A Rare Case of Nodular Fasciitis Presenting as a Parotid Tumor: Clues to Cytodiagnosis

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Journal of Laboratory Physicians Pub Date : 2023-07-20 DOI:10.1055/s-0043-1771242
S. Palo, C. Gargade
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Abstract

Abstract A 14-year-old boy presented with left preauricular painless swelling of 10 months' duration. Local examination revealed a 3 × 2-cm, firm, nodular, nonmobile mass in the left preauricular area, just in front of tragus. Fine needle aspiration yielded paucicellular smears comprising singly scattered histiocyte/myofibroblast-like spindle cells and occasional giant cells. It was reported as benign mesenchymal lesion on cytology. Left superficial parotidectomy was performed. Histopathological and immunohistochemical analysis confirmed the diagnosis of nodular fasciitis (NF). It was an ill-circumscribed cellular neoplasm, abutting and focally infiltrating into otherwise normal parotid gland. The tumor comprised spindle cells arranged in short bundles and storiform pattern with interspersed osteoclast-like giant cells, foam cells, extravasated red blood cells (RBCs), and focal areas of keloidal collagenization. The cells were positive for smooth muscle actin and negative for CD34, beta-catenin, S100, and pan-cytokeratin. Final diagnosis of NF was rendered. NF can rarely involve the parotid gland or present as parotid enlargement and pose diagnostic challenge, especially on cytology. However, in appropriate clinical context, subtle cytomorphological clues such as presence of myofibroblasts and fibrocollagenous stromal fragments can help in ruling out the commonly occurring salivary gland neoplasms and offering a definitive cytodiagnosis of NF which will be helpful in deciding the further course of management.
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罕见结节性筋膜炎表现为腮腺肿瘤:细胞诊断线索
摘要一名14岁男孩表现为左耳前无痛性肿胀,持续10个月。局部检查发现在耳屏前左侧耳前区有一个3 × 2厘米的坚硬结节状不可移动肿块。细针抽吸得到的少细胞涂片包括单个分散的组织细胞/肌成纤维细胞样梭形细胞和偶见的巨细胞。细胞学报告为良性间质病变。行左侧腮腺浅表切除术。组织病理学和免疫组化分析证实结节性筋膜炎(NF)的诊断。它是一种界限不清的细胞肿瘤,邻近并局部浸润到其他正常的腮腺。肿瘤由梭形细胞组成,呈短束排列,呈层状分布,并伴有破骨细胞样巨细胞、泡沫细胞、外渗的红细胞(rbc)和角膜样胶原灶。细胞平滑肌肌动蛋白阳性,CD34、β -连环蛋白、S100和泛细胞角蛋白阴性。最终诊断为NF。NF很少累及腮腺或表现为腮腺肿大,并对诊断构成挑战,特别是在细胞学上。然而,在适当的临床背景下,细微的细胞形态学线索,如肌成纤维细胞和纤维胶原基质碎片的存在,可以帮助排除常见的唾液腺肿瘤,并提供NF的明确细胞诊断,这将有助于决定进一步的治疗方案。
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来源期刊
Journal of Laboratory Physicians
Journal of Laboratory Physicians MEDICINE, GENERAL & INTERNAL-
自引率
0.00%
发文量
99
审稿时长
31 weeks
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