Exulcerated, nodular tumor on the occiput of a 29-year-old patient

Abstract

Cranial fasciitis is a rare variation of nodular fasciitis that occurs in the region of the capillitium. We report on a 29-year-old patient who presented with a 2-month history of a tumor progressively increasing in size located on the occiput. Histological examination revealed a tumor, consisting of tightly packed spindle-shaped cells with underlying myxoid stroma, which extended from the dermis to the subcutis. Actin and vimentin were detected by immunohistochemistry. We established a diagnosis of cranial fasciitis and excised the tumor. Especially when a child or young adult presents with a tumor in the skull area, consideration should be given to cranial fasciitis in the differential diagnosis to avoid unnecessary and possibly very invasive treatment approaches.

Nodular fasciitis in cervicofacial region: a rare case description and literature review

“…In all the cases, nodular fasciitis presented as a unique, well‐circumscribed and non‐tender mass with a size that may vary between 5 mm and 88 mm. In 14 out of the 53 articles, the authors specified the nodular fasciitis subtype identifying: 5 cases of subcutaneous fasciitis, 7,10,27–29 4 cases of cranial fasciitis, 14,22,23,30,31 3 cases of intravascular fasciitis, 8,32,33 1 case of periosteal fasciitis 34 and 1 case of subepithelial myxoid fasciitis 35 . A total of 151 patients were asymptomatic, 3 suffered from pain 36 and 11 suffered from accessory symptoms, like diplopia, blurred vision, trismus, dyspnoea, proptosis, fever, masticatory deficiency and otorrhoea 2,4,19,26,31,33,36–40 …”

“…The nodular fasciitis diagnosis was generally based on a CT scan, sometimes associated with an MRI scan, ultrasound image and/or incisional biopsy. The gold standard therapy is surgical resection as documented by the literature 1,2,5–59 . In five cases, the authors preferred a wait‐and‐see approach, 3,11,60,61 while in another seven cases, the authors reported a spontaneous regression of the pathology 42 .…”