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Childhood proliferative fasciitis of the orbit mimicking sarcoma: a case report
Maria-Dolores Pérez-Bañón1, Esther Moreno Moreno2, Hae-Ryung Won-Kim3,4
1Oculoplastic Surgery Unit, Ophthalmology Department, Irycis, Ramón y Cajal Universitary, Madrid, Spain.
Abstract:
Proliferative fasciitis (PF) is a benign fibroblastic reaction with histological and clinical characteristics that overlap with those of malignant soft tissue tumors; thus, it is referred to as a pseudosarcomatous reaction. It continues to be an important cause of diagnostic error and overtreatment. The childhood PF subtype has some distinct histological and immunohistochemical characteristics that make differential diagnosis with malignant tumors even harder, especially with sarcoma. These proliferations generally occur in the lower limbs, and the periorbital region is a rare location of appearance. Here, we describe a case of childhood subtype PF in a 16-year-old girl located in the periorbital area. To the best of our knowledge, this is the first reported case of childhood subtype PF in the periorbital area, and the third case if PF subtypes are not taken into account.
Insights
Childhood proliferative fasciitis (PF), a benign condition mimicking sarcoma, rarely appears in the periorbital region. This case highlights a unique presentation of childhood PF in a 16-year-old girl, emphasizing diagnostic challenges.
Area of Science:
- Pathology
- Oncology
- Dermatology
Background:
- Proliferative fasciitis (PF) is a benign fibroblastic proliferation that can be mistaken for malignant soft tissue tumors due to overlapping clinical and histological features.
- This pseudosarcomatous reaction is a significant cause of diagnostic errors and unnecessary aggressive treatments.
- The childhood subtype of PF presents unique histological and immunohistochemical characteristics, further complicating differential diagnosis with sarcomas.
Observation:
- This report details a rare case of childhood proliferative fasciitis occurring in the periorbital region of a 16-year-old female patient.
- The periorbital location is exceptionally uncommon for PF, which typically presents in the lower limbs.
- The distinct features of childhood PF made the differential diagnosis challenging, particularly concerning malignant tumors.
Findings:
- The case represents the first documented instance of childhood-type proliferative fasciitis in the periorbital area.
- If PF subtypes are disregarded, this case is only the third reported instance of PF in this rare location.
- Histological and immunohistochemical analyses were crucial in differentiating this benign lesion from malignant neoplasms.
Implications:
- This case underscores the importance of considering proliferative fasciitis, especially the childhood subtype, in the differential diagnosis of periorbital soft tissue masses.
- Accurate diagnosis is critical to prevent misdiagnosis, overtreatment, and associated patient morbidity.
- Awareness of rare presentations of PF can improve diagnostic accuracy and patient management strategies in pediatric and adolescent cases.
