J Korean Soc Spine Surg.  2015 Sep;22(3):114-117. 10.4184/jkss.2015.22.3.114.

Nodular Fasciitis as a Pseudosarcomatous Lesion in the Ligamentum Nuchae: A Case Report

• Kim SH
• Kim JS
• Nam KH

• KMID: 2068930
• DOI: http://doi.org/10.4184/jkss.2015.22.3.114

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
Nodular fasciitis is a non-neoplastic soft-tissue lesion located in the deep subcutaneous region; it may be misdiagnosed as a malignant tumor due to its rapid growth and microscopic characteristics. We introduce an unusual case of nodular fasciitis which presented as a posterior neck mass. SUMMARY OF LITERATURE REVIEW: Nodular fasciitis is an unusual benign lesion.Becaue it sometimes shows aggressive microscopic characteristics, (being hypercellular and polymorphic), the condition has the potential to be misdiagnosed as sarcoma.
MATERIALS AND METHODS
A 20-year-old woman presented with a 1-month history of a progressively enlarging mass on her posterior neck. Computed tomography (CT) scans of the neck showed a markedly enhanced, well-defined, ovoid soft tissue mass at the posterior of the spinous process of C2. The patient underwent marginal excision. There was a 2 cm, well-capsulated, pinkish-gray mass.
RESULTS
She recovered without any complications. Histopathologic examination showed a spindle cell proliferation, increased cellularity, and nuclear atypia with mitosis. The immunohistochemistry stain showed negative findings. The mass was diagnosed as nodular fasciitis.
CONCLUSIONS
A diagnosis of nodular fasciitis, not just malignant tumor, should be considered for a rapidly growing posterior neck mass showing aggressive microscopic appearance, Nodular fasciitis is a self-limiting lesion readily treated by marginal excision. However, follow-ups should be increased to watch for recurrence.

Keyword

Nodular fasciitis; Neck; Tumor

MeSH Terms

Cell Proliferation
Diagnosis
Fasciitis*
Female
Follow-Up Studies
Humans
Immunohistochemistry
Mitosis
Neck
Recurrence
Sarcoma
Young Adult

Figure

• 

  FigI 1. (A) A CT scan of the soft tissuted tomography reveals a 1.2 cm sized oval shaped well-defed mass. (B) A CT scan of the soft tissuted tomography with enhancement reveals a strongly enhancing soft tissue mass between the superficial and deep muscle layers of the posteor neck. (C) A CT scan of the soft tissuted tomography with sagittal reconstruction shows that the mass is located posterior to the spinous procesof C2.

• 

  Fig 2. A Llongitudinal section of nodular fasciitis (x1.25 magnifations). (B) Histopathologic findings under the hematoxylin-eosin stain. The lesion is composed of interlacing fascicles of plump spindle-shaped fibroblasts/myofibroblasts lacking nuclear pleomorphism. The prominentculatures, and intralesional extravasated erythrocytes, and mixed chronic inflammat cells werear seen (H& x200). (C) Mitoses were present in 6/10 high power fields but no atypicforms were are idenified (H&E, x400).

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