[P082] A case of intradermal nodular fasciitis

( Shinwon Hwang ),( Jun Young Kim ),( Sang Kyum Kim ),( Sang Ho Oh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Nodular fasciitis is a rapidly growing benign lesion, presenting with a solitary tender subcutaneous nodule. Nodular fasciitis usually occurs in the subcutaneous layer and less often in muscle. However, it is rarely reported that nodular fasciitis is developed in the dermis. We report a case of intradermal nodular fasciitis, which has not regressed spontaneously for 1 year. A 41-year-old male without other medical history visited to our clinic due to solitary 1.8 x 1.5cm sized erythematous protruded mass on the right chest for 1 year. Skin specimen revealed that a well demarcated lesion was observed in the intradermal area beneath epidermis and the mass consisted of plump spindle cells with ovoid, vesicular nuclei embedded in a loosely structured stroma with capillaries and scattered erythrocytes in dermis. Final diagnosis reached to intradermal nodular fasciitis. Although nodular fasciitis is regressed spontaneously, the lesion of this patient have increased in sized and was accompanied with pain. Therefore, excision was performed. Intradermal nodular fasciitis is situated primarily in the dermis and and shows well circumscribed feature without capsulation. Dermatologists should perceive that nodular fasciitis can rarely occur in dermal area.

관골 주위 피하층에 발생한 결절성 근막염의 증례보고

양동현,차인호,양우익,김진,육종인,김현실 대한구강악안면병리학회 2011 대한구강악안면병리학회지 Vol.35 No.6

Nodular fasciitis is defined by the World Health Organization as a benign proliferative fibroblastic lesion. It was first described in 1955 by Konwaler et al. and also known as “nodular pseudosarcomatous fasciitis” and “infiltrative fasciitis”, which reflect the lesion’s rapid growth, dense cellularity, alarming mitotoic activity and lack of circumscription. Here, we report a case of nodular fasciitis, which appeared as subcutaneous mass of right perizygoma area in 40-year-old Korean female. She had no history of trauma or cosmetic surgery related with the lesion. She disclosed that the mass grew rapidly for last 2 months. Computed tomography showed relatively well-defined spherical mass with 1.2 cm in diameter. Under local anesthesia the mass was resected by intraoral approach. The histological examination revealed a relatively poor-dermacated mass with high cellularity, which was composed with infiltrative spindle-shaped cells without accompanying inflammatory reactions. The tumor cells were partially positive for α-smooth muscle actin and β-catenin, but negative for cytokeratin AE1/3, S-100, desmin, and CD34. Therefore, the lesion was pathologically diagnosed as nodular fasciitis. Although nodular fasciitis is known to pseudosarcomatous benign reactive lesion, the clinician need to follow up the patient periodically. The reasons are as follows; Nodular fasciitis may accompany nuclear accumulation of β-catenin, which imply neoplastic process rather than reactive process of the lesion. Moreover, it has many histological similarities with inflammatory myofibroblastic tumor which have malignant transformation tendency. Further research for mesenchymal tumor could help our understanding for the disease entity of nodular fasciitis

Expression of HuR and Cyclooxygenase-2 in Nodular Fasciitis and Low-Grade Sarcoma: An Immunohistochemical Study

손현진,백태화,이승윤,김주헌,강동욱,이혜경,박미자 대한병리학회 2014 Journal of Pathology and Translational Medicine Vol.48 No.4

Background: Nodular fasciitis is the most common reactive mesenchymal lesion to be misidentified as a type of sarcoma. HuR is an mRNA-binding protein that can stabilize cyclooxygenase-2 (COX-2) mRNA leading to COX-2 overexpression. The aim of this study is a comparison of the expressions of COX-2 and HuR and the relationships between their expressions and the clinicopathologicalparameters in nodular fasciitis and low-grade sarcoma. Methods: We measured the expression of HuR and COX-2 in 21 cases of nodular fasciitis and 37 cases of low-grade sarcoma using immunohistochemistry. Results: The frequency of cytoplasmic immunoreactivity for HuR was 5 of 21 cases of nodular fasciitis (23.8%) and 23 of 37 cases of low-grade sarcoma (62.1%) (p=.013). COX-2 expression was moderate or strong in nodular fasciitis (12/21, 57.1%) and in low-grade sarcoma (29/37, 78.4%) (p=.034). In addition, a significant difference existed between these two entities in terms of the relationship between moderate or strong COX-2 expression and HuR cytoplasmic immunoreactivity (p=.009). Moderate or strong COX-2 immunoreactivity correlated with nuclear (p=.016) or cytoplasmic HuR (p=.024) expression in low-grade sarcoma but not in nodular fasciitis. Conclusions: This study suggests that HuR and COX-2 expression may be useful to differentiate nodular fasciitis from low-grade sarcoma.

육종과 감별이 필요한 후경부의 결절성 근막염 - 증례 보고-

김승환,김정수,남경한 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: A case report. Objectives: Nodular fasciitis is a non-neoplastic soft-tissue lesion located in the deep subcutaneous region; it may be misdiagnosed as a malignant tumor due to its rapid growth and microscopic characteristics. We introduce an unusual case of nodular fasciitis which presented as a posterior neck mass. Summary of Literature Review: Nodular fasciitis is an unusual benign lesion.Becaue it sometimes shows aggressive microscopic characteristics, (being hypercellular and polymorphic), the condition has the potential to be misdiagnosed as sarcoma. Materials and Methods: A 20-year-old woman presented with a 1-month history of a progressively enlarging mass on her posterior neck. Computed tomography (CT) scans of the neck showed a markedly enhanced, well-defined, ovoid soft tissue mass at the posterior of the spinous process of C2. The patient underwent marginal excision. There was a 2 cm, well–capsulated, pinkish-gray mass. Results: She recovered without any complications. Histopathologic examination showed a spindle cell proliferation, increased cellularity, and nuclear atypia with mitosis. The immunohistochemistry stain showed negative findings. The mass was diagnosed as nodular fasciitis. Conclusions: A diagnosis of nodular fasciitis, not just malignant tumor, should be considered for a rapidly growing posterior neck mass showing aggressive microscopic appearance, Nodular fasciitis is a self-limiting lesion readily treated by marginal excision. However, follow-ups should be increased to watch for recurrence. 연구계획: 증례보고적: 결절성 근막염은 피하조직에 발생하는 비종양성 연부조직 질환으로 조직학적 특성과 빠른성장속도 때문에 육종으로 오진되는 경우가 있다. 육종과 감별해야 했던 후경부에서 발생한 결절성 근막염의 증례를 보고하고자 한다. 선행문헌의 요약: 결절성 근막염은 양성 병변이지만 병리소견에서 악성의 특성을 보이기도 하기때문에 육종으로 오진될 가능성이 있다. 대상 및 방법: 20세 여자가 1개월 전부터 커진 후경부 종양으로 내원했다. 목경추부 전산화단층촬영(CT)에서는 2번 경추 가시돌기 후방으로 조영증강잘 되며 경계가 명확한 타원형의 연부조직종양으로 경계부위 절제술을 시행하였다. 결과: 조직병리 검사에서 방추세포증식이 관찰되었고 유사분열과 동반된 비정청 핵 및 세포의 증가가 보였으나 면역조직화학검사에서는 특이사항이없었다. 이 병변은 최종적으로 결절성 근막염으로 진단되었다. 수술 후 환자는 합병증 없이 회복되었으며 현재까지 재발의 증거도 없다. 결론: 본 증례와 같이 머리와 목 부위에서 발생하여 빠르게 성장하는 연부조직종양으로 조직학적으로 악성 종양의 특성을 보일 경우에는 악성 연부조직 종양 뿐만 아니라 결절성 근막염도 고려해야 한다. 결정성 근막염은 경계부위 절제술 후 자기한정성으로 치료되는 양성 질환이나 재발에 대한 추적이 필요하다.

관골 주위 피하층에 발생한 결절성 근막염의 증례보고

양동현,차인호,양우익,김진,육종인,김현실 대한구강악안면병리학회 2011 대한구강악안면병리학회지 Vol.35 No.6

Nodular fasciitis is defined by the World Health Organization as a benign proliferative fibroblastic lesion. It was first described in 1955 by Konwaler et al. and also known as “nodular pseudosarcomatous fasciitis” and “infiltrative fasciitis”, which reflect the lesion’s rapid growth, dense cellularity, alarming mitotoic activity and lack of circumscription. Here, we report a case of nodular fasciitis,which appeared as subcutaneous mass of right perizygoma area in 40-year-old Korean female. She had no history of trauma or cosmetic surgery related with the lesion. She disclosed that the mass grew rapidly for last 2 months. Computed tomography showed relatively well-defined spherical mass with 1.2 cm in diameter. Under local anesthesia the mass was resected by intraoral approach. The histological examination revealed a relatively poor-dermacated mass with high cellularity, which was composed with infiltrative spindle-shaped cells without accompanying inflammatory reactions. The tumor cells were partially positive for α-smooth muscle actin and β-catenin, but negative for cytokeratin AE1/3, S-100, desmin, and CD34. Therefore, the lesion was pathologically diagnosed as nodular fasciitis. Although nodular fasciitis is known to pseudosarcomatous benign reactive lesion, the clinician need to follow up the patient periodically. The reasons are as follows; Nodular fasciitis may accompany nuclear accumulation of β-catenin, which imply neoplastic process rather than reactive process of the lesion. Moreover, it has many histological similarities with inflammatory myofibroblastic tumor which have malignant transformation tendency. Further research for mesenchymal tumor could help our understanding for the disease entity of nodular fasciitis.

A nodular fasciitis developed on the temple

( Min-jeong Kang ),( Ji-hoon Lim ),( Yae-jin Lee ),( Bark-lynn Lew ),( Woo-young Sim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Soft tissue masses with or without tenderness on the scalp are commonly encountered in clinical practice. The most likely diagnoses still remain as epidermoid cysts, sebaceous cysts and benign lipomas. However, clinicians should recognize of other possible, though uncommon, pathologies as differential diagnoses. We hereby present a case of soft scalp mass which was mis-diagnosed as benign lipoma until clarified by histological confirmation to be a nodular fasciitis. A 35-year-old man visited our dermatologic clinic with a 2-month history of a progressively enlarging subcutaneous nodule on the right temporal area. He complained of tenderness on the mass, although he had no trauma history. Ultrasonography revealed a well-defined mass, 2.2 x 2.2m in size, which was projecting slightly into the subcutaneous fatty tissue from the deep muscle layer. We planned a complete local excision with suspicion of intramuscular lipoma. However, during our surgical procedure, we identified a mass attached to the fascia, and we performed excisional biopsy with suspicion of nodular fasciitis and confirmed a nodular fasciitis on the histopathology. In our case, the intramuscular lipoma was suggested more on the preoperative ultrasonography, so we could not place a nodular fasciitis in the first among possible diagnosis. Therefore, clinicians need to consider a nodular fasciitis if there is a relatively rapidly growing mass with tenderness on the scalp.

Nodular Fasciitis with Cortical Erosion of the Hand

박진성,박형빈,이종실,나재범 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.1

Nodular fasciitis is a benign, reactive myofi broblastic tumor that is often mistaken for a sarcoma because of its histological appearanceand rapid growth. Involvement of a fi nger is extremely rare. We report a case of nodular fasciitis of the thumb, accompaniedby bone erosion. Magnetic resonance fi ndings suggested the possibility of a malignancy, which could have led to misdiagnosisas a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confi rmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarilyaggressive surgery, nodular fasciitis must be included in the differential diagnosis for any fi nger lesion that resembles asarcoma, even if bone erosion is present.

Nodular Fasciitis with Cortical Erosion of the Hand

Park, Jin Sung,Park, Hyung Bin,Lee, Jong-Sil,Na, Jae-Boem 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.1

<P>Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.</P>

안와주위에 발생한 결절근막염 3예

박민선(Min Seon Park),권미정(Mi Jung Kwon),이민정(Min Joung Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.12

목적: 안와주위에 발생한 종괴를 주소로 내원하여 결절근막염을 진단 받은 3예를 보고하고자 한다. 증례요약: 18세 남자 환자가 3개월 전에 발견한 왼쪽 눈썹 옆 관자놀이 부위의 종괴를 주소로 내원하였다. 이학적 검사상 20 mm 크기의 피부밑 종괴가 촉지되었다. 자기공명영상에서 T1에서 isointensity, T2에서 hyperintensity를 보이며 조영증강이 잘 되는 고형 종괴로 나타났다. 36세 남자가 6개월 전부터 시작된 우측 위눈꺼풀 종괴를 주소로 내원하였다. 이학적 검사상 우측 눈썹 중앙부 아래로 15 mm 크기의 피부밑 종괴가 촉지되었다. 안와 전산화 단층촬영에서 균일하고 주변조직과 구별이 잘 되는 종괴로 나타났으며, 중등도의 조영증강을 보였다. 3세 남자 환자가 4개월 전 시작된 우측 위눈꺼풀의 종괴로 내원하였다. 안과 검사상 위안와연 내측에 10 mm 크기의 종괴가 촉지되었다. 자기공명영상에서 조영증강이 잘 되는 부정형의 종괴를 나타내었다. 세 증례 모두 절제 생검을 시행하였고 병리조직검사 상에서 특징적인 방추형 세포의 증식과 함께, 면역조직화학검사에서 smooth muscle actin 양성, S-100 음성, CD34 음성 등의 특징을 보여 결절근막염으로 확진하였다. 각각 수술 후 4개월, 3개월, 48개월까지 경과관찰하였을 때 재발은 관찰되지 않았다. 결론: 결절근막염은 드물지만 안와 주위에 발생할 수 있으며, 특히 소아 및 청장년층에서 비교적 이환 기간이 짧은 피부밑 종괴의 감별진단으로 염두에 두어야 한다. Purpose: Herein, we report 3 cases of nodular fasciitis presenting with periorbital mass. Case summary: An 18-year-old male presented with a mass in his left lateral temple area 3 months in duration. On physical examination, a subcutaneous mass approximately 20 mm in size was palpable with upper eyelid swelling. Orbital magnetic resonance imaging (MRI) showed T1 isointensity and T2 hyper intensity and a well-circumscribed enhancing lesion. A 36-year-old male presented with a 6-month history of a bump under his right upper eyelid. External examination revealed a 15 mm-sized subcutaneous mass in the right central sub-brow area. Orbital computed tomography showed a homogenous, well-circumscribed mass with moderate enhancement. A 3-year-old boy presented with a mass in his right upper eyelid 4 months in duration. A subcutaneous mass approximately 10 mm in size was palpated at the medial superior orbital rim. Orbital MRI revealed an enhanced mass of irregular shape. Surgical excision was performed for all cases. Histopathological examination showed pathognomonic proliferation of spindle cells and immunohistochemical stains showed the spindle cells were positive for smooth muscle actin, negative for S-100 and negative for CD34, consistent with nodular fasciitis. Recurrence of the tumors after excision in the 3 cases was not observed after 4 months, 3 months and 48 months, respectively. Conclusions: Nodular fasciitis is rare but can occur at the periorbital region. In particular, nodular fasciitis should be considered as a differential diagnosis of a subcutaneous mass short in duration in children or young adults.

결막에 발생한 결절근막염 1예

김진호(Jin-ho Kim),나경선(Kyung Sun Na),박창현(Chang-hyun Park),이승진(Seung Jin Lee),오태훈(Tae Hoon Oh),김현승(Hyun Seung Kim) 대한안과학회 2020 대한안과학회지 Vol.61 No.3

목적: 국내에는 보고된 바 없는 결막에 발생한 결절근막염 1예를 보고하고자 한다. 증례요약: 18세 여자 환자가 1개월 간 크기가 증가하는 좌안 결막 종괴를 주소로 내원하였다. 종괴는 가로 1 mm, 세로 1.5 mm 정도의 크기의 경계가 뚜렷한 병변이었으며, 좌안 결막 코쪽구석에 위치하였고, 압통이나 발적은 없었다. 외상의 과거력 또한 없었다. 좌안 결막 종괴 절제 시행하였으며, 종괴의 공막 침범은 확인되지 않았고, 주변부 결막조직에도 특이 소견은 없었다. 면역조직화학검사상 S-100 음성, smooth muscle actin 양성 확인되었고, HHV8 PCR 검사 상에서는 음성이 확인되었다. 이는 본 증례의 병변이 근섬유모세포 기원임을 보여주는 결과이며, 본 증례의 조직학적, 조직면역학적 특징 및 임상 소견을 종합하여 최종적으로 위와 같은 조직면 역학적 특징을 보이는 결절근막염으로 진단할 수 있었으며, 종괴를 제거한 후 4개월 경과 상 재발 소견은 발견되지 않았다. 결론: 악성 종양 및 공막염과 같은 염증성 병변과 결절근막염의 치료 및 예후는 확연한 차이가 있기에 이러한 질환과의 감별은 수술적 절제만으로 예후가 양호한 결절근막염의 진단에 중요하다. Purpose: We report a case of nodular fasciitis of the conjunctiva that has not been previously reported in the Republic of Korea. Case summary: A 18-year-old female patient presented with a left conjunctival mass, which had been enlarging for 1 month. The tumor was located at the corner of the conjunctiva of the left eye. The size of the tumor was 1 mm in width and 1.5 mm in height, and tenderness and redness were not observed. There was no history of trauma, but bilateral upper lid blepharoplasty was performed 2 months prior to her visit. Excision of a conjunctival mass was performed and there was no evidence of involvement of the sclera or peripheral conjunctiva around the mass. We performed immunohistochemistry and PCR for human herpes virus 8(HHV8). Immunohistochemistry was positive for S-100 and negative for smooth muscle actin and HHV8. The mass was myofibroblastic in nature and the histopathological features and clinical findings of this case were diagnosed as nodular fasciitis with the features as described above. There was no recurrence for 4 months after removal of the mass. Conclusions: Because the treatments and prognoses of malignant tumors or other inflammatory diseases such as nodular scleritis and nodular fasciitis are quite different, differentiation from these diseases is considered an important factor in the diagnosis of nodular fasciitis.