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1.
Clin Nucl Med ; 45(1): e41-e42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31246686

RESUMO

Nodular fasciitis is an uncommon benign mass-forming myofibroblastic proliferation, most frequently found in the upper limbs, with only rare intramuscular cases. We describe herein a case of chronic nodular fasciitis of the left triceps muscle with a low Ga-labeled prostate-specific membrane antigen (PSMA) ligand uptake on PET/CT. Ga-PSMA ligands bind to PSMA-expressing prostate cancer cells, but uptake has also been demonstrated in other solid neoplasms and various benign lesions. Nodular fasciitis should be included in the differential diagnosis of soft tissue lesions with variable Ga-PSMA uptake.


Assuntos
Fasciite/diagnóstico , Fasciite/metabolismo , Glicoproteínas de Membrana/metabolismo , Músculos/diagnóstico por imagem , Compostos Organometálicos/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Transporte Biológico , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias da Próstata/patologia
2.
Am J Case Rep ; 20: 1411-1417, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31551403

RESUMO

BACKGROUND Proliferative fasciitis/myositis is a benign disease that can be treated conservatively. However, some patients are mistakenly treated surgically because of a misdiagnosis of the condition as a malignant tumor. CASE REPORT A 50-year-old Japanese man developed swelling in his left cheek 12 days before admission; he developed a fever and trismus 3 days later. He was admitted to our hospital because of worsening of his condition despite treatment with sitafloxacin for 5 days and needle-aspiration drainage. On admission, he had a fever of 38.1°C, swelling in his left cheek spreading to the lower jaw, and several dental caries. Although ceftriaxone and clindamycin were administered for 7 days because an odontogenic infection was suspected, his condition did not improve. T2-weighted magnetic resonance imaging of the facial muscles on Day 5 of hospitalization showed swelling and high-intensity signals in the left masseter, temporalis, and pterygoid muscles. Macroscopic findings from a biopsy of the left temporalis muscle performed on Day 17 showed white and thickened fascia. Histopathological examination revealed fibrous hyperplasia of the fascia, increased fibrous connective tissue between muscle fibers, and infiltration of inflammatory cells, providing not a definite but a compatible diagnosis of proliferative fasciitis/myositis. Beginning on Day 18, the patient's fever lessened with gradual improvement of his facial swelling and trismus. CONCLUSIONS It is imperative to include proliferative fasciitis/myositis as a possible diagnosis when patients present with facial swelling and trismus of unknown cause.


Assuntos
Músculos Faciais , Fasciite/diagnóstico , Miosite/diagnóstico , Trismo/etiologia , Músculos Faciais/diagnóstico por imagem , Febre/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Z Rheumatol ; 78(4): 322-332, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30937528

RESUMO

Among the eosinophilic diseases treated by rheumatologists other than eosinophilic granulomatosis with polyangiitis, there are further organ-related and systemic diseases with hypereosinophilia. Only the exact differential diagnostic demarcation of the diseases enables a pathogenetic oriented treatment. This article focuses on the hypereosinophilic syndromes. The potential differential diagnoses of Ig(immunoglobulin)G4-related disease, eosinophilic fasciitis and drug-induced vasculitis as well as eosinophilia-myalgia syndrome and toxic oil syndrome as historic drug-induced inflammatory rheumatic diseases are described and the clinical manifestations and treatment are summarized.


Assuntos
Eosinofilia , Fasciite , Síndrome Hipereosinofílica , Doenças Reumáticas , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Fasciite/diagnóstico , Humanos , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/diagnóstico , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico
7.
Allergol Int ; 68(4): 437-439, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30910631

RESUMO

Eosinophilic fasciitis is a disease originally proposed as "diffuse fasciitis with eosinophilia" by Shulman in 1974. The patients with this disease often have history of strenuous exercise or labor a few days to 1-2 weeks before the onset. The chief symptoms are symmetrical, full-circumference swelling and plate-like hardness of the distal limbs. This is accompanied by redness and pain in the early stages, with many cases exhibiting systemic symptoms such as fever or generalized fatigue. The lesions have been observed extending to the proximal limbs, though never on the face or fingers. En bloc biopsies from the skin to the fascia show marked fascial thickening and inflammatory cell infiltration by the lymphocytes and plasma cells. Eosinophilic infiltration is useful for the diagnosis but is only seen in the early stages of the disease. Recently, "Diagnostic criteria, severity classification, and clinical guidelines for eosinophilic fasciitis" were published. This review article discusses about eosinophilic faciitis in detail, from its pathophysiology to the treatment.


Assuntos
Eosinofilia/diagnóstico , Eosinofilia/etiologia , Eosinofilia/terapia , Fasciite/diagnóstico , Fasciite/etiologia , Fasciite/terapia , Biópsia , Citocinas/metabolismo , Gerenciamento Clínico , Suscetibilidade a Doenças , Eosinofilia/epidemiologia , Fasciite/epidemiologia , Humanos , Fenótipo , Pele/imunologia , Pele/metabolismo , Pele/patologia
9.
World Neurosurg ; 125: e829-e842, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30743035

RESUMO

OBJECTIVE: Cranial fasciitis is a rare benign mass that typically presents in pediatric patients from 3 weeks to 6 years of age. It is classified as a subset of nodular fasciitis and was first reported in 1980. This study evaluates the literature for common characteristics that may affect diagnosis and treamtent. METHODS: We describe the case of a 13-month-old girl with a history of accidental head trauma 7 months before presentation and the case of a 5-month-old girl with an expansile skull lesion. We also performed a systematic review of the reported data on cranial fasciitis, including a total of 57 reported studies with 80 unique cases. RESULTS: There were 80 total cases reviewed in the literature. There was a male predominence, 1.75:1. The average age at presentation was 5.2 years. The most common causes for this lesion were idiopathic (65%), blunt trauma (14%) and radiation therapy (7%). Overall, there was a 9% recurrence rate following treatment. CONCLUSION: We report the characteristics at presentation, including, to the best of our knowledge, the first account of gender differences, and the treatment modalities used in the included studies and the implications in relation to the recurrence rates.


Assuntos
Traumatismos Craniocerebrais/patologia , Fasciite/patologia , Cabeça/patologia , Recidiva Local de Neoplasia/patologia , Adolescente , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Diferencial , Fáscia/patologia , Fasciite/diagnóstico , Feminino , Humanos , Recidiva Local de Neoplasia/diagnóstico , Crânio/patologia , Tomografia Computadorizada por Raios X/métodos
10.
J Clin Pathol ; 72(6): 438-442, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30739079

RESUMO

Benign spindle cell lesions of the breast include neoplastic and reactive entities that are diagnostically challenging given their rarity and similar histomorphology. Accurate diagnosis on percutaneous core biopsy within this category is essential as some lesions require excision and surveillance, whereas others may be observed. We present three cases of rare benign spindle cell lesions of the breast that reflect the diversity of this group: solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. Through these cases, we discuss the associated differential diagnosis and demonstrate how emerging ancillary studies can be integrated into a diagnostic approach. We highlight distinctive clinical and histopathological features and summarise recent updates to the clinical management of these lesions. An organised approach to the broad differential of spindle cell lesions is essential for appropriate diagnosis and treatment.


Assuntos
Angiomatose/diagnóstico , Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Fasciite/diagnóstico , Hiperplasia/diagnóstico , Tumores Fibrosos Solitários/diagnóstico , Adulto , Angiomatose/diagnóstico por imagem , Angiomatose/patologia , Angiomatose/cirurgia , Biópsia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Diagnóstico Diferencial , Fasciite/diagnóstico por imagem , Fasciite/patologia , Fasciite/cirurgia , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Hiperplasia/cirurgia , Imuno-Histoquímica , Mastectomia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/cirurgia , Resultado do Tratamento , Ultrassonografia Mamária
11.
Z Rheumatol ; 78(1): 14-23, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30255410

RESUMO

BACKGROUND: Systemic sclerosis (SSc) is characterized by heterogeneous clinical symptoms. Peripheral skin fibrosis can be a common symptom. Nevertheless, a variety of diseases with different etiologies are associated with a thickening of the skin and make the initial diagnosis of systemic sclerosis more difficult. OBJECTIVE: The different disease entities that can lead to dermal fibrosis should be differentiated. An earlier diagnosis of SSc would therefore be facilitated. METHODS: A literature search was carried out for clinical pictures that can be associated with skin fibrosis. The clinical picture, the etiology and the treatment of the individual diseases are described. RESULTS: Diseases that can mimic the cutaneous symptoms of SSc include morphea, scleroderma, diabetic cheirarthritis, scleromyxedema, nephrogenic systemic fibrosis and eosinophilic fasciitis. The characteristic pronounced skin involvement, an accompanying Raynaud's phenomenon, capillary microscopy, histopathology and antinuclear antibodies help to enable a differentiation of SSc from its mimics. CONCLUSION: An early differential diagnostic distinction between SSc and other sclerosing diseases is important due to SSc-associated and potentially life-threatening systemic organ involvement. If a diagnosis of SSc has been made, a critical and organ-specific evaluation with respect to pulmonary, gastrointestinal, renal and cardiac involvement is mandatory and should be repeated at regular intervals.


Assuntos
Doenças do Tecido Conjuntivo/diagnóstico , Esclerodermia Localizada , Escleroderma Sistêmico , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Fasciite/diagnóstico , Humanos , Escleredema do Adulto/diagnóstico , Esclerodermia Localizada/diagnóstico , Escleroderma Sistêmico/diagnóstico , Escleromixedema/diagnóstico , Pele , Sinovite
13.
Int J Dermatol ; 58(2): 190-193, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30191556

RESUMO

BACKGROUND: Nodular fasciitis is a benign pseudosarcomatous, self-limited, and reactive process. Based on its clinical and histological features - a fast-growing, solitary tumor with high cellularity and mitotic count - nodular fasciitis is considered to be a benign mimic of sarcoma. METHODS: We present four cases of nodular fasciitis and a review of the literature. RESULTS: The cases we present were initially misdiagnosed as sarcoma; two as dermatofibrosarcoma protuberans, one as atypical fibroxanthoma, and one as leiomyosarcoma. CONCLUSION: Awareness of this entity among dermatologists is important as misdiagnosis may lead to unnecessary treatments associated with increased morbidity.


Assuntos
Fasciite/diagnóstico , Fasciite/metabolismo , Antígeno 12E7/metabolismo , Actinas/metabolismo , Adulto , Antígenos CD/metabolismo , Antígenos CD34/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Fasciite/patologia , Fasciite/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Antígeno MART-1/metabolismo , Masculino , Pessoa de Meia-Idade , Neprilisina/metabolismo , Remissão Espontânea , Adulto Jovem
14.
Acta Radiol ; 60(5): 663-669, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30060672

RESUMO

BACKGROUND: Nodular fasciitis rarely occurs in young adults and children; it usually resembles other tumors, even malignancy. PURPOSE: To review the imaging findings of six cases of nodular fasciitis misdiagnosed radiologically. MATERIAL AND METHODS: The clinical and radiologic features of six cases of histologically proven but radiologically misdiagnosed nodular fasciitis were reviewed retrospectively. Two cases underwent both plain and enhanced computed tomography (CT) scans and the other four had both regular and enhanced magnetic resonance (MR) scans. RESULTS: All six patients were young (five children and one young adult). A rapid growing mass, pain or painless, was the most frequent presentation. Most masses were oval, well-defined, and homogeneous, with an average diameter of 2.2 cm. Five were found in superficial fascia with a broad base. Two cyst-like masses showed hypodensity relative to muscle on plain CT and without enhancement. Compared to muscle, these masses showed isointensity (n = 3) or slight hyperintensity (n = 1) on T1-weighted imaging, hyperintensity on T2-weighted imaging (n = 4), with homogeneous notable enhancement (n = 3) or mild enhancement (n = 1). Five (83.3%) were found with a "fascial tail" sign characterized as thickening of adjacent fascial layer with notable enhancement. One mass showed an "inverted target" sign. CONCLUSION: Nodular fasciitis in young adults and children is usually superficial, rapid growing, well-defined, and homogeneous, frequently with a "fascial tail" sign. Radiologically, it can resemble a benign cyst and might be easily misdiagnosed. Therefore, nodular fasciitis should be remembered in the differential diagnosis for superficial soft tissue tumor found in young adult and children.


Assuntos
Erros de Diagnóstico , Fasciite/diagnóstico , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Adulto Jovem
15.
Cancer Cytopathol ; 126(10): 872-880, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30311731

RESUMO

BACKGROUND: Nodular fasciitis (NF) is a clonal, self-limited proliferation that has only rarely been described in the parotid gland. Because of its potential to mimic benign and malignant parotid neoplasms clinically, radiographically, and cytomorphologically, NF is often managed with unnecessary surgery, which is associated with a risk for significant surgical complications. The purpose of this study is to present the clinical and cytomorphologic findings for NF of the parotid gland by fine-needle aspiration (FNA). METHODS: The pathology archives of the authors' respective institutions were searched for salivary gland FNA cytology specimens with a confirmed diagnosis of NF. The clinical history, pathologic diagnosis, cytomorphologic findings, and immunocytochemical results were recorded. RESULTS: A total of 15 cases were identified; the average age was 37 years, and 10 patients (66.7%) were female. Five cases (33.3%), all treated surgically, showed recurrence within an average timeframe of 1.6 months. Only 3 cases (20.0%) were classified as definitive, probable, or suggestive of NF. On average, smears were composed of predominantly single (69.2%), spindled cells (100.0%) with short unipolar (76.9%) and/or bipolar processes (38.5%), round (61.5%) or elongated (84.6%) nuclei, and inconspicuous nucleoli (53.8%). In 69.2%, a tissue-culture appearance was shown, and 76.9% contained myxoid stroma. In 46.2%, a minimal amount of cytologic atypia was shown. CONCLUSIONS: Keeping NF in the differential for any bland, single, spindled cell proliferation with elongated cytoplasmic processes and bland nuclei may prompt the clinician to consider more conservative management in the correct clinical context.


Assuntos
Adenoma Pleomorfo/diagnóstico , Citodiagnóstico/métodos , Fasciite/diagnóstico , Glândula Parótida/patologia , Adulto , Biópsia por Agulha Fina , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
17.
BMJ Case Rep ; 20182018 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-29973411

RESUMO

A 25-year-old man admitted for generalised muscle pain with an insidious onset 3 years ago. He had exercise intolerance and decrease in muscle strength, requiring gait support. He was previously healthy, with no chronic medication or recent history of drugs or toxics. National vaccination plan actualised with hepatitis B and tetanus vaccines administered 10 and 2 years, respectively, before symptom onset. No analytical, imaging or electromyography changes were found. Muscle biopsy revealed an inflammatory infiltrate predominantly macrophagic with aluminium deposits suggestive of macrophagic myofasciitis (MMF). It is probably associated with vaccines previously administered. MMF lesion can be regarded as pathological only if detected at least 18 months after last aluminic immunisation, as our case illustrates.


Assuntos
Fasciite/diagnóstico , Músculo Esquelético/patologia , Miosite/diagnóstico , Adulto , Alumínio/efeitos adversos , Alumínio/imunologia , Biópsia , Fasciite/complicações , Fasciite/patologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Macrófagos/patologia , Masculino , Debilidade Muscular/diagnóstico , Miosite/complicações , Miosite/patologia
18.
Clin Dermatol ; 36(4): 487-497, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30047432

RESUMO

Eosinophilic fasciitis (EF) is an uncommon connective tissue disease characterized by abrupt onset of edema, followed by progressive induration of primarily the distal extremities. Patients may exhibit inflammatory arthritis, joint contractures, decreased mobility, and nerve entrapment. Almost half of patients with EF may have coexisting morphea plaques. Classic laboratory studies display peripheral eosinophilia, hypergammaglobulinemia, and elevated inflammatory markers. EF is included in the spectrum of scleroderma like disorders and may be difficult to distinguish from other sclerosing skin disorders. Full-thickness biopsy containing muscle and fascia is considered the gold standard for diagnosis and reveals sclerosis of the middeep dermis, subcutaneous fat, and thickening of the fascia. Magnetic resonance imaging (MRI) has been increasingly utilized to augment diagnostic capabilities. Ultimately, the diagnosis of EF relies upon the combination of characteristic clinical, laboratory, imaging, and histologic findings. Although some patients experience spontaneous remission, systemic corticosteroids (SCS) are the mainstay of treatment. Patients who fail to improve with SCS alone require the addition of a second immunosuppressive drug. Additionally, although data are limited, there is evidence to suggest that initial combination therapy with SCS and methotrexate (MTX) may be most beneficial.


Assuntos
Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Fasciite/diagnóstico , Fasciite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Prednisona/uso terapêutico , Antimaláricos/uso terapêutico , Antirreumáticos/uso terapêutico , Diagnóstico Diferencial , Eosinofilia/complicações , Eosinofilia/fisiopatologia , Fasciite/complicações , Fasciite/fisiopatologia , Doenças Hematológicas/etiologia , Humanos , Hidroxicloroquina/uso terapêutico , Artropatias/etiologia , Doenças Neuromusculares/etiologia , Penicilamina/uso terapêutico , Dermatopatias/etiologia
19.
Ann R Coll Surg Engl ; 100(5): e128-e131, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29658336

RESUMO

Nodular fasciitis (NF) is a self-limiting fibrous neoplasm that can be mistaken for a soft tissue sarcoma. It is characterised by rapid growth, slight pain and local tenderness. Although it is frequently found in the forearm, a lesion distal to the wrist is quite rare. We present two unusual cases of NF involving the palm, supported by detecting ubiquitin specific protease 6 gene rearrangement. The first patient had non-intraneural NF presenting as peripheral neuropathy affecting the digital nerve while the second patient suffered from painless, non-tender NF in the palm, which had not regressed spontaneously during the five months prior to surgery.


Assuntos
Fasciite/diagnóstico , Mãos , Fasciite/cirurgia , Feminino , Mãos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Virchows Arch ; 473(3): 351-360, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29623468

RESUMO

Although harmless, reactive and benign neoplastic myo-/fibroblastic proliferations represent a diagnostic challenge in routine surgical pathology practice as reflected by their frequency among consultation cases. In addition to resembling each other, the prototypical nodular fasciitis (NF) and NF-like lesions can be mistaken for low-grade or aggressive sarcomas. USP6 translocation was reported recently as the molecular driver and potential diagnostic marker of NF. We reviewed 71 lesions with a diagnosis of NF (n = 48) or NF-like myofibroblastic proliferations (n = 23) and screened them for USP6 translocation by fluorescence in situ hybridization (FISH). Only one third of NFs were correctly diagnosed by submitting pathologists while one third was initially judged as malignant. NF was mentioned in the differential diagnosis in only half of the cases. A high Ki67/mitotic index, misleading immunohistochemistry (false-positive h-caldesmon), and unusual sites/circumscription were main causes behind overdiagnosis as malignant. FISH analysis revealed USP6 translocation in 74.4% of NF cases. None of the reactive/reparative myofibroblastic proliferations showed USP6 translocation. NF is still significantly misdiagnosed by general surgical pathologists, with a higher tendency toward overdiagnosis of malignancy. Inclusion of NF in the differential diagnosis of any fibromyxoid soft tissue lesion and awareness of its diverse morphology are mandatory to avoid misdiagnoses with the risk of disastrous overtreatment. In the appropriate clinicopathological context, USP6 gene translocation is a valuable adjunct for diagnosis of NF, particularly in limited biopsies. Absence of the USP6 gene translocation in NF-like reparative pseudosarcomatous myofibroblastic proliferations underlines their reactive nature and distinguishes them from NF which is currently considered a benign neoplasm with a self-limiting "transient" growth phase.


Assuntos
Fasciite/genética , Rearranjo Gênico , Miofibroblastos/patologia , Proteínas Proto-Oncogênicas/genética , Ubiquitina Tiolesterase/genética , Adolescente , Adulto , Idoso , Erros de Diagnóstico , Fasciite/diagnóstico , Fasciite/patologia , Feminino , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade
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