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A case of nodular fasciitis causing compressive optic neuropathy
Divakar Gupta1, Tina D Tailor, C Dirk Keene
1*Department of Ophthalmology, University of Washington Eye Institute; and Departments of †Radiology, ‡Pathology, and §Neurological Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A.
Ophthalmic Plastic and Reconstructive Surgery
|August 9, 2013
Summary
A rare orbital tumor in a teen was diagnosed as nodular fasciitis. This deep orbital case is the first to cause optic neuropathy, highlighting its potential to mimic cancer.
Area of Science:
- Ophthalmology
- Pathology
- Oncology
Background:
- Nodular fasciitis is a benign, reactive soft tissue proliferation.
- It rarely occurs in the orbit and can mimic malignant tumors.
- Orbital apex tumors present diagnostic challenges due to proximity to vital structures.
Observation:
- A 16-year-old female presented with progressive vision loss and visual field deficits.
- Orbital imaging demonstrated a tumor in the right orbital apex with associated bony erosion.
- The patient underwent biopsy and surgical excision of the orbital mass.
Findings:
- Histopathological examination confirmed the diagnosis of nodular fasciitis.
- This represents the first reported case of nodular fasciitis in the deep orbit.
- It is also the first documented instance of nodular fasciitis causing optic neuropathy.
Implications:
- Nodular fasciitis should be considered in the differential diagnosis of orbital apex tumors, even in the absence of typical features.
- This case expands the known clinical spectrum of nodular fasciitis.
- Accurate diagnosis is crucial to avoid unnecessary aggressive treatment for a benign condition.
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