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[Cranial fasciitis of childhood]
N Foureur1, O Enjolras, L Boccon-Gibod
1Service de Dermatologie, CHU Cochin, Paris, France.
Insights
Cranial fasciitis is a benign scalp nodule in young children. This diagnosis is important to consider, even with concerning pathological signs, and surgical removal ensures a good outcome.
Area of Science:
- Pediatric Pathology
- Dermatopathology
- Surgical Oncology
Background:
- Scalp nodules in children under eleven warrant consideration of serious diagnoses, including cranial fasciitis.
- Cranial fasciitis, though benign, can present with concerning pathological features that complicate diagnosis.
- Early identification and management are crucial for favorable outcomes in pediatric scalp lesions.
Observation:
- A four-month-old infant presented with a slow-growing, firm, pink parietal nodule.
- Surgical excision revealed spindle-shaped cells in a myxoid matrix with smooth muscle actin reactivity.
- Pathology confirmed cranial fasciitis, ruling out sarcoma.
Findings:
- Cranial fasciitis presents as a firm scalp nodule in infants and young children.
- Histopathological analysis, including immunohistochemistry, is key to diagnosis.
- Benign nature can be masked by concerning pathological features.
Implications:
- Cranial fasciitis should be considered in pediatric scalp nodules.
- Complete or incomplete excision prevents recurrence and ensures good prognosis.
- Accurate diagnosis avoids unnecessary aggressive treatments.
Introduction:
A nodule of the scalp in a child of less than eleven years should evoke a cranial fasciitis among other serious diagnoses.
Observation:
A four-month old infant had a firm and pink nodule at the left parietal level, exhibiting a slow growth since two months. It was excised. The pathologic sample showed spindle-shaped cells within a myxoïde matrix, with a strong reactivity for smooth muscle actin (immunohistochemical analysis). Diagnosis of cranial fasciitis was made. Due to the results of pathology, it was possible to rule out the diagnosis of sarcoma, therefore, no complementary work-up was performed. Evolution was favorable.
Discussion:
Cranial fasciitis is a diagnosis to be considered when confronted with a firm nodule of the scalp in a infant or a young child, with or without bone involvement. This is a benign lesion but worrying pathological signs may exist, making diagnosis of benignity difficult. Exeresis of the lesion, even incomplete, protects the child from possible recurrence. Evolution is always good.