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Nodular fasciitis-often a tumor mimic

Sriram Jaganathan

Abstract: Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It is frequently mistaken for a sarcomatous lesion because of its rapid growth, imaging features and aggressive pathological findings. Though imaging plays a vital role in evaluating these lesions, strong suspicion with a careful histopathology is the final answer. We present a patient with nodular fasciitis involving the upper extremity. A 15-year-old boy presented with complaints of progressively increasing right wrist swelling since 2 months, and had been having severe pain on exertion. On clinical examination the swelling was tender. MRI revealed T2 hyperintense lesion along the volar-lateral aspect of wrist, completely encasing the abductor pollicis longus tendon and indenting the extensor pollicis brevis tendon. Per operatively, the tumor was seen to involve the abductor pollicis longus tendon sheath and insinuating between the tendons. Excision biopsy was performed and histopathology confirmed the diagnosis of nodular fasciitis.
Keywords: indenting / tendon / pollicis / abductor / swelling / longus / tumor / Nodular fasciitis

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