Nodular Fascitis and Other Benign Fibroblastic Lesions

Epidemiology

Nodular fascitis is a benign soft tissue mass that results from fibroblastic proliferation. This entity is also referred to as subcutaneous pseudosarcomatous fibromatosis, infiltrative fascitis, and proliferative fascitis. Nodular fascitis represents a separate entity among a spectrum of lesions of fibroblastic origin. The benign entities include congenital generalized fibromatosis, fibrous hamartoma of infancy, palmar and plantar fibromatosis, and musculoaponeurotic fibromatosis. The malignant disorders that fall under this spectrum include aggressive fibromatosis and poorly differentiated fibrosarcoma. The pathogenesis of nodular fascitis is not exactly known but is generally felt to be a reactive nonneoplastic response to trauma. Nodular fascitis most commonly occurs in the upper extremities and trunk. Head and neck involvement is reported in about 15% of all cases of nodular fascitis. The disease most commonly presents between the ages of 30 and 40, but has been reported in all age groups.

Clinical Features

Patients often present with an enlarging palpable, firm, and mildly tender mass. The mass is usually fixed to the underlying structures and is not fixed to the skin. The specific symptoms depend on the location of the lesions. Lesions in the masticator space may present with trismus.