Nodular fasciitis involving the palm

Area of Science:

• Orthopedic Surgery
• Oncology
• Pathology

Background:

• Nodular fasciitis (NF) is a benign, self-limiting neoplasm often mistaken for soft tissue sarcoma.
• NF typically presents in the forearm, with lesions distal to the wrist being uncommon.

Observation:

• Two rare cases of nodular fasciitis involving the palm are presented.
• The first case involved non-intraneural NF presenting as peripheral neuropathy of the digital nerve.
• The second case was a painless, non-tender palmar NF that did not regress spontaneously.

Findings:

• Both cases demonstrated nodular fasciitis confirmed by ubiquitin specific protease 6 (USP6) gene rearrangement.
• The clinical presentations were atypical for NF, highlighting diagnostic complexities.

Implications:

• These cases expand the known anatomical distribution of nodular fasciitis.
• Recognition of these rare presentations is crucial for accurate diagnosis and avoiding misclassification as sarcoma.
• USP6 gene rearrangement serves as a key diagnostic marker for nodular fasciitis.