4>Clinical presentation</h4><p>In most cases (~45%) it is localised to the upper extremity, particularly the volar aspect of the forearm. Other common sites are:</p><ul>
- +<li>trunk (20%)</li>
- +<li>head and neck (18%)</li>
- +<li>lower extremities (16%)</li>
- +</ul><p>Symptoms of tenderness and pain are frequently described at presentation.</p><h4>Pathology</h4><p>The pathogenesis of nodular fasciitis is poorly understood. Some describe it as a reactive lesion related to trauma, others have described chromosomal abnormalities that are suggestive of a neoplastic origin</p><p>The lesions tend to be small (<4 cm).Three general subtypes of nodular fasciitis may be identified on the basis of the lesion location:</p><ul>
-</ul><p>Most occurrences of nodular fasciitis are subcutaneous, fascia based, and circumscribed; these lesions may be amenable to biopsy or excision without any need for imaging evaluation. </p><h4>Pathology</h4><p>Benign proliferation of fibro-blasts and myofibroblasts, typically mistaken for a sarcomatous lesion because of its rapid growth, abundant spindle-shaped cells, and mitotic activity. </p><h5>Pathogenesis</h5><p>The pathogenesis of nodular fasciitis is poorly understood. Some describe it as a reactive lesion related to trauma, others have described chromosomal abnormalities that are suggestive of a neoplastic origin</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Sonography can show one or more well-defined isoechoic to hypoechoic nodules with mildly increased vascular flow in the deep portion of the subcutaneous fat layer, adjacent to or in the fascia.</p><h5>MRI</h5><p>Nodular fasciitis may be categorized as myxoid, cellular, or fibrous. This histologic diversity likely accounts for the variable MR imaging appearance of the lesions. </p><ul>-<li>-<strong>hypercellular lesions</strong> appears nearly isointense to that in skeletal muscle on T1-weighted images and hyperintense to that in adipose tissue on T2-weighted images </li>-<li>-<strong>highly collagenous lesions</strong> have hypointense signal on all sequences</li>-<li>-<strong>contrast enhancement</strong> is typically diffuse but may be peripheral </li>-</ul><p>The imaging-based diagnosis should be verified with an excisional biopsy</p><h4>Treatment and prognosis</h4><ul>-<li>treatment typically consists of marginal excision of the lesion(s)</li>-<li>several weeks of observation (after a diagnosis based on the results of percutaneous fine-needle biopsy) also have been advocated given the self-limited course of the disease</li>-<li>spontaneous regression and involution of lesions in response to steroid injections have been reported </li>-</ul><h4>Differential diagnosis</h4><p>Imaging differential considerations include </p><ul>-<li>Dupuytren's disease (<a href="/articles/palmar-fibromatosis" title="palmar fibromatosis">palmar fibromatosis</a>)</li>-<li>extra-abdominal <a href="/articles/desmoid-tumour" title="Desmoid tumor">desmoid tumor</a>- +</ul><p>Most occurrences of nodular fasciitis are subcutaneous, fascia based, and circumscribed; these lesions may be amenable to biopsy or excision without any need for imaging evaluation. </p><h5>Histology</h5><p>Benign proliferation of fibroblasts and myofibroblasts, typically mistaken for a sarcomatous lesion because of its rapid growth, abundant spindle-shaped cells, and mitotic activity.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Sonography can show one or more well-defined isoechoic to hypoechoic nodules with mildly increased vascular flow in the deep portion of the subcutaneous fat layer, adjacent to or in the fascia.</p><h5>MRI</h5><p>Nodular fasciitis may be categorized as myxoid, cellular, or fibrous. This histologic diversity likely accounts for the variable MR imaging appearance of the lesions:</p><ul>
- +<li>hypercellular lesions appears nearly isointense to that in skeletal muscle on T1WI and hyperintense to that in adipose tissue on T2WI</li>
- +<li>highly collagenous lesions have hypointense signal on all sequences</li>
- +<li>contrast enhancement is typically diffuse but may be peripheral</li>
- +</ul><h4>Treatment and prognosis</h4><p>The imaging-based diagnosis should be verified with an excisional biopsy.</p><p>Ttreatment typically consists of marginal excision of the lesion(s). Several weeks of observation (after a diagnosis based on the results of percutaneous fine-needle biopsy) also have been advocated given the self-limited course of the disease</p><p>Spontaneous regression and involution of lesions in response to steroid injections have been reported <sup>ref required</sup>. </p><h4>Differential diagnosis</h4><p>Imaging differential considerations include </p><ul>
- +<li>Dupuytren's disease (<a href="/articles/palmar-fibromatosis">palmar fibromatosis</a>)</li>
- +<li>extra-abdominal <a href="/articles/desmoid-tumour">desmoid tumor</a>
-<li><a href="/articles/neurofibroma" title="neurofibroma">neurofibroma</a></li>-<li><a href="/articles/benign-fibrous-histicytoma-of-bone" title="Benign Fibrous Histiocytoma">fibrous histiocytoma</a></li>-<li>soft-tissue sarcoma</li>-<li>if intramuscular - early <a href="/articles/myositis-ossificans-1" title="Myositis ossificans">myositis ossificans</a> may be considered </li>- +<li><a href="/articles/neurofibroma">neurofibroma</a></li>
- +<li><a href="/articles/benign-fibrous-histiocytoma-of-bone">fibrous histiocytoma</a></li>
- +<li><a title="Soft tissue sarcoma" href="/articles/soft-tissue-sarcoma-1">soft tissue sarcoma</a></li>
- +<li>if intramuscular early <a href="/articles/myositis-ossificans-1">myositis ossificans</a> may be considered</li>
References changed:
- 4. Kim S, Kim H, Park S, Baek C, Byun H, Kim Y. Nodular Fasciitis in the Head and Neck: CT and MR Imaging Findings. AJNR Am J Neuroradiol. 2005;26(10):2617-23. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976172">PMC7976172</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16286411">Pubmed</a>
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