Nodular fasciitis of the hand in a young athlete. A case report
Source: Upsala Journal of Medical Sciences, Volume 115, Number 4, November 2010 , pp. 291-296(6)
Publisher: Informa Healthcare
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.
Document Type: Case Report
Affiliations: 1: 1Department of Orthopaedic Surgery, Hyogo Cancer Center, Japan 2: 2Department of Pathology, Hyogo Cancer Center, Japan 3: 3Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
Publication date: November 1, 2010