HomePhilippine Journal of Otolaryngology Head and Neck Surgeryvol. 25 no. 2 (2010)

Nodular Fasciitis in a One-Year-Old Male: A Diagnostic Dilemma

Adrian F. Fernando | Antonio H. Chua, Md | Lily L. Sia-vargas

 

Abstract:

Objectives: To present a rare case of nodular fasciitis presenting as a supra-auricular mass.
Methods:
Design: Case Report
Setting: Private Tertiary University Hospital
Patient: One
Results: A one-year-old boy presented with an initially painless, left supra-auricular mass that rapidly enlarged from < 1 cm to 3 cm (widest diameter) in a two-month period. Sarcoma was initially considered over an inflammatory process as the mass was non-responsive to antibiotic therapy. Fine-Needle Aspiration Cytology (FNAC) and High-Resolution Computed Tomography (HRCT) with contrast revealed benign cytologic and radiologic findings making nodular fasciitis the primary impression. The patient eventually underwent complete surgical excision of the left supra-auricular mass. Histopathologic findings then showed a stroma rich in collagen and myxoid ground substance
and loose array of short S-shaped fascicle cells with scattered lymphocytes, macrophages and red blood cells consistent with nodular fasciitis.
Conclusion: Nodular fasciitis is a rare benign myofibroblastic soft tissue tumor which typically presents as a rapidly progressive nodular lesion in the head and neck region of the young pediatric age group. Cytopathologic recognition with FNA is a challenge. The gold standard of treatment is still surgical and in most reported cases, curative. More importantly, early clinical recognition and correlation with radiologic and histopathologic appearance is very important to avoid unnecessary work-ups and over-treatment.