Intradermal Nodular Fasciitis: A Case Report

Nodular fasciitis is a reactive myofibroblastic proliferative lesion frequently misdiagnosed as a sarcoma. Most lesions are located in the subcutaneous tissue of the upper extremities. Rarely, intravascular, intradermal, and cranial variants have been described. Intradermal nodular fasciitis, first reported by Goodlad and Fletcher in 1990, may be confused with fibrohistiocytic tumors because of the unexpected location. A 32-year-old male had a rapidly growing tender nodule in the occipital region of the scalp for one month. Histopathology revealed an ill-defined dermal nodule composed of interwining fascicles of spindle cells in a loose myxoid stroma with focal hemorrhage. The diagnosis was intradermal nodular fasciitis. Because of the possibility of cranial fasciitis, skull films were obtained to evaluate for possible bony involvment, but no lesion was identified. Although the deep surgical margin contained tumor spindle cells, MRI showed only a linear low intensity signal suggestive of scar. We report a case of intradermal nodular fasciitis and discuss the clinical, pathologic and radiographic findings.(Dermatol Sinica 23: 212-216, 2005)