How is nodular fasciitis (pseudosarcomatous) treated?

Updated: Oct 07, 2019
  • Author: Guy J Petruzzelli, MD, PhD, MBA, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Because of the resemblance to malignant lesions, the clinical management of nodular fasciitis lesions necessitates proper diagnosis.

In a limited number of patients, Stanley and colleagues reported that fine needle aspiration is an effective method for diagnosing nodular fasciitis lesions. [72] All 11 of their patients had spontaneous resolution of lesions within 11 months and did not require surgical excision.

In contrast, others have reported difficulty with utilizing cytology to distinguish nodular fasciitis lesions from malignant low-grade sarcomas. [73, 71] Despite this limitation, fine needle aspiration and cytology results can help differentiate metastatic carcinoma, lymphoma, high-grade sarcoma, and infectious processes.

In the context of the clinical history, nodular fasciitis lesions can usually be identified properly with fine-needle aspiration. [68] For lesions with equivocal fine needle aspiration results, surgical excision and subsequent histologic studies can be used for proper diagnosis.

Even with positive margins on the biopsy specimen, nodular fasciitis lesions do not reappear. [74, 68, 75] If the lesion recurs, then a different diagnosis must be considered. For larger lesions for which complete surgical excision may be difficult, Graham and colleagues used corticosteroid injections to reduce the size of the lesion. [76]

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