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Clinical Problem Solving: Pathology
December 2005

Pathology Quiz Case 2: Diagnosis

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Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Otolaryngol Head Neck Surg. 2005;131(12):1123-1124. doi:10.1001/archotol.131.12.1123

Nodular fasciitis, which was first described by Konwaler et al1 in 1955, is a benign and quasineoplastic proliferation of fibroblasts that is often mistaken for a sarcoma owing to its rapid growth, rich cellularity, and mitotic activity. Synonymous terms such as pseudosarcomatous fasciitis, proliferative fasciitis, infiltrative fasciitis, and nodular fibrositis have been used in the literature to describe this fibrous tissue tumor.2 Although the exact pathogenesis remains unknown, it is thought that the lesion represents a self-limiting, reactive process rather than a true neoplasm. With 80% to 90% of lesions occurring outside the head and neck, most patients report a history of a rapidly growing mass over a 1- to 2-week time frame.3,4 There is associated soreness, tenderness, or slight pain in about 50% of cases, but a history of inciting trauma is elicited in no more than 10% to 15% of cases.4 On further questioning of our patient, she reported that approximately 10 days before she underwent magnetic resonance imaging she had been involved in a motor vehicle accident, which had resulted in 2 weeks of cervical pain and stiffness.

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