Periorbital nodular fasciitis: a case report

Nodular fasciitis (NF), also known as pseudosarcoma fasciitis, is defined as a benign, self-limiting, vascular, or fibrovascular proliferation. It is commonly found on the trunk and upper extremities. NF is rarely found in the orbit and periorbital regions, with only a few case studies reported since it was initially described by Font et al. in 1966. NF usually presents as a rapidly growing solitary tumor and is often mistaken for a sarcoma due to its high cellularity and increased mitotic activity.

We present a case of NF in a 41-year-old Saudi man with a 1-year history of a gradually enlarging left medial subbrow mass in the left eye. The mass was not associated with pain, visual disturbances, double vision, or a history of trauma. An external ophthalmic examination revealed a firm, oval mass over the nasal aspect of the superior orbital rim of the left eye. The mass was non-tender, measured 1 × 2 cm in diameter, and fixed to deep tissues. Computed tomography (CT) with contrast revealed a well-demarcated left para-orbital soft tissue round lesion with peripheral enhancement occupying the nasal aspect of the superior orbital rim above the inner canthus. Debulking and incisional biopsies were performed, and the histopathological findings were consistent with those of NF.

NF is a rare benign tumor that infrequently presents in the periorbital region. It lacks distinctive features for a definitive diagnosis and should be suspected when imaging results are inconclusive. Management typically involves complete local excision or debulking.