A welcome surprise: nodular fasciitis presenting as soft tissue sarcoma

Area of Science:

• Oncology
• Pathology
• Surgical Oncology

Background:

• Soft tissue masses require accurate diagnosis to guide appropriate surgical management.
• Preoperative imaging can sometimes suggest malignancy, influencing surgical planning.
• Distinguishing benign from malignant soft tissue lesions is crucial for patient outcomes.

Observation:

• A 15-year-old male presented with an anterior chest wall mass.
• Clinical presentation and imaging were suggestive of soft tissue sarcoma.
• Intraoperative pathology identified the mass as nodular fasciitis.

Findings:

• Nodular fasciitis, a benign soft tissue lesion, was diagnosed intraoperatively.
• The diagnosis led to a lesional excision instead of a wide resection.
• This case underscores the potential for preoperative imaging to misdirect diagnosis.

Implications:

• Benign soft tissue lesions like nodular fasciitis can mimic sarcomas.
• Considering benign etiologies is vital even with imaging suggestive of malignancy.
• Accurate intraoperative diagnosis can prevent overly aggressive surgical interventions and associated morbidity.