Nodular fasciitis:
when it’s not sarcoma
L. Benoiton*, M. Seeley*, S Kirkwood^, H Stegehuis*
*ENT Department,
Palmerston North Hospital
^Pathology
Department, Medlab Central, Palmerston North Hospital
Introduction
Nodular fasciitis is a benign proliferation of
fibroblasts in the subcutaneous tissues often centred on deep fascia. It belongs to a group of benign fibrous
proliferations, including proliferative myositis, that can mimic sarcoma due to
its rapid onset and rapid growth.
Aims/Methods
To present a case report of nodular fasciitis and carry
out a literature review of the presentation, investigations and management of this
rare condition.
Results
A 30 year old female presented with a 2 week history
of a rapidly enlarging mass within her left stenocleidomastoid muscle. Subsequent investigations included a contrast
computed tomography (CT) scan and an ultrasonography scan (USS), both
suggestive of a soft tissue sarcoma. An urgent magnetic resonance imaging (MRI)
scan, was also suspicious of a soft tissue tumour. Following discussion with
the musculoskeletal tumour unit at Middlemore Hospital, an USS guided
percutaneous core biopsy was recommended.
Due to limited compliance, only one pass was made with histology showing
scant voluntary muscle and fibrous tissue only. Histology from a repeated USS
guided core biopsy was initially reported as proliferative myositis. Subsequent review at Middlemore Hospital
including cytogenetic testing concluded that the lesion was nodular fasciitis. The
mass progressively decreased in size and the patient was treated
conservatively.
Conclusions
Proliferative
myositis and nodular fasciitis belong to a large group of benign fibrous
proliferations. Nodular fasciitis is
caused by proliferation of fibroblasts and myofibroblasts. Imaging findings are non-specific and
diagnosis is made histopathologically.
Cytogenetic testing for USP6 gene rearrangement has recently led to
improved diagnosis. Treatment options include watchful waiting as spontaneous
regression is possible, or surgical resection.
References
Hseu, A., Watters, K., Perez-Atayde, A., Silvera, V.M. and Rahbar, R.,
2015. Pediatric nodular fasciitis in the head and neck: evaluation and
management. JAMA Otolaryngology–Head & Neck Surgery, 141(1),
pp.54-59.
Management of ankyloglossia and upper lip
ties
Lara
Benoiton*1,
Maggie Morgan2, Katherine Baguley1
1ENT Department, Wellington Public
Hospital
2Neonatal Intensive Care Unit,
Wellington Public Hospital
Aims
Recent studies have shown an association between
ankyloglossia (tongue tie) and upper-lip ties to breastfeeding
difficulties. Treatment is commonly
multidisciplinary involving lactation consultants and surgical management with tongue
tie and upper lip tie release. There is
currently limited data looking at this condition.
Methods
Consecutive patients seen at an ENT outpatient clinic for ankyloglossia
and upper-lip ties from May 2014-August 2015 were assessed for an outpatient frenotomy.
Breastfeeding outcomes were assessed following the procedure.
Results
43 babies were seen and 34 patients had a procedure carried out. Babies
ranged from 2-20 weeks old with the median age being 6.6 weeks. The most common
presenting complaint was latching issues (85%) with mothers’ painful nipples
being the second (65%). 21 patients (62%)
had a tongue tie release, 10 (29%) had both a tongue tie and upper lip tie
divided, whereas 3 (9%) had an upper-lip tie alone divided. 29 (85%) of the
patients who had a procedure carried out had an immediate improvement in
breastfeeding, while 28 (82%) had a continued improvement at 2 weeks follow up.
Conclusions
Frenotomy
for ankyloglossia and upper lip ties is a simple procedure that can be carried
out in an outpatient setting with apparent immediate benefit. Otolaryngologists
are likely to have an increasing role to play in the evaluation and management
of ankyloglossia and upper lip ties in babies with breastfeeding difficulties.
Reference
Benoiton,
L., Morgan, M. and Baguley, K., 2016. Management of posterior ankyloglossia and
upper lip ties in a tertiary otolaryngology outpatient clinic. International
Journal of Pediatric Otorhinolaryngology.
