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|Year : 2021 | Volume
| Issue : 2 | Page : 530-531
Intramuscular Nodular Fasciitis Mimicking a Peripheral Nerve Sheath Tumour
Roberto S Martins1, Mario G Siqueira2
1 Hospital Israelita Albert Einstein; Peripheral Nerve Surgery Unit, Division of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazill
2 Peripheral Nerve Surgery Unit, Division of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazill
|Date of Submission||17-Jan-2020|
|Date of Decision||15-Feb-2020|
|Date of Acceptance||06-Jun-2020|
|Date of Web Publication||24-Apr-2021|
Dr. Roberto S Martins
Rua Oscar Freire 2250, CEP 5409-011, São Paulo, SP
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Martins RS, Siqueira MG. Intramuscular Nodular Fasciitis Mimicking a Peripheral Nerve Sheath Tumour. Neurol India 2021;69:530-1
Nodular fasciitis (NF) is a rare, proliferative myofibroblast lesion that usually presents as a solitary non-invasive mass and the diagnosis is often made only during a surgical procedure. We report a patient with intramuscular NF whose imaging findings mimicked a neural sheath tumor.
A 30-year-old woman patient presented with a painful nodule on the right shoulder with rapidly and progressive growth. The examination showed a hard nodule on the right shoulder with well-defined borders.
Her MRI showed a homogeneous oval tumor with well-defined contours at the middle third of the deltoid muscle with homogenous and marked enhancement after contrast infusion. From the tumor, a tail-like image was seen entering and exiting the lesion and was interpreted as a tail signal, often described in tumors originating from peripheral nerves [Figure 1]a.
|Figure 1: (a). Coronal fat saturation T2-weighted MR image: homogeneous and well-defined rounded lesion inside the right deltoid muscle (D) with high post-contrast enhancement. Note the tail sign (arrows) characteristically present in peripheral nerve sheath tumors. H: humerus. (b). Intraoperative view of an intramuscular fibrous tumor. Macroscopically the lesion resembled an intramuscular schwannoma. Note the linear expansion at the extremities of the tumor resulting in an image compatible with schwannoma. D: deltoid muscle; T: tumor. (c). Histological examination (H and E) showing myofibroblastic cells set in a myxoid stroma compatible with the diagnosis of nodular fasciitis|
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The patient underwent ultrasound-guided biopsy and surgery with total excision of the lesion [Figure 1]b. The histological analysis revealed a cellular lesion formed by myofibroblasts without atypia, compatible with nodular fasciitis [Figure 1]c.
NF typically presenting as a solid and painful nodule displaying rapidly progressive growth and often diagnosed as soft tissue sarcoma. The radiological aspect of NF is non-specific and a tail-sign, often described in tumors originating from peripheral nerves, maybe infrequently identified. In the present case, the initial imaging diagnosis was schwannoma, which was incongruent with the clinical presentation and biopsy was important for scheduling an eventual oncological surgery.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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