Nodular fasciitis can be defined as a highly reactive tumor originating from the superficial fascia of the skin which is often mistaken with the sarcoma (malignancy of the connective tissue) due to its high mitotic activity and rapid growth.
This term was first coined and described by Kaon Walker in 1955. Its synonyms are Pseudosarcomatous fasciitis, Infiltrative fasciitis, and proliferative fasciitis. It can happen to all ages but it is more seen in middle-aged people. In infants, it can happen in the neck area and sometimes in the head too.
Nodular Fasciitis Signs and symptoms
It is associated with soft tissue, therefore, it can be seen in the breast(often mistaken as breast carcinoma), a mucosal surface, and parotid gland. It may grow in 3 different patterns, either up into the overlying subcutaneous tissue or down into the underlying skeletal muscle i.e the intramuscular type or alternatively horizontally running parallel to the fascia which is called fascia type. This grows up to a size of 2-3 cm. The two other conditions are proliferative fasciitis and proliferative myositis. These are similar but can happen more in aged individuals. Proliferative fasciitis mostly happens in the arms while the other one occurs in the chest area.
Mainly 3 salivary glands are associated with this disease. The parotid salivary gland which is seen at the side of the face. The submandibular salivary gland-both side of the jaw and the Sublingual salivary gland is seen on the floor of the mouth. The symptoms are tenderness and pain in the affected area. It can cause difficulty in mastication, asymmetry of the face, xerostomia and swallowing food sometimes. It can grow up to 5cm in its maximum shape.
Nodular Fasciitis Causes
The etiology of Nodular fasciitis is generally unknown. Trauma due to some injury can be considered as one of the etiology. It grows rapidly in 3-6 weeks to form a mass but eventually regresses on its own. The problem is its growth rate is very fast but it doesn’t show any pain so people don’t get to know that they are having this.
Nodular Fasciitis Risk Factors
High proliferative fibroblasts, chronic inflammatory cells, sometimes extravasation of red blood cells, the mucoid matrix can be the risk factors. On another hand sudden increase of collagen fibers lined by spindle cells can be the diagnostic feature of nodular fasciitis. Fascicular patterns can be of S or C shaped. The presence of plasma cells and neutrophils and sometimes the infiltration of the adjacent fat cells can be the risk factor. Hyperchromatic of the nuclei gives a characteristic “tram-track” pattern of the myofibroblasts on positive staining. Some of the possible complications are
- The tumor can hardly recur after removing it surgically
- Bigger the tumor size the dangers it can be for that individual’s life.
Nodular Fasciitis Pathology
The pathology of this disease is not clear as per now as it doesn’t show any symptoms directly. Some say it is a reactive lesion which is related to trauma and other describes it as abnormalities in chromosomes that are suggestive of neoplastic origin. The lesions can be less than 4cm in size. There are basically three types of nodular fasciitis which can be categorized as per the lesion location in the body they are:
Though most of them are subcutaneous, fascia and circumscribed.
Nodular Fasciitis Diagnosis
The chances of developing nodular fasciitis in salivary gland are very rare as well as quite challenging when it comes to diagnosis. Taking a brief medical history and physical evaluation the physicists can test the radiographical images under MRI which will create high-quality images and reveal the presence of tumor.X-ray of the head and neck region. FNAC can also be done for further confirmation. For Salivary gland, open biopsy of the tumor can don’t as per the stage and size. Tissue biopsy is usually done by sending the biopsy to the laboratory where they gather the clinical and microscopical findings related to the tumor.
Specific stains are used such as hematoxylin which imparts blue color and eosin which imparts pink color for the identification of specific cells under the microscope. Other diagnosis includes doing tests such as MRI and CT scans. But the problem is all the clinical problems may have more or less same kinds of signs and symptoms that’s why it’s better to consult your doctors so that they can ask you to do other additional tests for further confirmations to be sure of a definitive diagnosis.
Nodular Fasciitis Prevention
As the etiology of this soft tissue tumor is unknown so we cannot stop its occurrence. Early diagnosis can help in the treatment.
Nodular Fasciitis Treatment
Conservative surgical excision is indicated for this tumor of the salivary gland. Several weeks of surveillance is necessary to check the recurrence rate of it. In many cases, it is observed as a self-limiting tumor which regresses by itself within 3-4 months. Prognosis is excellent as the chance of recurrence is low.