Journal of Pathology and Translational Medicine

Case Study

Nodular Fasciitis of External Auditory Canal: Jihyun Ahn, Sunyoung Kim, Youngsil Park; J Pathol Transl Med. 2016;50(5):394-396. Published online June 6, 2016; DOI: https://doi.org/10.4132/jptm.2016.03.11

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Nodular fasciitis is a pseudosarcomatous reactive process composed of fibroblasts and myofibroblasts, and it is most common in the upper extremities. Nodular fasciitis of the external auditory canal is rare. To the best of our knowledge, less than 20 cases have been reported to date. We present a case of nodular fasciitis arising in the cartilaginous part of the external auditory canal. A 19-year-old man complained of an auricular mass with pruritus. Computed tomography showed a 1.7 cm sized soft tissue mass in the right external auditory canal, and total excision was performed. Histologic examination revealed spindle or stellate cells proliferation in a fascicular and storiform pattern. Lymphoid cells and erythrocytes were intermixed with tumor cells. The stroma was myxoid to hyalinized with a few microcysts. The tumor cells were immunoreactive for smooth muscle actin, but not for desmin, caldesmon, CD34, S-100, anaplastic lymphoma kinase, and cytokeratin. The patient has been doing well during the 1 year follow-up period.

Citations

Citations to this article as recorded by

Nodular Fasciitis of the Nose and External Auditory Canal: Two Rare Case Reports
Wanjie Luo, Tianyu Ma, Siqi Wang, Xiaowei Qin, Li Jiang, Yuyao Wang, Tianhong Zhang
Ear, Nose & Throat Journal.2025;[Epub] CrossRef
Pathology Clinic: Nodular Fasciitis Involving the External Ear
Christina M. Yver, Michael A. Husson, Oren Friedman
Ear, Nose & Throat Journal.2023; 102(5): NP203. CrossRef
Nodular fasciitis of the external auditory canal: Clinical case report and review of the literature
Adrien Philippart, Jean-Christophe Degols, Jacques Vilain
Journal of Otology.2023; 18(4): 240. CrossRef
Diagnosis and Treatment of Nodular Fasciitis of Ear Region in Children: A Case Report and Review of Literature
Antonio Della Volpe, Paola Festa, Alfonso Maria Varricchio, Carmela Russo, Eugenio Maria Covelli, Delfina Bifano, Piera Piroli, Antonietta De Lucia, Arianna Di Stadio, Franco Ionna
Healthcare.2022; 10(10): 1962. CrossRef
A Case of Recurred Nodular Fasciitis in Supraauricular Region
Dong-Jo Kim, Seong-Wook Choi, Chung-Su Hwang, Hyun-Min Lee
Journal of Clinical Otolaryngology Head and Neck Surgery.2022; 33(4): 203. CrossRef

Original Article

Expression of HuR and Cyclooxygenase-2 in Nodular Fasciitis and Low-Grade Sarcoma: An Immunohistochemical Study: Hyun-Jin Son, Tae-Hwa Baek, Seung Yun Lee, Joo-Heon Kim, Dong-Wook Kang, Hye-Kyung Lee, Mee-Ja Park; Korean J Pathol. 2014;48(4):270-275. Published online August 26, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.4.270

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Abstract PDF

Background

Nodular fasciitis is the most common reactive mesenchymal lesion to be misidentified as a type of sarcoma. HuR is an mRNA-binding protein that can stabilize cyclooxygenase-2 (COX-2) mRNA leading to COX-2 overexpression. The aim of this study is a comparison of the expressions of COX-2 and HuR and the relationships between their expressions and the clinicopathological parameters in nodular fasciitis and low-grade sarcoma.

Methods

We measured the expression of HuR and COX-2 in 21 cases of nodular fasciitis and 37 cases of low-grade sarcoma using immunohistochemistry.

Results

The frequency of cytoplasmic immunoreactivity for HuR was 5 of 21 cases of nodular fasciitis (23.8%) and 23 of 37 cases of low-grade sarcoma (62.1%) (p=.013). COX-2 expression was moderate or strong in nodular fasciitis (12/21, 57.1%) and in low-grade sarcoma (29/37, 78.4%) (p=.034). In addition, a significant difference existed between these two entities in terms of the relationship between moderate or strong COX-2 expression and HuR cytoplasmic immunoreactivity (p=.009). Moderate or strong COX-2 immunoreactivity correlated with nuclear (p=.016) or cytoplasmic HuR (p=.024) expression in low-grade sarcoma but not in nodular fasciitis.

Conclusions

This study suggests that HuR and COX-2 expression may be useful to differentiate nodular fasciitis from low-grade sarcoma.

Citations

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Nodular Fasciitis of the Cubital Fossa in a Young Female Mimicking a Neurogenic Tumor
Hyung-Joon Lee, Ji-Kang Park, Seok-Won Kim, Min-Boo Kim
Journal of the Korean Orthopaedic Association.2023; 58(2): 179. CrossRef
Nodular fasciitis of the anterior chest wall mimicking myxofibrosarcoma: A case report and literature review
Antonino Cattafi, Mariarosaria Galeano, Pietro Pitrone, Carmelo Sofia, Maria Adele Marino, Giorgio Ascenti, Maria Lentini, Antonio Ieni, Roberta Cardia, Alfio Luca Costa, Dario Familiari, Mario Barone, Francesco Monaco, Michele Rosario Colonna
Radiology Case Reports.2021; 16(6): 1557. CrossRef

Case Study

Papillary Carcinoma of the Thyroid Gland with Nodular Fasciitis-like Stroma: Ki Yong Na, Hyun-Soo Kim, Ji-Youn Sung, Won Seo Park, Youn Wha Kim; Korean J Pathol. 2013;47(2):167-171. Published online April 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.2.167

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Abstract PDF

Papillary thyroid carcinoma with nodular fasciitis-like stroma (PTC-NFS) is a rare variant of PTC. The term 'PTC with fibromatosis-like stroma' has been used as a synonym to describe this variant. It is characterized by extensive proliferation of fibroblasts and myofibroblasts in the tumor stroma, which occurs in up to 80% of the tumors. We herein describe a case of PTC-NFS which developed in a 49-year-old woman with the demonstration of findings of ultrasonography, fine needle aspiration cytology and histological examination of the lesion. To characterize the stromal components, we investigated the expression of several immunohistochemical markers which have been shown to be expressed differently in nodular fasciitis (NF) and fibromatosis (FM). The immunostaining results demonstrated nuclear and cytoplasmic accumulation of β-catenin, cytoplasmic transforming growth factor-β expression and nuclear Smad expression in the stromal cells, suggesting that the stromal cells in this case have similar molecular profiles to those of FM rather than NF.

Citations

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Papillary thyroid carcinoma with desmoid-type fibromatosis: the clinicopathological features with characteristic imaging and molecular correlation requiring comprehensive treatment
Haining Huang, Lei Li, Xiaolong Liu, Lihua Zhao, Zhihong Cui, Renya Zhang, Shuai Chen
Human Pathology.2023; 136: 84. CrossRef
Papillary Thyroid Carcinoma with Desmoid-Type Fibromatosis: Review of Published Cases
Abdallah Roukain, Stefano La Rosa, Massimo Bongiovanni, Marie Nicod Lalonde, Valérie Cristina, Michael Montemurro, Stephane Cochet, Alexandra Luquain, Peter A. Kopp, Gerasimos P. Sykiotis
Cancers.2021; 13(17): 4482. CrossRef
Case of medullary thyroid carcinoma with desmoid‐type fibromatosis
Yoon Ah Cho, Young Lyun Oh
Pathology International.2020; 70(6): 364. CrossRef
SOX11 expression in a case of papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma containing BRAF c.1799_1801delTGA and CTNNB1 c.133T>C mutations
Soon Boon Justin Wong, Min En Nga, Michal Michal, Tomas Vanecek, Ju Ee Seet, Fredrik Petersson
Virchows Archiv.2019; 475(4): 519. CrossRef
Papillary thyroid cancer with extrathyroidal extension of desmoid-type fibromatosis. A case report of an aggressive presentation of an uncommon pathologic entity
Eve M. Roth, Courtney E. Barrows, Michiya Nishino, Barry Sacks, Per-Olof Hasselgren, Benjamin C. James
International Journal of Surgery Case Reports.2019; 63: 5. CrossRef
Papillary thyroid carcinoma with nodular fasciitis-like stroma and β-catenin mutations should be renamed papillary thyroid carcinoma with desmoid-type fibromatosis
Caterina Rebecchini, Antoine Nobile, Simonetta Piana, Rossella Sarro, Bettina Bisig, Sykiotis P Gerasimos, Chiara Saglietti, Maurice Matter, Laura Marino, Massimo Bongiovanni
Modern Pathology.2017; 30(2): 236. CrossRef
Papillary thyroid carcinoma with desmoid-type fibromatosis: A clinical, pathological, and immunohistochemical study of 14 cases
Nami Takada, Mitsuyoshi Hirokawa, Masahiro Ito, Aki Ito, Ayana Suzuki, Miyoko Higuchi, Seiji Kuma, Toshitetsu Hayashi, Masao Kishikawa, Shuichi Horikawa, Akira Miyauchi
Endocrine Journal.2017; 64(10): 1017. CrossRef
A Case of Papillary Thyroid Carcinoma with Fasciitis-like Stroma
Toshihiko WAKU, Hiroshi SONOBE
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2016; 77(12): 2892. CrossRef
Stromal Modulation and its Role in the Diagnosis of Papillary Patterned Thyroid Lesions
Sahar Aly Daoud, Reham Shehab El Nemr Esmail, Amal Ahmed Hareedy, Abdullah Khalil
Asian Pacific Journal of Cancer Prevention.2015; 16(8): 3307. CrossRef
Papillary Thyroid Carcinoma With Nodular Fasciitis–Like Stroma
Paula S. Ginter, Theresa Scognamiglio
International Journal of Surgical Pathology.2015; 23(4): 305. CrossRef
Notch and TGF-β/Smad3 pathways are involved in the interaction between cancer cells and cancer-associated fibroblasts in papillary thyroid carcinoma
Jie Zhang, Yuan Wang, Dan Li, Shanghua Jing
Tumor Biology.2014; 35(1): 379. CrossRef

Case Reports

Eosinophilic Fasciitis Associated with Overlying Intraepidermal Blister Formation: A Case Report.: Na Rae Kim, Dong Hae Chung, Seung Yeon Ha; Korean J Pathol. 2009;43(5):478-481.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.5.478

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Abstract PDF: Eosinophilic fasciitis is a scleroderma-like disease and it may present with paraneoplastic syndrome or as an isolated form of the disease. We report here on a case of eosinophilic fasciitis in a 20-year-old woman who presented with an abrupt onset of subcutaneous limb swelling and peripheral eosinophilia. Pathologically, the specimen was characterized by acute inflammation and thickening of the collagen bundles in the reticular dermis and superficial muscle fascia in addition to the overlying intraepidermal blisters that contained many eosinophils. Eosinophils, some lymphocytes and plasma cells were infiltrated in the superficial muscle fascia and subcutaneous fat. The diagnosis of eosinophilic fasciitis was confirmed by biopsy. It is intriguing that eosinophilic fasciitis showed the microscopic findings of intraepidermal blister with predominant inflammation, and the patient showed a good response to steroid therapy.

Cranial Fasciitis of Childhood: A case report.: Ok Ran Shin, Kyo Young Lee, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Pathol. 2000;34(2):164-166.

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Abstract PDF: Cranial fasciitis is a rare fibroblastic tumor which shows a predilection for the scalp of young children. We present a child with a rapidly growing mass and lytic skull lesion which on pathologic evaluation was diagnosed as cranial fasciitis. Histologically this lesion was identical to nodular fasciitis which was typically found in the trunk and extremities of adults. Cranial fasciitis is unique in that it may present as a lytic lesion in the skull, but this disease entity is not widely known to pathologists and radiologists, and should be included in the differential diagnosis of fibroblastic lesion occurring in the cranium of young children.

Fine Needle Aspiration Cytology of Proliferative Fasciitis: A Case Report.: Hyang Jeong Jo, Won Cheol Han, Ki Jung Yun, Won Cheol Park; Korean J Cytopathol. 2002;13(1):47-50.

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Abstract PDF: Fine needle aspiration cytology (FNAC) is an easy convenient non-invasive method in the diagnosis of superficial palpable masses. The cytologic findings by FNAC of reactive and neoplastic lesions in various organs including breast, lymph node, thyroid, salivary gland, etc., have been described, but, those of soft tissue lesions including proliferative fasciitis are relatively rare to find. We recently experienced a case of FNAC of proliferative fasciitis in the left back of a 72-year-old male. The FNAC smears were scant in cellularity and contained large cells with abundant basophilic cytoplasm, one to two nuclei lying at the periphery, and prominent nucleoli that resemble ganglion cells.

Thyroid Papillary Carcinoma with Exuberant Nodular Fasciitis-like Stroma: A Case Report.: Kyung Hwa Lee, Jae Hun Chung, Jung Han Yoon, Kyung Whan Min, Chan Choi, Ji Shin Lee; Korean J Pathol. 2006;40(1):76-79.

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Abstract PDF: Thyroid papillary carcinoma (TPC) with exuberant nodular fasciitis-like stroma is one of the rare variants of TPC. To date, only 19 cases have been reported in the English medical literature. We report here on the the first Korean case of TPC that contained a prominent nodular fasciitis-like stroma. A 40-year-old female presented with a hard painless right neck mass that had been present for two months. Total thyroidectomy disclosed a solitary nodule in the mid portion of the right lobe that measured 25 x 20 mm. The tumor was well delineated, but it was not encapsulated. Microscopically, the tumor was a typical papillary carcinoma except that large areas of the tumor were occupied by a stroma composed of irregular fascicular spindle cells. The stromal component accounted for 60% of the tumor mass. The spindle cells exhibited neither atypism nor mitosis, and the tumor's extensive stromal cell proliferation resembled the appearance of nodular fasciitis of the soft tissues. Immunohistochemically, the spindle cells were positive for vimentin and alpha-smooth muscle actin, but they were negative for thyroglobulin, thyroid transcription factor-1, S-100 protein, CD34 and desmin, and this represents myofibroblastic features.

Nodular fasciitis (13 cases analysis).: Jung Ran Kim, Je G Chi; Korean J Pathol. 1988;22(2):190-194.

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Abstract PDF: Nodular fasciitis is a rare and benign soft tissue tumor that can easily confused microscopically to spindle cell sarcoma. Therefore it is very important disease to the surgical pathologists. However, this lesion has been seldom reported or described in Korean literature. This paper deals with 13 Korean cases of nodular fasciitis diagnosed microscopically. It's pertinent clinicopathologic findings are described. The youngest patients among 13 cases was 18 years and the oldest was 63 years with the mean of 34 years. Nine were males and 4 were females. Pathologically, the size of the lesion at the time of diagnosis ranged from 0.7 cm to 4.0 cm in the maximum extent. Two were smaller than 1.0 cm and 8 cases were between 1.0~3.0 cm. The site distibution was; trunk(5) upper extremitiy (4), lower extremity (2) and head (2). All the lesions were located in the subcutaneous tissue. The history of recent rapid growth was noted in nearly half of the cases. Mass and tenderness were two common manifestations. In one case, multiple nodules were found in the right breast and in flank. All of the lesions except one were managed by local excision. In one case, a wide excision was done under the impression of malignant fibrous histiocytoma of frozen section. Follow up observation of all cases did not show any evidence of recurrence in all.

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