Nodular Fasciitis: Definitive Diagnosis by Fine Needle Aspiration

Abstract

Objectives: Nodular fasciitis (NF) is a self-limited, mass-forming, fibrous proliferation that can occur in the head and neck and may mimic malignancy. Fine-needle aspiration biopsy (FNAB) is a minimally invasive, rapid, accurate method of obtaining diagnostic material from head and neck masses. In this study, we verify the usefulness of FNAB in obtaining a definitive diagnosis of NF. Methods: Cases were identified from our laboratory information system. Cytology slides were reviewed to note morphologic features and confirm diagnoses. Clinical history was obtained to document the case presentations and outcomes. Results: All 9 cases were found to have clinical presentations and common distinguishing morphologic features consistent with NF. Two cases were excised surgically, and the remainder regressed spontaneously. There were no recurrences. Conclusions: FNAB can produce a definitive diagnosis of NF, providing an opportunity to avoid surgical excision in patients with a typical clinical presentation.

Nodular fasciitis: A frequent diagnostic pitfall on fine‐needle aspiration

“…The morphologic features of NF in the current study appear to be similar to those previously described in the literature; however, a few items are worth noting specifically. 1,[9][10][11][12][13][14][15] First, similar to the majority of cases published to date, the cytologic smears were hypercellular and comprised predominately of single cells with some component of myxoid stroma. Second, approximately 50% of cases contained an inflammatory component, either chronic or acute and chronic.…”

“…8 Although the clinical course of NF is completely benign and typically regresses within a few months without surgery or treatment of any kind, it can be very challenging diagnostically, often mimicking a malignant process due to its rapid growth clinically and its high cellularity, mitotic activity, and variable/nonspecific cytomorphologic findings. 1,[9][10][11][12][13][14][15] In fact, NF is frequently misclassified as malignant, leading to unnecessary surgery and patient distress. 2,13,[16][17][18] Conversely, mistaking a malignant process for NF can lead to mismanagement and the delay of treatment.…”

“…Although the cytomorphologic features of NF on fine-needle aspiration (FNA) have been reported previously, to the best of our knowledge these studies are limited by small sample sizes and are all single-institution reports. [9][10][11][12][13][14][15] To our knowledge, the current study is the largest and the first multi-institutional study of the cytomorphologic characteristics of NF by FNA.…”

Nodular fasciitis of the parotid gland: A challenging diagnosis on FNA

“…To avoid unnecessary parotidectomy for NF with its attendant risk for serious complications, including facial nerve transection, it is essential to identify the possibility of NF on FNA. Although there are several reports characterizing the FNA findings in NF, the cytomorphology has not been systematically evaluated in the parotid gland . This study characterizes the clinical and cytomorphologic findings of NF of the parotid gland by FNA to facilitate better preoperative recognition of this entity.…”

“…Because no unique radiographic features of NF have been reported to date on ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), minimally invasive sampling of the lesion is often performed to assess the need for surgery . However, NF can be easily mistaken for an aggressive neoplasm on fine‐needle aspiration (FNA) because of its high cellularity and somewhat nonspecific cytomorphology, and this can lead to patient anxiety and aggressive management . This challenge is especially acute in the parotid gland, where NF can show morphologic overlap with a wide range of benign and malignant neoplasms.…”