Weekly Case

Title : Case 556

Age / Sex : 35 / F

Chief complaint : Papable mass at the left forearm

What is your impression?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy of Sekyoung Park, Kosin University Gospel Hospital  



Answer:  Nodular fasciitis


Findings: Magnetic resonance imaging revealed a subcutaneous mass at the left forearm. The mass exhibited low to intermediate signal intensity on axial T1-weighted image and high signal intensity with perilesional edema on axial T2-weighted and coronal fat-suppressed T2-weighted images. Axial and coronal fat-suppressed Contrast-enhanced T1-weighted images demonstrated heterogenous enhancement with linear extension along the fascia (fascial tail sign).


Differential Diagnosis: Epithelioid sarcoma, Dematofibrosarcoma protuberans, Desmoid-type fibromatosis



Nodular fasciitis is a pseudosarcomatous benign fibrous tumor that is thought to be reactive in etiology and, therefore, to be self-limiting. It is primarily located in the upper extremities in young adults (ages 20–40 years). It has been known that nodular fasciitis represents 11 % of all benign soft tissue tumors and comprises 38 % of benign soft tissue tumors in the upper extremity in persons aged between 24 and 45. At MR imaging, nodular fasciitis demonstrates a nonspecific signal intensity. After the administration of contrast material, there is usually diffuse enhancement. An important diagnostic feature at MR imaging is the linear extension of the lesion along the fascia (fascial tail sign), which also may appear enhanced. Locally aggressive imaging features such as trans-compartmental spread and osseous involvement may be seen in cases of documented nodular fasciitis.



Weiss SW, Goldblum JR. Enzinger and Weiss’s soft tissue tumors. 4th ed. St. Louis, Mo: Mosby, 2001; 535–569, 1483–1571.

Kransdorf MJ. Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location. AJR Am J Roentgenol. 1995;164:395–402

Coyle & L. M. White & B. Dickson & P. Ferguson & J. Wunder & A. Naraghi. MRI characteristics of nodular fasciitis of the musculoskeletal system. Skeletal Radiol (2013) 42:975–982

Francesca D. Beaman, MD2, Mark J. Kransdorf, MD, Tricia R. Andrews, MD, Mark D. Murphey, MD Superficial Soft-Tissue Masses: Analysis, Diagnosis, and Differential Considerations RadioGraphics 2007; 27:509–523


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Correct Answer
Total applicants 35 Correct answers 20
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