Nodular Fasciitis of External Auditory Canal

Abstract

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.

Diagnosis and Treatment of Nodular Fasciitis of Ear Region in Children: A Case Report and Review of Literature

“…Its prevalence in children is approximately 10% [ 3 ]. Rarely NF localized in the ear region was reported in literature [ 4 , 5 ] and more rarely described in pediatric age [ 6 , 7 ]. Masses in the external ear can be due to rhabdomyosarcoma [ 8 ], angioleiomyoma [ 9 ], fibroepithelial polyp [ 10 ], squamous cell carcinoma [ 11 ], otitis malignant and suppurate tissue in case of persistence of an external body in the EAC [ 12 ].…”

Pathology Clinic: Nodular Fasciitis Involving the External Ear

“…1 Recent reports have identified a potential MYH9-USP6 fusion gene that may trigger clonal neoplastic origin. 2 Treatment is generally via surgical excision, although if diagnosed definitively on FNA, expectant management for 4 to 8 weeks may lead to spontaneous regression. 4 When treated with surgical excision, recurrence rates are reported to be 1% to 2%.…”

“…4,6 Although the head and neck is a relatively common location, particularly in children, involvement of the ear is less common. Reported cases of nodular fasciitis involving the external ear include a 2001 series of 50 cases of nodular fasciitis involving the external ear region by Thompson et al, and an additional series published in 2016 of 20 cases involving the external auditory canal by Ahn et al 1,2 Accurate diagnosis presents a unique challenge, as these lesions frequently mimic malignancy clinically and pathologically. Nodular fasciitis often presents as an irregular-appearing lesion, characterized by rapid growth and sometimes infiltrative of the surrounding soft tissues.…”

“…1 However, nodular fasciitis can be differentiated from malignant lesions by a lack of significant nuclear atypia, hypercellularity, cellular necrosis, or atypical mitotic activity on cellular staining. 2 Although nodular fasciitis of the external ear is rare, a diagnosis of nodular fasciitis should be considered on the differential whenever one encounters an irregular or rapidgrowing lesion of the head and neck area. Particularly in cosmetically sensitive regions, an accurate diagnosis is particularly important in order to avoid aggressive overresection or overtreatment.…”

“…Nodular fasciitis is characterized by a benign, pseudosarcomatous proliferation of fibroblasts and myofibroblasts. 1,2 These lesions tend to occur in patients between 20 and 40 years of age, and anecdotally are often associated with a site of previous trauma, although a direct mechanism for this has not been established. 1,3 Lesions are generally small, but rapid growth may raise clinical concern for malignancy.…”