Dermal nodular fasciitis: three case reports of the head and neck and literature review

Abstract

Nodular fasciitis is a benign reactive myofibroblastic proliferative process of unknown etiology. It presents as a solitary painless, rapidly growing nodule over several weeks' duration. The condition is self-limited, and proper diagnosis is essential to avoid unnecessary aggressive treatment. Diagnosis is often a challenge because it may be confused with a malignant tumor due to its aggressive clinical behavior and histological features. Immunohistochemical staining can be a useful tool to aid in the diagnosis. Although most commonly located on the extremities and then the trunk, it is estimated that the head and neck region represents only 10 to 20%. The majority of cases arise in the soft tissue, i.e. fascia, muscle, or subcutaneous tissue. Interestingly, cases in the head and neck region often involve dermal tissue. There have been five separate reports documenting rare cases of dermal nodular fasciitis in the dermatopathology literature and one case series involving 28 of 50 dermal variants from the external ear region. We report three additional cases of dermal nodular fasciitis occurring on the left cheek, base of the scalp, and right medial canthus.

Nodular fasciitis of the external auditory canal in six Egyptian children

“…Goodlad and Fletcher documented the first case of dermal nodular fasciitis in 1990 [7]; 7 cases have since been documented in the English dermatopathologic literature, and 28 additional cases of dermal nodular fasciitis in the otorhinolaryngic literature involving the external ear region [2].…”

“…However, the condition is self-limited, and proper diagnosis is essential to avoid unnecessary aggressive treatment [2].…”

“…They also suggested that recurrence may be due to wrong diagnosis and the recurrent lesion should be considered a neoplastic mass from the start. However Nishi et al [2] reported that the majority of recurrences are in children, and of these recurrences, the location is usually involving the auricle. In our study, we reported recurrence in two cases that needed reremoval without recurrence till the end of the follow up period.…”

“…Some authors [2,10] treated nodular fasciitis with injection of intralesional steroids and they achieved complete recovery while others [10,11] used the same method of treatment without recovery and the mass remained unchanged even after two injections. However, spontaneous regression -either after biopsy or incomplete removal -has been reported [2,12].…”

Neonatal nodular fasciitis of the larynx

“…This pseudosarcomatous soft tissue tumor occurs mostly in the subcutaneous fat and fascia of the upper extremities in adults [10]. Fifteen percent of cases occur in the subcutaneous tissues of the head and neck, half of which are found in children, showing a predilection for this anatomical site in the younger population [11][12][13]. Most commonly, the cranium is involved [14], but other sites such as the external auditory canal [15], dermis and the eyelids have been described [12,16].…”