Head and neck region nodular fasciitis: A clinicopathological study of 50 patients

Nodular fasciitis is a benign, self-limiting, and rapidly proliferating fibroblastic/myofibroblastic lesion. Nodular fasciitis, in the head and neck region, in particular, poses significant diagnostic challenges due to its rapid growth and resemblance to malignant neoplasms. In this single-center observational study, we report on 50 patients who presented with nodular fasciitis in the head and neck region, with a male-to-female patient ratio of 1.94:1 and an age range of 1.5 to 78.5 years. The lesions were primarily located in the cheek (38%), followed by the scalp (16%), orbital region (12%), nasal region (10%), neck (10%), auricular region (6%), supraclavicular region (4%), and maxillary and zygomatic regions (each 2%). These lesions exhibited typical histologic features, including spindle-shaped cells with a predominantly fascicular arrangement, along with "tissue culture," haphazard, storiform, and sheeting patterns. Collagen, keloid-type fibers, and a mucin/myxoid matrix were noted. Extravasated erythrocytes, abundant mitoses, lymphoid infiltration, and multinucleated giant cells were commonly observed. There was positive expression of immunostains ASMA and CD10. Follow-up demonstrated a benign clinical course, with only one recurrence despite its rapid growth and similarity to malignancy. This study aims to highlight key clinical and histopathological features of nodular fasciitis in the head and neck region to prevent misclassification and unnecessary treatment, ultimately improving patient outcomes.