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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 530-531

Intramuscular Nodular Fasciitis Mimicking a Peripheral Nerve Sheath Tumour


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 Submission17-Jan-2020
Date of Decision15-Feb-2020
Date of Acceptance06-Jun-2020
Date of Web Publication24-Apr-2021

Correspondence Address:
Dr. Roberto S Martins
Rua Oscar Freire 2250, CEP 5409-011, São Paulo, SP
Brazill
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314571

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How to cite this article:
Martins RS, Siqueira MG. Intramuscular Nodular Fasciitis Mimicking a Peripheral Nerve Sheath Tumour. Neurol India 2021;69:530-1

How to cite this URL:
Martins RS, Siqueira MG. Intramuscular Nodular Fasciitis Mimicking a Peripheral Nerve Sheath Tumour. Neurol India [serial online] 2021 [cited 2021 Oct 17];69:530-1. Available from: https://www.neurologyindia.com/text.asp?2021/69/2/530/314571




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.[1] 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.[2] The radiological aspect of NF is non-specific and a tail-sign, often described in tumors originating from peripheral nerves,[3] maybe infrequently identified.[4] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lu L, Lao IW, Liu X, Yu L, Wang J. Nodular fasciitis: A retrospective study of 272 cases from China with clinicopathologic and radiologic correlation. Ann Diagn Pathol 2015;19:180-5.  Back to cited text no. 1
    
2.
Singh S, Paul S, Dhall K, Khichy S. Nodular fasciitis: A diagnostic challenge. Indian J Pathol Microbiol 2013;56:288-90.  Back to cited text no. 2
  [Full text]  
3.
Tagliafico AS, Isaac A, Bignotti B, Rossi F, Zaottini F, Martinoli C. Nerve tumors: What the msk radiologist should know. Semin Musculoskelet Radiol 2019;23:76-84.  Back to cited text no. 3
    
4.
Mallina S, Rosalind S, Philip R, Harvinder S, Gurdeep S, Sabaria MN. Nodular fasciitis: A diagnostic dilemma. Med J Malaysia 2007;62:420-1.  Back to cited text no. 4
    


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