Diagnostic Imaging of Musculoskeletal Diseases by Akbar Bonakdarpour William R. Reinus & Jasvir S. Khurana

Author:Akbar Bonakdarpour, William R. Reinus & Jasvir S. Khurana
Language: eng
Format: epub
Publisher: Humana Press, Totowa, NJ

Fibrous Lesions

Benign

Nodular Fasciitis

Nodular fasciitis represents an idiopathic rapid proliferation of benign fibroblasts. Histologically, it has three different cell subtypes (myxoid, cellular, and fibrous) that affect the tumor’s appearance on MR imaging. Typically it is approximately 2.0 cm in size. Approximately half of the cases occur in the subcutaneous fat, especially of the forearm. The remaining cases may arise from muscle, intermuscular fascia, or from deep fat. The masses typically are low signal intensity on T1-weighted sequences with varying degrees of heterogeneous high signal intensity on T2-weighted sequences, an appearance often strikingly similar to peripheral nerve sheath tumors. Their rapid growth, occasional heterogeneous and ill-defined appearance on MR imaging, and histologic demonstration of fibroblast proliferation may lead to a misdiagnosis of sarcoma, but any rapidly appearing mass in the subcutaneous tissue of the forearm should raise the consideration of this benign process.

Surgical Pathology: Nodular fasciitis might appear to be circumscribed grossly with grey-white firm mass, sometimes with central cystic change on cut surface. Histologically, it is a non-encapsulated nodular or stellate lesion characterized by a proliferation of fusiform or stellate-shaped stromal cells with plump spindle nuclei. The stromal cells are arranged loosely in a haphazard pattern in a myxoid matrix. Extravasated red cells, chronic inflammatory cells, and osteoclast-like giant cells are frequently seen. In some cases keloid-like collage deposition can be seen focally or even prominently.

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