Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia.
Department of Pathology, University Hospital Center Zagreb, Zagreb, Croatia.
J Neurol Surg A Cent Eur Neurosurg. 2023 Jul;84(4):404-407. doi: 10.1055/s-0041-1739218. Epub 2021 Dec 12.
Nodular fasciitis is a benign neoplasm occurring predominantly in the subcutaneous tissue. There have been nine intraneural occurrences described in the literature.
A 37-year-old woman presented with numbness and tenderness in her left shoulder and scapula and a slightly dropped left shoulder, without history of trauma. A magnetic resonance imaging (MRI) of the cervical spine showed a well-circumscribed oval mass deep to the levator scapula muscle. Due to persisting symptoms and an unknown nature of the process, surgical excision was performed, and histopathologic analysis confirmed diagnosis of a benign fibroblastic/myofibroblastic neoplasm, nodular fasciitis. The postoperative course was uneventful and the patient was without symptoms at 4 months of follow-up.
We reviewed the available literature (PubMed, Google Scholar), with nine published cases of intraneural nodular fasciitis. The reported clinical, radiologic, and histopathologic parameters were evaluated and compared.
Most of the cases reported in the literature were symptomatic, with tenderness and palpability being the main symptoms. Six of the reported cases occurred in the forearm, whereas three were in the leg. To the best of our knowledge, ours is the first reported case of nodular fasciitis occurring in the trunk. Ours is the only case to display desmin positivity, which supports the reactive hypothesis of nodular fasciitis.
Intraneural nodular fasciitis is an extremely rare diagnosis. Due to its benign natural course, a multidisciplinary approach with this extremely rare diagnosis in mind is needed to avoid overtreatment.
结节性筋膜炎是一种主要发生在皮下组织的良性肿瘤。文献中已有 9 例发生于神经内的报道。
一名 37 岁女性因左肩和肩胛骨麻木和压痛，以及左肩轻度下垂就诊，无外伤史。颈椎磁共振成像（MRI）显示肩胛提肌深面有一个边界清楚的椭圆形肿块。由于症状持续存在且病变性质不明，进行了手术切除，组织病理学分析证实为良性纤维母细胞/肌纤维母细胞瘤，结节性筋膜炎。术后过程顺利，患者在 4 个月的随访中无任何症状。
我们回顾了文献（PubMed、Google Scholar）中 9 例发生于神经内的结节性筋膜炎的病例。评估并比较了报道的临床、影像学和组织病理学参数。
文献中报道的大多数病例均有症状，主要症状为压痛和可触及性。报告的 6 例发生在前臂，而 3 例发生在腿部。据我们所知，我们的病例是首例发生在躯干的结节性筋膜炎。我们的病例是唯一显示结蛋白阳性的病例，这支持结节性筋膜炎的反应性假说。
神经内结节性筋膜炎是一种极为罕见的诊断。由于其良性自然病程，需要多学科方法考虑这种极其罕见的诊断，以避免过度治疗。
