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Year : 2006  |  Volume : 16  |  Issue : 3  |  Page : 345-347
Nodular fascitis (pseudosarcomatous fibromatosis)

Department Of Radiology And Imaging Science, Sri Ramachandra Medical College And Research Institute, Porur - Chennai - 600 116, India

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Keywords: Fascitis, Subcutaneous Nodular Lesion, Fibromatosis

How to cite this article:
Somasundaram S, Murali K, Joseph S, Paul T. Nodular fascitis (pseudosarcomatous fibromatosis). Indian J Radiol Imaging 2006;16:345-7

How to cite this URL:
Somasundaram S, Murali K, Joseph S, Paul T. Nodular fascitis (pseudosarcomatous fibromatosis). Indian J Radiol Imaging [serial online] 2006 [cited 2020 May 26];16:345-7. Available from:

   Introduction Top

Nodular fascitis is a common soft tissue tumor that remains almost unreported in the radiology literature. The natural history of Nodular Fascitis is unknown, since the diagnosis is usually based on excised lesions. Nodular Fascitis can be histologically mistaken for a Sarcoma. Here we present a case, of rapidly enlarging subcutaneous nodular lesion of the left thigh which was histologically proved to be benign nodular fascitis.

   A case report Top

A 27 year old male patient presented with a swelling in the left lower thigh. The swelling was rapidly enlarging over a few weeks and was tender on examination. Ultrasound of the lesion was performed an Aloka SSD 5500, with linear probe 10 MHZ. Later MRI of the thigh was performed with 1.5 T Siemens, Magnetom using a dedicated extremity coil. Spin echo, fast spin echo and inversion recovery sequences were used to obtain T1 W, T2W and fat suppressed STIR images. Post contrast images were also obtained after intravenous injection of gadolinium.

USG showing a Ovoid hypoechoic lesion in the subcutaneous plane having two nodular components.

On ultrasound the lesion was round to oval in configuration, measuring 3.5cm in size. The lesion was subcutaneous in location predominantly hypoechoic and showed two well defined nodular echogenic components attached to wall of the lesion [Figure - 1].

On MRI the lesion was in the subcutaneous plane and showed isointensity on T1W [Figure - 2], and hyperintensity on T2W [Figure - 3]. Fat suppressed images revealed hyperintensity of the lesion. Marked subcutaneous soft tissue edema noted involving left lower thigh region [Figure - 4]. Post contrast images revealed homogenous enhancement of the lesion [Figure - 5][Figure - 6].

The diagnosis of nodular fascitis was made histopathologically after resection of the mass [Figure - 7].

[TAG:2]Discussion:Fascitis is of three major types:[/TAG:2] 1. Eosinophillic fascitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orange - peel configuration suggestive of scleroderma and considered by some a variant of scleroderma.

2. Necrotizing fascitis; a serioud fulminating infection (usually by a Beta hemolytic streptococcus) causing extensive necrosis of superficial fascia.

3. Nodular fascitis is a soft tissue lesion composed of proliferating fibroblasts. The lesion is described as pseudosarcomatous or proliferative fibromatosis demonstrating an alarming nodular proliferation of fibroblasts [1],[2]. It is not malignant but it is sometimes mistaken for fibrosarcoma.

Clinically most patient present with a rapidly enlarging, palpable soft tissue mass. Commonly this occur on the upper extremities (48%), the trunk (20%), head and neck (17% and lower extremities (15%). Nodular fascitis can be classified into three subtypes according its anatomic location: subcutaneous, intramuscular and fascial which spreads along the superficial fascial tissue [2]. Fine needle aspiration of Nodular Fascitis has been described and features benign appearing spinde cells (singly and in groups), collagen and myxoid material [3].

   MRI findings of Nodular Fascitis Top

The subcutaneous lesions were well defined by the surrounding fat on MR images although the appearance is otherwise non-specific and varied according to the histology of the lesion [6].

The intramuscular lesions were mucoid or cellular and were hyperintense to skeletal muscle on T1W and hyperintense to fat on T2W spin echo (SE) images [6]

After intravenous Gadolinium administration lesions usually show homogenous enhancement [4]. Some lesions are fibrous in nature and appears hypointense on all pulse sequences [6].

Enhanced CT examination is also helpful in investigating the origin and extension of the mass and its connection with surrounding tissues, therefore providing valid diagnostic support for surgery [5],[6].

   Conclusion Top

Since there are no unique radiologic findings in Nodular Fascitis, this entity must be included in the preoperative differential diagnosis of small soft tissue masses occurring in the extremities of young adults. Spontaneous resolution of small subcutaneous lesions occur and should be managed non-surgically. If resolution does not occur within a few weeks, excision of the lesion can be performed surgically.

   References Top

1.Gelfand JM, Mirza N, Kantor J, Yug, Reale D, Bandi E, Junkins - Hopkins JM. Nodular Fascitis Arch Dermatol 2001 Jun; 137 (6): 719-21  Back to cited text no. 1    
2.Krasoyec M, Burg G, Nodular Fascitis (pseudotumor of skin), Dermatology 1999; 198(4);431 - 3.  Back to cited text no. 2    
3.Stanley MW, skoog L, Tanie M, Horwiz CA. Nodular Fascitis Diagn cytopathol 1993; 9(3) : 322 - 4.  Back to cited text no. 3    
4.Leungly, Shus J, Chan AC, Chan MK, Chan CH. Nodular Fascitis; MRI appearance and literature review. Skeletal Radiology of 2002 Jan; 31 (1) 9-13.  Back to cited text no. 4    
5.Kolo Kythas O, Karhousen J, Von Baer A, Land grebek, Craciun M, Nussle K. (Radiologic - pathologic conference Nodular Fascitis), Roentgen Praxis, 1997 Aug; 50(8) : 229 - 32.  Back to cited text no. 5    
6.Meyer CA, Kransdorf MJ, Jelinek JS, Moser RP JR. MR and CT appearance of Nodular Fascitis. J Comput assist Tomography 1991 Mar-Apr (15(2): 276 - 9  Back to cited text no. 6    

Correspondence Address:
S Somasundaram
Assistant Professor, Srmc & Ri Old No.38, New No.94, B-Block, F2 Mylappa Street, Ayanavaram Chennai - 600 023
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.29013

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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]

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