Infantile nodular fasciitis of the hand: A case report and literature review

• Nodular fasciitis typically arises in the upper extremities of young adults.
• This benign fibrous lesion can also occur in children but has a preference for the head and neck region.
• Occurrence in the hand is extremely rare, particularly in a newborn.
• A distinction from an infantile fibrosarcoma as well as a variety of other fibrous neoplasms is warranted.
• In such instance, molecular assay is essential in the differential diagnosis.

Pediatric nodular fasciitis is uncommon and has a preference for the head and neck region. Occurrence in other anatomic locations is uncommon. We describe here a case of nodular fasciitis that arose in the hand of a newborn infant who presented with a rapidly growing mass. On MRI, it was heterogeneous isointense on T1-weighted and hyperintense on T2-weighted images. Histological examination showed short intersecting fascicles of uniform spindled myofibroblasts embedded in a myxoid to collagenous stroma, consistent with a nodular fasciitis. However, the lesion was initially diagnosed as an infantile fibrosarcoma due to the rapid growth, brisk mitotic activity and focally infiltrative architecture. This study illustrates that unusual presentation of nodular fasciitis may cause diagnostic confusion.

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