Nodular fasciitis of the hand in a young athlete. A case report

Abstract

Nodular fasciitis is a rapidly growing mass, with high cellularity and mitotic activity, that can be both clinically and histologically misdiagnosed as a soft tissue sarcoma. Nodular fasciitis of the hand is an extremely rare condition. We report a 17-year-old male hand-ball player with nodular fasciitis in the dominant hand. The patient presented with a rapidly growing mass in his right hand and no history of major trauma. On physical examination, a painful mass measuring 2 cm in diameter was observed in the first web space. Magnetic resonance imaging (MRI) demonstrated a subcutaneous mass with isointensity on T1-weighted images and inhomogeneous high intensity on T2-weighted images. The lesion was inhomogeneously enhanced after intravenous administration of gadolinium. Moreover, thallium-201 scintigraphy showed high uptake at the early phase and no wash-out at the delayed phase. We performed an excisional biopsy. The mass was present subcutaneously and adhered to the interosseous muscle fascia. Although a pathological examination by frozen section during surgery showed a low-grade spindle cell sarcoma, the final histological diagnosis was nodular fasciitis. There was no evidence of local recurrence at the recent follow-up 2 years after the operation. We speculate that repeated small injuries as a result of sports activities played an important causative role in the nodular fasciitis.

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.…”

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

“…with tumour cells at the resection margin). For nodular fasciitis, some authors believe that it is not a true tumour, but a local reactive process of fibrous tissue secondary to repeated minor trauma (Hara et al, 2010); and others believe it is an inflammatory process within connective tissue that may even respond to intra-lesional corticosteroid injections (Graham et al, 1999). Furthermore, a study of gene expression of nodular fasciitis revealed up-regulation of genes encoding inflammatory cytokines (Bacac et al, 2006).…”

Differentialdiagnose Noduläre Fasziitis

“…Das spontane Auftreten, zum Teil mit Bagatelltraumata assoziiert, das schnelle Wachstum und die oft schwierige histopathologische Diagnosestellung verleiten zu der Annahme einer malignen Neoplasie [7,8].…”