Nodular fasciitis of the hand in a young athlete. A case report.
Nodular fasciitis is a rapidly growing mass, with high cellularity and mitotic activity, that can be both clinically and histologically misdiagnosed as a soft tissue sarcoma. Nodular fasciitis of the hand is an extremely rare condition. We report a 17-year-old male hand-ball player with nodular fasciitis in the dominant hand. The patient presented with a rapidly growing mass in his right hand and no history of major trauma. On physical examination, a painful mass measuring 2 cm in diameter was observed in the first web space. Magnetic resonance imaging (MRI) demonstrated a subcutaneous mass with isointensity on T1-weighted images and inhomogeneous high intensity on T2-weighted images. The lesion was inhomogeneously enhanced after intravenous administration of gadolinium. Moreover, thallium-201 scintigraphy showed high uptake at the early phase and no wash-out at the delayed phase. We performed an excisional biopsy. The mass was present subcutaneously and adhered to the interosseous muscle fascia. Although a pathological examination by frozen section during surgery showed a low-grade spindle cell sarcoma, the final histological diagnosis was nodular fasciitis. There was no evidence of local recurrence at the recent follow-up 2 years after the operation. We speculate that repeated small injuries as a result of sports activities played an important causative role in the nodular fasciitis.
Hara
Hitomi
H
Department of Orthopaedic Surgery, Hyogo Cancer Center, Japan.
Fujita
Ikuo
I
Fujimoto
Takuya
T
Hanioka
Keisuke
K
Akisue
Toshihiro
T
Kurosaka
Masahiro
M
D000293:Adolescent; D056352:Athletes; D001706:Biopsy / Q000379:methods; D005208:Fasciitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006225:Hand / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007249:Inflammation; D008198:Lymph Nodes / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D013794:Thallium Radioisotopes / Q000494:pharmacology; D014057:Tomography, X-Ray Computed / Q000379:methods
D013794:Thallium Radioisotopes