[Fasciitis nodularis pseudosarcomatosa. A difficult differential diagnosis in the head-neck area]

Nodular fasciitis (nF) was first described in 1955 by Konwaler et al. as a benign fibroblastic proliferation. The onset of the disease occurs suddenly as a solitary tumor reaching a size of 10 to 50 mm in a few weeks. Relapse is rare and spontaneous remission frequent. The literature points out histologic similarities to a sarcoma.

The 57 year old female patient presented a spheroid, coarse, nonadherent, slightly painful tumor of the left paramandibular region. The history was inconspicuous. The B-scan sonography revealed a spheroid, anechoic, defined mass of 10-11 mm. The palpatory dimension increased noticeably during the following 2 weeks. Under local anesthesia the suspected lymph node was exposed via intraoral approach. Intraoperatively a non-capsulated, coarse, adherent, spheroid node of 25 mm was resected subtotally to preserve the marginal branch of the facial nerve. Histologically a fibroblastic cell-rich proliferation with mucoid milieu and few mitosis was found. No atypical cells or nuclei were observed and the proliferation reached fascial parts.

Based on clinical findings the diagnosis nF cannot be proven. Ultrasound and clinical findings suppose a lymphadenopathia, whereas the dynamics points out a malignant tumor. Therefore, histologic assurance after diagnosis is mandatory. In case of vulnerable anatomic structures in vicinity, the absence of a capsule should lead to partial resection despite of a total excision. The histology plays a primary role to avoid surgical overtherapy.