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A rapidly progressing periorbital mass in an infant: fasciitis nodularis
Pirkko Ruoppi1, Martine Vornanen, Juhani Nuutinen
1Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland. pirkko.ruoppi@kuh.fi
Abstract:
Nodular fasciitis is a benign, rapidly growing proliferation of fibroblasts, which is histologically difficult to distinguish from neoplasms. In several reports, as many as half of all cases have been initially misdiagnosed as a fibrosarcoma or some other malignancy. Although the head and neck is a region of predilection in infants and children, only eight periocular lesions have previously been reported in paediatric patients. We present a case of nodular fasciitis which occurred in the periorbital region in a 1 1/2-year-old girl. The process was excised locally in order to perform a biopsy. The mass was initially classified as a sarcoma but subsequently as infantile fibromatosis. Only after a thorough review of the case and four independent pathological consultations was the final diagnosis of nodular fasciitis confirmed. No further treatment was scheduled. Although the primary surgical removal of the tumour was not radical, no recurrence was observed during a 3-year follow-up period.
Insights
Nodular fasciitis, a benign fibroblast proliferation, can mimic malignancy. This case highlights a rare periocular presentation in a child, emphasizing diagnostic challenges and favorable outcomes with conservative management.
Area of Science:
- Pathology
- Pediatric Oncology
- Ophthalmology
Background:
- Nodular fasciitis is a benign fibroblast proliferation often misdiagnosed as sarcoma.
- Periocular nodular fasciitis is rare in pediatric patients, with only eight cases previously reported.
- Accurate diagnosis is crucial due to the potential for misclassification as malignancy.
Observation:
- A 1.5-year-old girl presented with a rapidly growing periorbital mass.
- Initial biopsies led to misdiagnoses of sarcoma and infantile fibromatosis.
- Multiple pathological consultations were required to confirm nodular fasciitis.
Findings:
- The periorbital mass was definitively diagnosed as nodular fasciitis after extensive review.
- Despite non-radical excision, no recurrence was observed over a 3-year follow-up.
- This case underscores the diagnostic difficulties associated with nodular fasciitis.
Implications:
- Highlights the importance of considering nodular fasciitis in pediatric periocular masses.
- Emphasizes the need for careful pathological evaluation to avoid misdiagnosis of malignancy.
- Demonstrates that conservative management can be effective for periocular nodular fasciitis in children.
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