Nodular fasciitis of the hand: excision preserving ‘vital’ structures

Abstract

Nodular fasciitis is an extremely rare benign fibrous tumour of the hand. Although benign, the tumour is frequently adherent to tendons/nerves and joints of the hand. However, the tumour may spontaneously regress and does not tend to recur following excision with histologically positive margins. For the last 20 years, the author has adopted a specific management approach for these and other benign fibrous tumours of the hand. Following the clinical/radiological diagnosis, tumour excision is done preserving 'vital' structures within the hand. The diagnosis is confirmed histologically and by immune stains, and the patient is then followed up for local recurrence. Over a 20-year period, the author has treated four cases of nodular fasciitis of the hand using this management approach. Despite the positive margins in all cases, there were no recurrences at a minimum follow-up interval of 3 years.

Intra-articular nodular fasciitis of the proximal interphalangeal joint of a finger: A case report

“…Al-Qattan and Arafah reported four cases of NF of the hand treated surgically over a 20-year period. They preserved vital structures such digital nerve, both digital arteries of a finger, the volar plate, and the flexor profundus tendon; none of these tumors had joint involvement [6].…”

An aggressive nodular fasciitis lesion protruding from the palm (USP6 gene fusion helps differentiate from sarcomas): A case report

“…The relationship between the malignant potential of nodular fasciitis and its oncogenic mechanism is currently being intensively investigated (4). In contrast, some nodular fasciitis lesions are self-limiting and spontaneously regress (7,8). Guo et al reported a case of 'malignant nodular fasciitis', which recurred several times and even metastasized to soft tissues (4).…”

Nodular fasciitis involving the palm

“…Only 18 cases have been reported in the English literature. 3,6,[9][10][11][12][13][14][15][16][17][18][19] A third of these patients (n=6, 33%) suffered from pain or tenderness. In NF involving the palm, such symptoms appear to be less frequent than in other locations.…”