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Nodular Fasciitis : Intro, Clinical & Gross

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Nodular fasciitis (NF) is a benign, self-limiting, pseudosarcomatous myofibroblastic proliferation that is frequently misdiagnosed as a sarcoma.

Clinical Features: NF is a rapidly growing lesion. Most patients present with a solitary soft tissue mass of less than 1 months' duration. Nerve compression may give rise to paresthesia, numbness, shooting pain, or tenderness. The most commonly affected age group is 20 to 40 years. Cases involving very young or very old patients are less frequent. There is no sex predilection.

Sites: It can occur anywhere in the body. The most common sites, in order of frequency, are upper extremities (volar aspect of forearm), chest wall, back, and head & neck region (especially in infants and children). Less frequent locations include lower extremities and hands and feet. Isolated cases have been reported in a variety of other organs/sites, including breast, parotid gland, external ear, oral cavity, and lymph node capsule.

Gross Pathology: NF is a relatively well-circumscribed but unencapsulated lesion. Cases located in deep fascia may be ill-defined and infiltrate into the surrounding soft tissues. Most cases are smaller than 3 cm in size. The appearance of cut surface depends upon the degree of cellularity and relative proportions of myxoid and collagenous matrix. Lesions with copious myxoid material are soft with a gelatinous appearance. When collagenous stroma predominates, the lesions are firm and white-tan, resembling fibromatoses.

Image courtesy of: Rola Ali, MD, FRCPC, Associate Professor of Pathology, Kuwait University, Kuwait; used with permission.

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