Grobmyer Stephen R, Knapik Jacquelyn A, Foss Robin M, Copeland Edward M, Hochwald Steven N
Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Florida, USA.
Am Surg. 2009 Jul;75(7):610-4.
Nodular fasciitis (NF) typically presents as an enlarging soft tissue mass with imaging characteristics that may be suggestive of soft tissue sarcoma or desmoid tumor. This presentation can make a correct diagnosis and management of patients with NF a challenge. We report our recent experience with two cases of NF that were both referred with a diagnoses of "soft tissue sarcoma." Patient 1 was a 46-year-old woman who had undergone breast augmentation and was referred with a rapidly growing firm mass on the left chest wall beneath the breast implant. Computed tomography of the chest noted the mass to be 8 cm x 11 cm in size displacing the implant laterally with no radiological involvement of the bony structures of the chest. Core biopsy was suggestive of inflammation only. Given the clinical suspicion of malignancy, the patient underwent resection of the mass with implant removal. Final pathology showed NF. Patient 2 was a 65-year-old woman referred with an enlarging tender 3-cm infraclavicular mass and a clinical diagnosis of "soft tissue sarcoma." Preoperative biopsy suggested NF. The patient underwent complete excision, which confirmed the diagnosis. These cases highlight the clinical issues associated with management of patients with NF. Current approaches to evaluation, diagnosis, and treatment of NF are discussed.
结节性筋膜炎（NF）通常表现为软组织肿块不断增大，其影像学特征可能提示软组织肉瘤或硬纤维瘤。这种表现使得对NF患者进行正确诊断和管理具有挑战性。我们报告了最近两例NF患者的经验，这两例患者最初均被诊断为“软组织肉瘤”。病例1是一名46岁女性，曾接受隆胸手术，因乳房植入物下方左胸壁出现快速生长的坚实肿块前来就诊。胸部计算机断层扫描显示肿块大小为8厘米×11厘米，将植入物向外推移，胸部骨骼结构无放射学受累。粗针活检仅提示炎症。鉴于临床怀疑为恶性肿瘤，患者接受了肿块切除及植入物取出术。最终病理显示为NF。病例2是一名65岁女性，因锁骨下3厘米处不断增大的压痛性肿块前来就诊，临床诊断为“软组织肉瘤”。术前活检提示为NF。患者接受了完整切除，确诊为此病。这些病例突出了与NF患者管理相关的临床问题。本文讨论了目前NF的评估、诊断和治疗方法。
