Management of Recurrent Ischemic Fasciitis, a Rare Soft Tissue Pseudosarcoma

89 Ischemic fasciitis, also termed atypical decubital fibroplasia, is considered a pseudosarcoma that usually presents as a painless mass in areas overlying bony prominences [1]. Historically, ischemic fasciitis is thought to be a condition that occurs only in the elderly and debilitated because of direct pressure on bony prominences. However, recently, ischemic fasciitis has also been detected in mobile young individuals [1,2]. Epidemiological studies have revealed a predominance of this condition in patients in their 70s and 80s [1]. Common sites of occurrence are the limb girdles, sacrum, greater trochanter, and shoulders. The other locations described include the buttocks and the posterior chest wall. Isolated lesions have also been reported in skeletal muscle [3]. Upon histological analysis, ischemic fasciitis is noted to involve the entire depth of the subcutis, including the deep dermis, muscle, and tendon. Ischemic fasciitis is characterized by a “pseudosarcomatous proliferation of fibroblasts and myofibroblasts with a central area of fibrinoid degeneration surrounded by granulation tissue” [1]. The granulation tissue is characterized by capillary growth and plump endothelium. Further, the fibroblasts are enlarged mimicking ganglion cells [3]. Similar entities include nodular fasciitis and proliferative fasciitis. In the case of nodular fasciitis, also known as infiltrative fasciitis, lesions grow rapidly and are located typically on the volar aspect of the forearm, chest, and back. These lesions have dense cellularity with immature fibroblasts and are generally less than 3 cm in diameter [3]. In proliferative fasciitis, lesions affect the LETTER