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Yu SL, Sun PL, Li J, Jia M, Gao HW. Giant nodular fasciitis originating from the humeral periosteum: A case report. World J Clin Cases 2022; 10:1572-1579. [PMID: 35211594 PMCID: PMC8855249 DOI: 10.12998/wjcc.v10.i5.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 10/09/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nodular fasciitis (NF) is a self-limiting tumor that mostly occurs in the subcutaneous superficial fascia. NF originating from the appendicular periosteum is extremely rare. A large NF lesion of periosteal origin can be misdiagnosed as a malignant bone tumor and may cause overtreatment.
CASE SUMMARY A right axillary mass was found in a 46-year-old man and was initially diagnosed intraoperatively as low-grade sarcoma, but later diagnosed as NF after post-resection histopathological evaluation. Furthermore, fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement that confirmed the diagnosis. To the best of our knowledge, this is the first case of NF in the humeral periosteum.
CONCLUSION NF poses a diagnostic challenge as it is often mistaken for sarcoma. Postoperative histopathological examination of whole sections can be combined with immunohistochemical staining and, if necessary, the diagnosis can be confirmed by molecular detection, and thus help avoid overtreatment.
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Affiliation(s)
- Shi-Li Yu
- Department of Pathology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Ping-Li Sun
- Department of Pathology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jian Li
- Department of Pathology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Meng Jia
- Department of Pathology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Hong-Wen Gao
- Department of Pathology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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Jelin G, Forien M, Choudat L, Ottaviani S, Palazzo E, Quint R, Dieudé P. A fast-growing lesion of the lower limb after medically assisted procreation. Scand J Rheumatol 2017; 47:79-80. [PMID: 28573903 DOI: 10.1080/03009742.2017.1321780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- G Jelin
- a Department of Rheumatology , Bichat-Claude Bernard Hospital , Paris , France
| | - M Forien
- a Department of Rheumatology , Bichat-Claude Bernard Hospital , Paris , France
| | - L Choudat
- b Department of Anatomopathology , Bichat-Claude Bernard Hospital , Paris , France
| | - S Ottaviani
- a Department of Rheumatology , Bichat-Claude Bernard Hospital , Paris , France
| | - E Palazzo
- a Department of Rheumatology , Bichat-Claude Bernard Hospital , Paris , France
| | - R Quint
- a Department of Rheumatology , Bichat-Claude Bernard Hospital , Paris , France
| | - P Dieudé
- a Department of Rheumatology , Bichat-Claude Bernard Hospital , Paris , France
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4
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Shin C, Low I, Ng D, Oei P, Miles C, Symmans P. USP6gene rearrangement in nodular fasciitis and histological mimics. Histopathology 2016; 69:784-791. [DOI: 10.1111/his.13011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Christina Shin
- Histopathology Department; Middlemore Hospital; Auckland New Zealand
| | - Irene Low
- Histopathology Department; Middlemore Hospital; Auckland New Zealand
| | - Daniel Ng
- IGENZ Limited; Auckland CBD; Auckland New Zealand
| | - Paul Oei
- IGENZ Limited; Auckland CBD; Auckland New Zealand
| | - Carina Miles
- Histopathology Department; Middlemore Hospital; Auckland New Zealand
| | - Pennie Symmans
- Histopathology Department; Middlemore Hospital; Auckland New Zealand
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5
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Abstract
Nodular fasciitis (NF) is a benign proliferation of fibroblasts and myofibroblasts that rarely occurs in the periorbital region. We report what we believe to be the first case of periorbital NF associated with pregnancy. A case of intravascular fasciitis, a NF variant, has been reported during pregnancy, but it was not located in the periorbital region. A weak presence of estrogen receptors has been reported in NF. This may make it more susceptible to the hormone-related changes during pregnancy and contribute to the development of the lesion by stimulating fibroblasts and smooth muscle cell types. Although rare, NF should be considered in the differential diagnosis of periorbital soft-tissue masses arising during pregnancy.
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Affiliation(s)
- Brandon N Phillips
- Ophthalmology Service, Walter Reed Army Medical Center, Washington DC, USA
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Kakudo N, Morimoto N, Ogawa T, Hihara M, Koseki R, Kusumoto K. Elastofibroma dorsi: a case report with an immunohistochemical and ultrastructural studies. Med Mol Morphol 2015; 49:42-7. [DOI: 10.1007/s00795-015-0112-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/25/2015] [Indexed: 12/31/2022]
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8
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Chami R, Ertresvaag K, Azzie G, Thorner PS. Myofibroblastoma: report of a rare entity in the pediatric population. Pediatr Dev Pathol 2012; 15:499-506. [PMID: 22901100 DOI: 10.2350/12-05-1204-cr.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fibroblastic and myofibroblastic tumors constitute an important group of neoplasms in children and adolescents. These span the full spectrum of clinical behavior, ranging from benign to intermediate and malignant. We report a case of a benign mesenchymal tumor with myofibroblastic differentiation in a 9-year-old girl arising in the left groin that met the histologic features described for myofibroblastoma in adults. Two types are recognized in adults: angiomyofibroblastoma and mammary-type myofibroblastoma of soft tissue. Our case shared features of both these subtypes but was not typical of either one, and we therefore designated our case simply as "myofibroblastoma." Our case showed expression of estrogen receptor protein, which is characteristic of adult lesions, but not a deletion of 13q14, as has been reported in some adult cases. In the English-language literature, only 6 cases have been reported in patients under 21 years of age, and all but 1 were teenagers. Pediatric surgeons, oncologists, and pathologists should be aware that such a benign entity can occur in this patient population and could be confused with other lesions, including malignant ones.
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Affiliation(s)
- Rose Chami
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Canada
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9
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Azouz H, Nfoussi H, Chelly I, Chebbi F, Haouet S, Kchir N, Zitouna M. [A particular tumour of the shoulder]. Ann Pathol 2009; 29:516-8. [PMID: 20005444 DOI: 10.1016/j.annpat.2009.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Heifa Azouz
- Service d'anatomie et de cytologie pathologiques, hôpital La Rabta, 1007 Bab Saadoun, Tunis, Tunisie
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10
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Tosios KI, Economou I, Vasilopoulos NN, Koutlas IG. Elastofibromatous changes and hyperelastosis of the oral mucosa. Head Neck Pathol 2009; 4:31-6. [PMID: 20237986 PMCID: PMC2825534 DOI: 10.1007/s12105-009-0153-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 11/11/2009] [Indexed: 10/20/2022]
Abstract
Three cases of abnormalities of elastic fibers, two of them on the floor of the mouth and one on the lingual alveolar mucosa, close to the floor of the mouth, in a patient with history of homolateral squamous cell carcinoma of the floor of the mouth, are presented. Comparison with elastofibromatous changes and elastofibromas are made and their possible pathogenesis is discussed. It is suggested that increased awareness may facilitate recognition of such lesions as they can be easily overlooked, especially when they do not present as discrete tumors or they are associated with other "more significant" pathologic processes.
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Affiliation(s)
- Konstantinos I. Tosios
- Department of Oral Pathology and Surgery, School of Dentistry, National and Kapodestrian University of Athens, Athens, Greece
| | - Ioanna Economou
- Department of Oral Pathology and Surgery, School of Dentistry, National and Kapodestrian University of Athens, Athens, Greece
| | - Nektarios-Nikolaos Vasilopoulos
- Department of Oral Pathology and Surgery, School of Dentistry, National and Kapodestrian University of Athens, Athens, Greece
| | - Ioannis G. Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, 515 Delaware Street, SE #16-206B, Minneapolis, MN 55455 USA
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11
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Daum O, Ferda J, Curik R, Choc M, Mukensnabl P, Michal M. Elastofibromatous Changes in Tissues From Spinal Biopsies. A Degenerative Process Afflicting a Small but Important Subset Of Patients Operated for Spinal Canal Compression: Report of 18 Cases. Int J Surg Pathol 2009; 18:508-15. [DOI: 10.1177/1066896909339736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elastofibroma is a tumorlike lesion occurring usually in the subscapular region of elderly females. In this study, 18 cases of elastofibromatous tissue retrieved from the spinal canal were analyzed to elucidate its frequency and possible clinical associations. The patients included 8 men and 10 women with a mean age of 63.4 years (range, 40-84 years). The elastic nature of the material was confirmed by Weigert’s elastic stain and immunohistochemically. Elastofibroma was diagnosed in 6 patients, and elastofibroma-like tissue was found in 11 samples. The finding of elastofibromatous tissue was associated with clinical diagnosis of juxtaarticular cysts (3 cases), thickening of ligamentum flavum (4 cases), extradural expansion (2 cases), metastatic involvement of the dorsal spine (3 cases), and a vertebral fracture (1 case). Two cases were located above the transpedicular fixation. Elastofibromatous tissue may be found in approximately 2.6% of all spinal biopsies and it may take part in compression of spinal cord and nerve roots.
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Affiliation(s)
- Ondrej Daum
- Departments of Pathology, Medical Faculty Hospital, Charles University in Prague
| | - Jiri Ferda
- Radiology, Medical Faculty Hospital, Charles University in Prague
| | - Romuald Curik
- Medical Faculty in Plzen; Biopticka Laborator s.r.o (RC), Plzen, Czech Republic
| | - Milan Choc
- Neurosurgery (MC), Medical Faculty Hospital, Charles University in Prague
| | - Petr Mukensnabl
- Departments of Pathology, Medical Faculty Hospital, Charles University in Prague
| | - Michal Michal
- Departments of Pathology, Medical Faculty Hospital, Charles University in Prague,
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Dauendorffer JN, Ortonne N, Bodemer C, Brousse N, Fraitag S. Étude anatomoclinique de dix cas de fasciite nodulaire de l’enfant. Ann Dermatol Venereol 2008; 135:553-8. [DOI: 10.1016/j.annder.2008.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 05/16/2008] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Given its rarity, varied histological presentation and often pseudosarcomatous appearance, nodular fasciitis is frequently misdiagnosed on pre-operative, intra-operative and final analyses. METHODS Four cases of nodular fasciitis are reviewed. RESULTS Physical and radiological findings were consistent with a parapharyngeal tumour, probably neurogenic, a level four neck mass suspicious for lymphoma; a sternoclavicular mass in a patient with a history of breast cancer suspicious for metastasis; and a cheek mass consistent with an accessory parotid tumour. Fine needle aspiration results were consistent with a neurogenic tumour in two patients and an undifferentiated malignancy in two patients. Frozen section examination most commonly included masses with spindle-type cells. The final diagnosis of nodular fasciitis was made only after permanent section and immunohistological analysis. CONCLUSIONS In a patient with nonspecific results following investigation of a head or neck mass, nodular fasciitis should be considered. Use of appropriate immunohistochemical markers will aid in the final diagnosis.
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Gun BD, Bahadir B, Behzatoglu K, Gun MO, Ozdamar SO. Elastofibroma: a clinicopathologic and immunohistochemical study of seven cases and literature review. APMIS 2007; 115:115-9. [PMID: 17295677 DOI: 10.1111/j.1600-0463.2007.apm_525.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elastofibroma is a rare fibrous lesion characterized by accumulated abnormal elastic fibers whose etiology remains largely unknown. In this study, we analyzed seven cases of elastofibroma to further explore the characteristics of its cellular composition. Immunohistochemistry was performed for mast cell tryptase, S-100 protein, vimentin, CD34, smooth muscle actin, desmin and collagen type IV. Histochemical staining methods for Gomori's trichrome and Verhoeff elastica-van Gieson were also evaluated. Histopathologically, a haphazard array of collagen, eosinophilic amorphous fibers, and globules in a fibrous tissue was seen. The elastic nature of the fibers was confirmed by elastic stain, and with Gomori's trichrome collagen fibers were also demonstrated. The interspersed spindle or stellate cells were almost consistently positive for vimentin and frequently positive for CD34. Mast cell tryptase-positive cells were present in five of the cases. Collagen type IV immunoreactivity was seen in two cases. No staining was observed with smooth muscle actin, desmin or S-100 protein. Our findings suggest that CD34-positive mesenchymal cells are an integral component of elastofibroma.
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Affiliation(s)
- Banu Dogan Gun
- Department of Pathology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.
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15
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Anand A, Tsapakis EM, Narvani AA, Alhakim A, Cannon SR, Tsiridis E. "Pseudosarcoma" in a pregnant woman. World J Surg Oncol 2007; 5:7. [PMID: 17229326 PMCID: PMC1794242 DOI: 10.1186/1477-7819-5-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 01/18/2007] [Indexed: 11/22/2022] Open
Abstract
Background Intravascular fasciitis (IVF) is a rare benign condition characterised by reactive myofibroblastic proliferation arising from the superficial or deep fascia and involving arteries and/or veins. It is a distinct variant of the more common condition of nodular fasciitis, which possesses similar clinical and histological features to IVF, but lacks vascular invasion. A thorough review of the literature revealed 26 reported cases of IVF. Case presentation We report a case of IVF in a 16-week pregnant lady affecting the hypothenar eminence of the hand associated with the ulnar artery. Conclusion The characteristic involvement of muscular arteries and veins by reactive myofibroblastic proliferation in IVF suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. We propose that hormone-related changes associated with pregnancy may play an important role in the aetiopathogenesis of this myofibroblastic lesion.
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Affiliation(s)
- Amarjit Anand
- Royal Free and University College London Hospitals, Royal National Orthopaedic Hospital, Bone Tumour Unit, Brockley Hill, Stanmore, Middlesex, HA7 4L, UK
| | - Eva Maria Tsapakis
- Royal Free and University College London Hospitals, Royal National Orthopaedic Hospital, Bone Tumour Unit, Brockley Hill, Stanmore, Middlesex, HA7 4L, UK
| | - Ali A Narvani
- Royal Free and University College London Hospitals, Royal National Orthopaedic Hospital, Bone Tumour Unit, Brockley Hill, Stanmore, Middlesex, HA7 4L, UK
| | - Ali Alhakim
- Royal Free and University College London Hospitals, Royal National Orthopaedic Hospital, Bone Tumour Unit, Brockley Hill, Stanmore, Middlesex, HA7 4L, UK
| | - Steve R Cannon
- Royal Free and University College London Hospitals, Royal National Orthopaedic Hospital, Bone Tumour Unit, Brockley Hill, Stanmore, Middlesex, HA7 4L, UK
| | - Eleftherios Tsiridis
- Royal Free and University College London Hospitals, Royal National Orthopaedic Hospital, Bone Tumour Unit, Brockley Hill, Stanmore, Middlesex, HA7 4L, UK
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Schafmayer C, Kahlke V, Leuschner I, Pai M, Tepel J. Elastofibroma Dorsi as Differential Diagnosis in Tumors of the Thoracic Wall. Ann Thorac Surg 2006; 82:1501-4. [PMID: 16996964 DOI: 10.1016/j.athoracsur.2005.10.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 10/13/2005] [Accepted: 10/17/2005] [Indexed: 10/24/2022]
Abstract
We report the case of a 73-year-old woman who presented with a soft tissue tumor located between the scapula and the rib cage. Magnetic resonance imaging showed an inhomogeneous tumor on the right dorsolateral thoracic wall that measured 7 x 4 x 7 cm with contrast enhancement. The findings were suggestive of partial infiltration of intercostal muscles and were suspicious of a malignant tumor. After local excision at a district hospital had failed to render definitive diagnosis, the patient underwent complete resection of the tumor at our institution. Histology from the specimen was consistent with elastofibroma dorsi with free resection margins.
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Affiliation(s)
- Clemens Schafmayer
- Department for General Surgery and Thoracic Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
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Nishi SPE, Brey NV, Sanchez RL. Dermal nodular fasciitis: three case reports of the head and neck and literature review. J Cutan Pathol 2006; 33:378-82. [PMID: 16640547 DOI: 10.1111/j.0303-6987.2006.00437.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Shawn P E Nishi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
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Hisaoka M, Hashimoto H. Elastofibroma: clonal fibrous proliferation with predominant CD34-positive cells. Virchows Arch 2005; 448:195-9. [PMID: 16133360 DOI: 10.1007/s00428-005-0053-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
Elastofibroma is a rare fibrous lesion that most commonly occurs in periscapular soft tissues and is characterized by accumulated abnormal elastic fibers. Although the lesion is generally regarded as a reactive process, an unusual fibroblastic pseudotumor, or as a fibroelastic tumor-like lesion, its etiology remains largely unknown. Recent cytogenetic demonstrations of chromosomal instability and some recurrent or clonal chromosomal changes have raised the possibility that the lesion represents a neoplastic process. We analyzed 14 cases of elastofibroma to further explore, morphologically and genetically, the characteristics of its cellular composition. The interspersed spindle or stellate cells showed a fibroblast-like appearance and were almost consistently positive for vimentin and frequently positive for CD34 and lysozyme immunohistochemically. No spindle cells of myofibroblastic phenotype were recognized. To assess the clonality of the lesions in female patients, the X-linked polymorphic human androgen receptor gene assay was performed using formalin-fixed, paraffin-embedded tissues. A nonrandom inactivation of the androgen receptor gene was detected in two informative cases. Thus, these findings suggest that CD34-positive mesenchymal cells are an integral component of elastofibroma, which represents a clonal fibrous proliferation.
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Affiliation(s)
- Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
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