J Korean Ophthalmol Soc.  2016 Dec;57(12):1946-1952. 10.3341/jkos.2016.57.12.1946.

Three Cases of Periorbital Nodular Fasciitis

• Park MS
• Kwon MJ
• Lee MJ

• KMID: 2362714
• DOI: http://doi.org/10.3341/jkos.2016.57.12.1946

Abstract

PURPOSE
Herein, we report 3 cases of nodular fasciitis presenting with periorbital mass.
CASE SUMMARY
An 18-year-old male presented with a mass in his left lateral temple area 3 months in duration. On physical examination, a subcutaneous mass approximately 20 mm in size was palpable with upper eyelid swelling. Orbital magnetic resonance imaging (MRI) showed T1 isointensity and T2 hyper intensity and a well-circumscribed enhancing lesion. A 36-year-old male presented with a 6-month history of a bump under his right upper eyelid. External examination revealed a 15 mm-sized subcutaneous mass in the right central sub-brow area. Orbital computed tomography showed a homogenous, well-circumscribed mass with moderate enhancement. A 3-year-old boy presented with a mass in his right upper eyelid 4 months in duration. A subcutaneous mass approximately 10 mm in size was palpated at the medial superior orbital rim. Orbital MRI revealed an enhanced mass of irregular shape. Surgical excision was performed for all cases. Histopathological examination showed pathognomonic proliferation of spindle cells and immunohistochemical stains showed the spindle cells were positive for smooth muscle actin, negative for S-100 and negative for CD34, consistent with nodular fasciitis. Recurrence of the tumors after excision in the 3 cases was not observed after 4 months, 3 months and 48 months, respectively.
CONCLUSIONS
Nodular fasciitis is rare but can occur at the periorbital region. In particular, nodular fasciitis should be considered as a differential diagnosis of a subcutaneous mass short in duration in children or young adults.

Keyword

Eyelid mass; Nodular fasciitis; Periorbital mass

MeSH Terms

Actins
Adolescent
Adult
Child
Child, Preschool
Coloring Agents
Diagnosis, Differential
Eyelids
Fasciitis*
Humans
Magnetic Resonance Imaging
Male
Muscle, Smooth
Orbit
Physical Examination
Recurrence
Young Adult
Actins
Coloring Agents

Figure

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  Figure 1. Clinical photograph, magnetic resonance images (MRI), and pathological findings of nodular fasciitis of 18-year old male patient (case 1). (A) Swelling of the left upper eyelid is noted in face photograph. Orbit MRI demonstrates a well-defined ovoid mass with strong enhancement (B), which shows isointensity to extraocular muscle on T1 (C) and hyperintensity on T2 (D). (E) Hematoxylin and eosin staining show a proliferation of spindle cells arranged in storiform pattern (Hematoxylin & Eosin stain, ×40). (F) The spindle cells have bland looking nucleus and fibrillar cytoplasm (Hematoxylin & Eosin stain, ×100).

• 

  Figure 2. Clinical, radiologic, and histological characteristics of a nodular fasciitis of 36-year old male patient (case 2). (A) About 15 mm sized mass is noted at right central brow area (arrowheads). (B) Axial computed tomography of the orbit shows a well-cir-cumscribed, homogenously enhanced mass around right superior orbital rim area. (C) Gross photograph of the surgical specimen. The mass size is 16 × 13 × 10 mm. (D) Hematoxylin & Eosin staining shows a proliferation of spindle-shaped fibroblasts (×100).

• 

  Figure 3. Clinical photograph, magnetic resonance images (MRI), histological findings of nodular fasciitis of 3-year old male patient (case 3). (A) About 10 mm subcutaneous mass is visible at right superomedial orbital wall rim with mild eyelid swelling (arrowheads). (B, C) Orbit MRI shows, an irregular shape, enhancing mass at right superomedial orbit. (D) Histopathologic examination shows a proliferation of spindle cell fibroblasts with myxoid matrix (Hematoxylin & Eosin stain, ×40). The Spindle cells were positive for smooth muscle actin (E), negative for S-100 (F) (×100).

Reference

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