Nodular fasciitis of the parotid gland: A challenging diagnosis on FNA

Abstract

BACKGROUND: Nodular fasciitis (NF) is a clonal, self-limited proliferation that has only rarely been described in the parotid gland. Because of its potential to mimic benign and malignant parotid neoplasms clinically, radiographically, and cytomorphologically, NF is often managed with unnecessary surgery, which is associated with a risk for significant surgical complications. The purpose of this study is to present the clinical and cytomorphologic findings for NF of the parotid gland by fine-needle aspiration (FNA). METHODS: The pathology archives of the authors' respective institutions were searched for salivary gland FNA cytology specimens with a confirmed diagnosis of NF. The clinical history, pathologic diagnosis, cytomorphologic findings, and immunocytochemical results were recorded. RESULTS: A total of 15 cases were identified; the average age was 37 years, and 10 patients (66.7%) were female. Five cases (33.3%), all treated surgically, showed recurrence within an average timeframe of 1.6 months. Only 3 cases (20.0%) were classified as definitive, probable, or suggestive of NF. On average, smears were composed of predominantly single (69.2%), spindled cells (100.0%) with short unipolar (76.9%) and/or bipolar processes (38.5%), round (61.5%) or elongated (84.6%) nuclei, and inconspicuous nucleoli (53.8%). In 69.2%, a tissue-culture appearance was shown, and 76.9% contained myxoid stroma. In 46.2%, a minimal amount of cytologic atypia was shown. CONCLUSIONS: Keeping NF in the differential for any bland, single, spindled cell proliferation with elongated cytoplasmic processes and bland nuclei may prompt the clinician to consider more conservative management in the correct clinical context. Cancer Cytopathol 2018;126:872-880.

Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

“…In this study, there were 4 nonneoplastic cases on surgical follow‐up that were diagnosed in the benign neoplasm category, including a benign squamous‐lined cyst, sialadenitis, nodular oncocytic hyperplasia, and nodular fasciitis, the last of which was misclassified because of the predominance of adjacent abnormal‐appearing salivary gland tissue in the FNA material. However, nodular fasciitis is recognized to be a challenging diagnosis on FNA and can mimic primary salivary gland neoplasms in the parotid gland 25,26 . Although there have been a number of studies assessing the performance of the MSRSGC, most of the literature provides data at the category level and does not break down the diagnostic accuracy for specific diagnoses or differentials.…”

Development and Validation of a Novel Prognostic Nomogram Combined With Desmoplastic Reaction for Synchronous Colorectal Peritoneal Metastasis

“…The potential for tumor growth and metastasis may depend on how tumor cells benefit by reshaping the stroma through different molecular mechanisms. Keloid-like collagen and myxoid stroma are distinct fibrotic stroma features formed by activated CAFs, although these features can also be seen in non-malignant diseases ( 31 , 32 ), such as inflammatory responses to infection and benign tumors. However, the present study found that these features are mainly located in the front of the primary tumor of colorectal cancer.…”

Nodular fasciitis of the submandibular gland

“…Nodular fasciitis is a benign proliferating fibroblastic tumour which is most commonly found in the upper arms but can be found in any part of the body including the salivary gland 1. Majority of nodular fasciitis lesions in the salivary gland have been reported to be intraparotid 2. Nodular fasciitis most commonly presents in adults of age 20–50 years 3 4.…”