Nodular Fasciitis of the Face Diagnosed by US-Guided Core Needle Biopsy: A Case Report

Abstract

Nodular fasciitis (NF) is a benign, reactive, tumor-like proliferation of myofibroblasts that appears as a rapidly growing solitary mass. The most common locations are the extremities; this is followed by trunk, head and neck in decreasing order. A literature search yielded only a few reports concerning the imaging findings of NF (1 5). Most of those reports are focused on the computed tomographic (CT) and magnetic resonance (MR) imaging findings of NF in the extremities and the neck. Ultrasonography (US) is the usual initial diagnostic modality for evaluating a palpable mass in the face. Thus, knowledge of the gray-scale and color Doppler US findings of NF is prerequisite for radiologists. A few reports (6 8) have stressed the role of the fine needle aspiration cytology (FNAC) in the cytologic diagnosis of NF in the extremities, breast and face, but the role of USguided core needle biopsy (CNB) in the histologic diagnosis of NF has not been discussed.We report here on a case of NF of the face along with gray-scale and color Doppler US and CT findings, and we report on the role of US-guided CNB for the histologic diagnosis of NF of the face. Case ReportA 31-year-old man presented with a palpable mass at the right cheek that was noticed 1 month earlier. There was no history of previous trauma. On physical examination, a firm, nontender, mobile mass about 3 cm in size was found at the right cheek. US demonstrated an approximately 2.5 cm sized lobular markedly hypoechoic solid mass in the right cheek that probably arose from the perioral muscle and it was protruding into the subcutaneous fat (Figs. 1A, B). Prominent vascularity was noted within the mass on the color Doppler images (Fig. 1C). Non-enhanced computed tomography (NECT) revealed a well circumscribed mass that was isoattenuated compared to the adjacent muscles, and it was mainly in the subcutaneous layer. The axial contrast-enhanced CT (CECT), and coronal and sagittal reformatted CECT images demonstrated a well-demarcated solid We report here on a case of nodular fasciitis (NF) that was diagnosed by ultrasonography (US)-guided core needle biopsy in a 31-year-old man, and we include the US and computed tomographic (CT) findings and the histopathologic findings at US-guided core needle biopsy (CNB). We suggest that high-resolution US is useful for the detailed evaluation of NF in the superficial regions, such as the face, and US-guided CNB is useful for the definitive histologic diagnosis of NF without causing scarring.