Nodular fasciitis

Clinical History

Pailess mobile tumefation of ligneous consistence in the left leg.

Imaging Findings

Patient two years ago noted the presence of a painless tumefation in the left ankle which had increased in size very fast until, at the time of the admitting to our hospital, the lesion was estended caudally along the lateral face of the coscia. ItÍs consistence was ligneous, was mobile to the superficial planes and more fixed to the deeper tissues.

Discussion

Nodular fasciitis is a being soft-tisse lesion due to proliferating fibroblasts; the lesion is described as subcutaneous pseudosarcomatous fibromatosis showing an alarming nodular proliferation of fibroblasts . Clinically most patients present a rapidly enlargy, palpable soft-tissue mass. This pathology is most frequently localized in the upper extremities (48%) in the trunk (20%) in head and neck (17%) and lower extremities (15%).According to anatomic localization we can distinguish 3 subtgypes: subcutaneous , intramuscolar and fascial which spreads along superficial fasciale planes . Histologically the lesion is predominantly composed of immature fibroblasts with little difference in size and shape. The fibroblasts are arranged in characteristic short irregular buldle and fascicles. There is a rich mixoid matrix present early; older lesion had a fibrous histology . The diagnosis of nodular fasciitis is founded on hystology. It may be confused clinically and histologically with aggressive fibromatosis and fibrosarcoma but on the basis of morphology of cells, their organization into fascicles the evidence of mucopolisaccaride matrix and vascularization allow a definitive diagnosis.

Differential Diagnosis List

Final Diagnosis

Nodular fasciitis

URL:	https://www.eurorad.org/case/184
DOI:	10.1594/EURORAD/CASE.184
ISSN:	1563-4086