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Age / Sex : 23 / M
Chief complaint: palpable mass at 1st web of right hand (about 1 month)
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 황윤미(Hwang Yunmi), 가천의대길병원(Gachon University Gil Hospital)
Diagnosis: Nodular fasciitis
Discussion
Differential Diagnosis: extraabdominal desmoids tumor, neurofibroma, fibrous
histiocytoma, soft tissue sarcoma
Diagnosis:
Nodular fasciitis
Discussion:
Nodular fasciitis is a benign, self-limiting
proliferation of fibroblasts of uncertain etiology. It is commonly seen in young adults
with 85% younger than 50 years of age and only 5% over 70 year]. It typically
involves the upper extremity (48%) and trunk (20%). Other sites include head
and neck (17%) and lower extremity (15%). Rare sites include retroperitoneum,
hand and foot. It is usually solitary. Multiple simultaneous lesions are rare.
The size of the lesions can vary from 0.5 cm to 10 cm, but 71% are 2 cm or smaller
and most smaller than 4 cm. The commonest presentation of nodular fasciitis is
a rapidly growing lesion, and about half have associated
tenderness
or pain. Three general subtypes of nodular fasciitis may be identified on the
basis of the lesion location (subcutaneous, intramuscular, or fascial).
Nodular fasciitis may be categorized
as myxoid, cellular, or fibrous, according to the pre-
dominant
histologic feature of the lesion. MR imaging appearance of the lesions. The
histologic diversity of nodular fasciitis likely accounts for the variable. The
signal in hypercellular lesions appears nearly isointense or slightly hyperintense
to that in skeletal muscle on T1-weighted images and hyperintense to that in
adipose tissue on T2-weighted images. Highly collagenous lesions have hypointense
signal on all MR images. Contrast enhancement is typically diffuse but may be
peripheral in lesions with a greater extra-cellular myxoid matrix and central
fluid-filled spaces.
Successful treatment typically
consists of marginal excision alone, after which there is a 1% incidence of
recurrence.
References:
1.
Pathologic
and MR imaging features of benign fibrous softi-tissue tumors in adults. Radiographics
2007;27:173-187.
2.
Nodular
fasciitis: MRI appearance and literature review. Skeletal Radiol 2002; 31:9-13.
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