Nodular Fasciitis: Differential Considerations and Current Management Strategies

• Published in: The American surgeon Vol. 75; no. 7; pp. 610 - 614
• Main Authors: GROBMYER, Stephen R, KNAPIK, Jacquelyn A, FOSS, Robin M, COPELAND, Edward M, HOCHWALD, Steven N
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Atlanta, GA Southeastern Surgical Congress 01.07.2009; SAGE PUBLICATIONS, INC
• Subjects: Biological and medical sciences; Biopsy; Breast implants; Clinical trials; Diagnosis, Differential; Fasciitis - complications; Fasciitis - diagnosis; Fasciitis - surgery; Female; General aspects; Humans; Mammography; Medical imaging; Medical sciences; Middle Aged; Patient care planning; Patients; Physical examinations; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sarcoma - diagnosis; Tomography; Transplants & implants; Medicine; Connective tissue disease; Skin disease; Clinical management; Treatment; Nodular fasciitis; Surgery; Systemic disease; Strategy
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313480907500714

Nodular fasciitis (NF) typically presents as an enlarging soft tissue mass with imaging characteristics that may be suggestive of soft tissue sarcoma or desmoid tumor. This presentation can make a correct diagnosis and management of patients with NF a challenge. We report our recent experience with two cases of NF that were both referred with a diagnoses of "soft tissue sarcoma." Patient 1 was a 46-year-old woman who had undergone breast augmentation and was referred with a rapidly growing firm mass on the left chest wall beneath the breast implant. Computed tomography of the chest noted the mass to be 8 cm x 11 cm in size displacing the implant laterally with no radiological involvement of the bony structures of the chest. Core biopsy was suggestive of inflammation only. Given the clinical suspicion of malignancy, the patient underwent resection of the mass with implant removal. Final pathology showed NF. Patient 2 was a 65-year-old woman referred with an enlarging tender 3-cm infraclavicular mass and a clinical diagnosis of "soft tissue sarcoma." Preoperative biopsy suggested NF. The patient underwent complete excision, which confirmed the diagnosis. These cases highlight the clinical issues associated with management of patients with NF. Current approaches to evaluation, diagnosis, and treatment of NF are discussed.