Facial nodular fasciitis in an adult patient: a case report of an uncommon manifestation

Carla Isabelly Rodrigues-Fernandes; Roberta Karolina Borges de Souza; Hélen Kaline Farias Bezerra; Elaine Judite de Amorim Carvalho; Pablo Agustin Vargas; Danyel Elias da Cruz Perez

doi:10.5327/2525-5711.330

Authors

Carla Isabelly Rodrigues-Fernandes Universidade Federal de Pernambuco, Oral Pathology Unit, Department of Clinic and Preventive Dentistry – Recife (PE), Brazil. https://orcid.org/0000-0002-1290-6235
Roberta Karolina Borges de Souza Hospital da Restauração – Recife (PE), Brazil.
Hélen Kaline Farias Bezerra University of Campinas, Piracicaba Dental School, Department of Oral Diagnosis, Semiology and Pathology Areas – Piracicaba (SP), Brazil. https://orcid.org/0000-0002-5236-8988
Elaine Judite de Amorim Carvalho Universidade Federal de Pernambuco, Oral Pathology Unit, Department of Clinic and Preventive Dentistry – Recife (PE), Brazil https://orcid.org/0000-0003-0446-6820
Pablo Agustin Vargas University of Campinas, Piracicaba Dental School, Department of Oral Diagnosis, Semiology and Pathology Areas – Piracicaba (SP), Brazil. https://orcid.org/0000-0003-1840-4911
Danyel Elias da Cruz Perez Universidade Federal de Pernambuco, Oral Pathology Unit, Department of Clinic and Preventive Dentistry – Recife (PE), Brazil. https://orcid.org/0000-0002-4591-4645

DOI:

https://doi.org/10.5327/2525-5711.330

Keywords:

Nodular fasciitis, Fibroblast, Myofibroblast, Face

Abstract

Nodular fasciitis is a pseudosarcomatous, self-limited lesion composed of fibroblasts and myofibroblasts. Craniofacial lesions are more common in pediatric patients. This report presents a rare case of nodular fasciitis involving the face of an adult patient. A 32-year-old woman presented with a painless subcutaneous mass at the right zygomatic region, with one year of duration. The diagnostic hypotheses were epidermoid cyst and neurofibroma. An excisional biopsy was performed, and the microscopic examination exhibited an admixture of spindle-shaped cells and acellular areas associated with prominent collagen bands. No cellular atypia was observed. Immunohistochemical findings demonstrated positivity for alpha-SMA, HHF35, and beta-catenin. Tumor cells were negative for STAT6. The final diagnosis was nodular fasciitis. The patient has not presented any recurrences so far. Clinicians and pathologists must be capable to distinct nodular fasciitis and malignant tumors to avoid misdiagnosis and overtreatment.

References

Konwaler BE, Keasbey L, Kaplan L. Subcutaneous pseudosarcomatous fibromatosis (fasciitis). Am J Clin Pathol. 1955;25(3):241-52. https://doi.org/10.1093/ajcp/25.3.241

Shin C, Low I, Ng D, Oei P, Miles C, Symmans P. USP6 gene rearrangement in nodular fasciitis and histological mimics. Histopathology. 2016;69(5):784-91. https://doi.org/10.1111/his.13011

Maloney N, LeBlanc RE, Sriharan A, Bridge JA, Linos K. Superficial nodular fasciitis with atypical presentations: report of 3 cases and review of recent molecular genetics. Am J Dermatopathol. 2019;41(12):931-6. https://doi.org/10.1097/DAD.0000000000001455

Patel NR, Chrisinger JSA, Demicco EG, Sarabia SF, Reuther J, Kumar E, et al. USP6 activation in nodular fasciitis by promoter-swapping gene fusions. Mod Pathol. 2017;30(11):1577-88. https://doi.org/10.1038/modpathol.2017.78

Sennett R, Friedlander S, Tucker S, Hinds B, Hightower G. USP6 rearrangement in pediatric nodular fasciitis. J Cutan Pathol. 2022;49(8):743-6. https://doi.org/10.1111/cup.14237

Vuong M, Mejbel HA, Mackinnon AC, Roden D, Suster DI. Nodular fasciitis of the buccal mucosa with a novel USP6 gene rearrangement: a case report and review of the literature. Head Neck Pathol. 2024;18(1):79. https://doi.org/10.1007/s12105-024-01687-6

Vyas T, Bullock MJ, Hart RD, Tristes JR, Taylor SM. Nodular fasciitis of the zygoma: a case report. Can J Plast Surg. 2008;16(4):241-3. https://doi.org/10.1177/229255030801600405

World Health Organization. WHO Classification of Tumours Editorial Board. Head and neck tumours. Lyon: International Agency for Research on Cancer; 2022.

Souza e Souza I, Rochael MC, Farias RE, Vieira RB, Vieira JST, Schimidt NC. Nodular fasciitis on the zygomatic region: a rare presentation. An Bras Dermatol. 2013;88(6 Suppl 1):89-92. https://doi.org/10.1590/abd1806-4841.20132474

Han W, Hu Q, Yang X, Wang Z, Huang X. Nodular fasciitis in the orofacial region. Int J Oral Maxillofac Surg. 2006;35(10):924-7. https://doi.org/10.1016/j.ijom.2006.06.006

Al-Hayder S, Warnecke M, Hesselfeldt-Nielsen J. Nodular fasciitis of the face: a case report. Int J Surg Case Rep. 2019;61:207-9. https://doi.org/10.1016/j.ijscr.2019.07.003

Parkinson B, Patton A, Rogers A, Farhadi HF, Oghumu S, Iwenofu OH. Intraneural nodular fasciitis of the femoral nerve with a unique CTNNB1::USP6 gene fusion: apropos of a case and review of literature. Int J Surg Pathol. 2022;30(6):673-81. https://doi.org/10.1177/10668969221080064

Carlson JW, Fletcher CDM. Immunohistochemistry for beta-catenin in the differential diagnosis of spindle cell lesions: analysis of a series and review of the literature. Histopathology. 2007;51(4):509-14. https://doi.org/10.1111/j.1365-2559.2007.02794.x

Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, et al. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011;91(10):1427-33. https://doi.org/10.1038/labinvest.2011.118

Patel D, Samson TD, Cochran EL, Zaenglein AL. Nodular fasciitis on the cheek of a child. Pediatr Dermatol. 2021;38(2):508-9. https://doi.org/10.1111/pde.14497

Oh BH, Kim J, Zheng Z, Roh MR, Chung KY. Treatment of nodular fasciitis occurring on the face. Ann Dermatol. 2015;27(6):694-701. https://doi.org/10.5021/ad.2015.27.6.694