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Updated: Jun 22 2021

Nodular Fasciitis

  • summary
    • Nodular Fasciitis is a common, fibrous, soft tissue lesion that usually occurs in the upper extremities of young people.
    • Diagnosis is made with MRI studies showing a deep-seated inhomogeneous mass with nodularity along the fascial planes. Biopsy shows short irregular bundles and fascicles in a dense reticulum network.
    • Treatment is usually marginal surgical resection. 
  • Epidemiology
    • Incidence
      • most common fibrous soft tissue lesion
      • half of the cases occur in the upper extremities
    • Demographics
      • males and females equally affected
    • Anatomic location
      • volar forearm, back, chest wall, head and neck
  • Presentation
    • Symptoms
      • may be painless or painful
        • painful in half of patients
      • often rapidly enlarging mass over 1 to 2 weeks
      • lesions 1 to 2 cm
  • Imaging
    • Radiograph
      • usually normal
    • MRI
      • shows deep seated inhomogeneous mass
      • nodularity with extension along the fascial planes
      • avid enhancement with gadolinium
      • most commonly is superficial but can occur intramuscularly or along the superficial plane
  • Histology
    • Classic characteristics are
      • short irregular bundles and fascicles
      • dense reticulum network
      • small amounts of mature collagen
  • Treatment
    • Operative
      • marginal resection
  • Differential
      • Differential of Nodular Fasciitis
      • Treated with marginal excision
      • Nodular fasciitis (soft tissue)
      • o
      • Periosteal chondroma
      • o
      • Neurilemoma (soft tissue)
      • o
      • Epidermal inclusion cyst
      • o
      • Glomus tumor
      • o
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