Cranial fasciitis of childhood

Abstract

A 2‐month‐old boy was seen at our pediatric dermatology department with a history of a tumoral lesion of the scalp since his birth. On examination he had a single, ovoid, firm, 2 × 1.8‐cm painless subcutaneous mass on the temporal left calvarium, covered by normal skin (Fig. 1). It had experienced explosive growth in the preceding 2 weeks. There was no history of previous trauma in the area. The remainder of the examination was normal. Roentgenographic studies of the skull revealed a soft‐tissue mass without involvement of the underlying bone. Ultrasonography of the lesion showed it to be an echolucid tumor. With the presumed diagnosis of dermoid cyst we sent the patient for surgical removal. At surgery, the lesion did not have the typical surgical appearance of a cyst. The histopathologic exam of the specimen was interpreted as cranial fasciitis of childhood (Fig. 2). Immunohistochemistry showed diffuse positivity for vimentin and muscle actin. After 1 year the patient is free of lesions. 1 Lesion at the temporal left calvarium 2 Proliferation of loosely arranged spindle cells in a loose myxoid stroma (H&E stain, × 40)

Cranial Fasciitis Presenting with Intracranial Mass: A Case Report

“…In most cases [2, 4, 10, 13, 17, 18, 33, 36], MRI showed iso-intensity as well as gray matter on T 1 - and T 2 -weighted images. Others reported low intensity on T 1 -weighted images and high intensity on T 2 -weighted images [19], [28], slightly high intensity on T 1 -weighted images [12], [23] and iso-intensity on T 1 -weighted images and high intensity on T 2 -weighted images (our case). Remarkable enhancement was seen after administration of contrast media.…”

“…Lesions occurred at the site of previous head trauma in 10 cases (20%) including birth trauma such as forceps delivery in 1 patient, but whether head trauma is an etiological factor has not been determined. In 12 of the reported 21 patients, skull X-ray showed an osteolytic change with a sclerotic rim [3, 4, 6, 13, 14, 18, 19, 24, 28, 36] and sometimes with a bone defect [2, 23], but in 8 patients [11, 12, 15, 21, 22, 25, 30], including ours, normal findings and in 1 patient [26] an ossifying change. CT scan showed an erosion, sometimes with calcification.…”

“…Forty-nine cases have been reported in the literature[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36] and table 1 summarizes 50 cases of cranial fasciitis, including our patient. The average patient age is less than 3 years and ranges from newborn to 47 years.…”

“…There were 4 patients with neurological deficits; exophthalmos and diplopia in 1[19], papilledema and arm paresis in 1[29], paresis and seizure in 1[31], and facial palsy in 1 [16]. …”

Cranial fasciitis in an infant

“…They were first described by Konwaler and Weiss in 1955 and the lesions in most cases occurred after trauma. 1,2 Such lesions are usually misdiagnosed as sarcomas because of their clinical and histological appearance. 2,3 Cranial fasciitis is considered a subset of deep nodular fasciitis and is a non-neoplastic benign subcutaneous condition of the head.…”