Nodular Fasciitis in a One-Year-Old Male: A Diagnostic Dilemma

Abstract

Objective: To present a rare case of nodular fasciitis presenting as a supra-auricular mass.
 
 Methods:
 Design: Case Report
 Setting: Private Tertiary University Hospital
 Patient: One
 
 Results: A one-year-old boy presented with an initially painless, left supra-auricular mass that rapidly enlarged from < 1 cm to 3 cm (widest diameter) in a two-month period. Sarcoma was initially considered over an inflammatory process as the mass was non-responsive to antibiotic therapy. Fine-Needle Aspiration Cytology (FNAC) and High-Resolution Computed Tomography (HRCT) with contrast revealed benign cytologic and radiologic findings making nodular fasciitis the primary impression.
 
 The patient eventually underwent complete surgical excision of the left supra-auricular mass. Histopathologic findings then showed a stroma rich in collagen and myxoid ground substance and loose array of short S-shaped fascicle cells with scattered lymphocytes, macrophages and red blood cells consistent with nodular fasciitis.
 
 Conclusion: Nodular fasciitis is a rare benign myofibroblastic soft tissue tumor which typically presents as a rapidly progressive nodular lesion in the head and neck region of the young pediatric age group. Cytopathologic recognition with FNA is a challenge. The gold standard of treatment is still surgical and in most reported cases, curative. More importantly, early clinical recognition and correlation with radiologic and histopathologic appearance is very important to avoid unnecessary work-ups and over-treatment.
 
 Keywords: Nodular fasciitis; pseudosarcomatous fasciits; aggressive fibromatosis, desmoid tumor