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Nodular fasciitis presenting as a rapidly enlarging episcleral mass in a 3-year-old
J B Holds1, N Mamalis, R L Anderson
1Department of Ophthalmology, University of Texas Medical Branch, Galveston 77550.
Insights
Rapidly growing eye masses in children can mimic malignancy. This case highlights nodular fasciitis, a benign condition, presenting as a rapidly enlarging episcleral mass in a pediatric patient.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Surgical Pathology
Background:
- Periocular masses in children necessitate ruling out malignancy, particularly rhabdomyosarcoma.
- Rapidly growing lesions require prompt and accurate diagnosis.
Observation:
- A 3-year-old girl presented with a rapidly growing episcleral mass.
- The mass was located superonasal to the globe, near the superior rectus muscle insertion.
Findings:
- The lesion was surgically excised and initially suspected of being a sarcoma on frozen sections.
- Permanent sections and electron microscopy confirmed the diagnosis of nodular fasciitis, a benign pseudosarcomatous lesion.
Implications:
- Nodular fasciitis should be included in the differential diagnosis for rapidly growing subconjunctival or orbital masses in children.
- Accurate histological examination is crucial for distinguishing benign from malignant periocular tumors.
Abstract:
A rapidly enlarging periocular mass in a child obligates the treating physician to rule out a malignancy, especially a rhabdomyosarcoma. A 3-year-old girl presented with a 5-day history of a rapidly growing episcleral mass superonasal to the globe, adjacent to the superior rectus muscle insertion. The lesion was locally excised. A sarcoma could not be excluded on frozen sections. Permanent sections and electron microscopy revealed nodular fasciitis, a benign lesion with a pseudosarcomatous histologic appearance. No recurrence has been noted at 9 months follow-up. Nodular fasciitis is a benign proliferation which should be considered in the differential diagnosis of a rapidly enlarging subconjunctival or orbital mass in a child.