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Parotid Gland Nodular Fasciitis: A Clinicopathologic Series of 12 Cases with a Review of 18 Cases from the Literature

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Abstract

Nodular fasciitis (NF), very uncommon in the parotid gland, is a benign myofibroblastic proliferation that may be mistaken for other neoplastic proliferations. The mass-like clinical presentation and histologic features result in frequent misclassification, resulting in inappropriate clinical management. There are only a few reported cases in the English literature. Cases within the files of the authors’ institutions (retrospective) confined to the parotid gland were compared to cases reported in the English literature (Medline 1966–2014). The patients included five females and seven males, aged 11–70 years (mean 45.2 years). All patients presented with a mass lesion, present on average 1.9 months, without a documented history of trauma. The lesions were 0.7–5.2 cm (mean 2.2 cm). Seven patients had fine needle aspiration. The majority of the lesions were circumscribed (n = 9), composed of spindle-shaped to stellate myofibroblasts (MF) arranged in a storiform growth pattern, juxtaposed to hypocellular myxoid tissue-culture-like areas with extravasation of erythrocytes. Dense, keloid-like collagen (n = 7) and occasional giant cells were seen (n = 6). Mitotic figures (without atypical forms) were readily identifiable (mean 4/10 HPFs). By immunohistochemical staining, the MF were reactive with vimentin, actins, and calponin, while the histiocytes were reactive with CD68. All patients had surgical excision. One patient developed local recurrence (12 months later). All were alive and disease free at last follow-up, with a mean 133 months of follow-up. The principle differential diagnoses include fibrosarcoma, fibromatosis, pleomorphic adenoma, myoepithelioma, neurofibroma, schwannoma, solitary fibrous tumor, leiomyoma, fibrous histiocytoma and myxoma. NF of the parotid gland occurs in middle-aged patients who present with a mass (mean 2.2 cm) in the parotid gland of short duration (1.9 months). FNA misinterpretation frequently leads to excision. Separation from myoepithelial and mesenchymal lesions affecting the parotid gland results in appropriate management.

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References

  1. Konwaller BE, Keasbey LE, Kaplan L. Subcutaneous pseudosarcomatous fibromatosis (fasciitis): report of 8 cases. Am J Clin Pathol. 1955;25:241–52.

    Google Scholar 

  2. Montgomery EA, Meis JM. Nodular fasciitis. Its morphologic spectrum and immunohistochemical profile. Am J Surg Pathol. 1991;15:942–8.

    Article  CAS  PubMed  Google Scholar 

  3. Abendroth CS, Frauenhoffer EE. Nodular fasciitis of the parotid gland. Report of a case with presentation in an unusual location and cytologic differential diagnosis. Acta Cytol. 1995;39:530–4.

    CAS  PubMed  Google Scholar 

  4. Carr MM, Fraser RB, Clarke KD. Nodular fasciitis in the parotid region of a child. Head Neck. 1998;20:645–8.

    Article  CAS  PubMed  Google Scholar 

  5. Chen KT, Bauer V. Nodular fasciitis presenting as parotid tumor. Am J Otolaryngol. 1987;8:179–81.

    Article  CAS  PubMed  Google Scholar 

  6. D’Antonio A, Paolella G, Zeppa P. Rapidly growing intraparotid mass in a young child. J Craniofac Surg. 2012;23:e305–6.

    Article  PubMed  Google Scholar 

  7. Fischer JR, Abdul-Karim FW, Robinson RA. Intraparotid nodular fasciitis. Arch Pathol Lab Med. 1989;113:1276–8.

    CAS  PubMed  Google Scholar 

  8. Han W, Hu Q, Yang X, et al. Nodular fasciitis in the orofacial region. Int J Oral Maxillofac Surg. 2006;35:924–7.

    Article  CAS  PubMed  Google Scholar 

  9. Hidir Y, Arslan HH, Gunhan O, et al. Case report: nodular fasciitis of the parotid region. J Laryngol Otol. 2011;125:1312–4.

    Article  CAS  PubMed  Google Scholar 

  10. Hwang K, Lee DK, Lee SI. Nodular fasciitis presenting as a parotid tumour after face lifting. Br J Plast Surg. 2000;53:345–7.

    Article  CAS  PubMed  Google Scholar 

  11. Jaryszak EM, Shah RK, Bauman NM, et al. Unexpected pathologies in pediatric parotid lesions: management paradigms revisited. Int J Pediatr Otorhinolaryngol. 2011;75:558–63.

    Article  PubMed  Google Scholar 

  12. Lando M, Abemayor E, Mendoza V. Pathologic quiz case 1. Nodular fasciitis of the parotid gland. Arch Otolaryngol Head Neck Surg. 1991;117:336–8.

    Article  CAS  PubMed  Google Scholar 

  13. Peng WX, Kudo M, Yamamoto T, et al. Nodular fasciitis in the parotid gland: a case report and review of the literature. Diagn Cytopathol. 2013;41:829–33.

    Article  PubMed  Google Scholar 

  14. Pereira C, Edwards M. Parotid nodular fasciitis in a mobile phone user. J Laryngol Otol. 2000;114:886–7.

    Article  CAS  PubMed  Google Scholar 

  15. Reitzen SD, Dogan S, Har-El G. Nodular fasciitis: a case series. J Laryngol Otol. 2009;123:541–4.

    Article  CAS  PubMed  Google Scholar 

  16. Saad RS, Takei H, Lipscomb J, et al. Nodular fasciitis of parotid region: a pitfall in the diagnosis of pleomorphic adenomas on fine-needle aspiration cytology. Diagn Cytopathol. 2005;33:191–4.

    Article  PubMed  Google Scholar 

  17. Stanley MW, Skoog L, Tani EM, et al. Nodular fasciitis: spontaneous resolution following diagnosis by fine-needle aspiration. Diagn Cytopathol. 1993;9:322–4.

    Article  CAS  PubMed  Google Scholar 

  18. Bernstein KE, Lattes R. Nodular (pseudosarcomatous) fasciitis, a nonrecurrent lesion: clinicopathologic study of 134 cases. Cancer. 1982;49:1668–78.

    Article  CAS  PubMed  Google Scholar 

  19. Dahl I, Jarlstedt J. Nodular fasciitis in the head and neck. A clinicopathological study of 18 cases. Acta Otolaryngol. 1980;90:152–9.

    Article  CAS  PubMed  Google Scholar 

  20. Ferreira AF, Albuquerque Cavalcante MA, Honorato I, et al. Nodular fasciitis of the angle of the mandible (P.114). Oral Oncol. 2005;41:180.

    Google Scholar 

  21. Jang EJ, Park TI, Nam SC, et al. Nodular fasciitis in the submandibular gland. Diagn Cytopathol. 2008;36:805–8.

    Article  PubMed  Google Scholar 

  22. Tomita S, Thompson K, Carver T, et al. Nodular fasciitis: a sarcomatous impersonator. J Pediatr Surg. 2009;44:e17–9.

    Article  PubMed  Google Scholar 

  23. Werning JT. Nodular fasciitis of the orofacial region. Oral Surg Oral Med Oral Pathol. 1979;48:441–6.

    Article  CAS  PubMed  Google Scholar 

  24. Wold LE, Weiland LH. Tumefactive fibro-inflammatory lesions of the head and neck. Am J Surg Pathol. 1983;7:477–82.

    Article  CAS  PubMed  Google Scholar 

  25. Erickson-Johnson MR, Chou MM, Evers BR, et al. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011;91:1427–33.

    Article  CAS  PubMed  Google Scholar 

  26. Oliveira AM, Chou MM. USP6-induced neoplasms: the biologic spectrum of aneurysmal bone cyst and nodular fasciitis. Hum Pathol. 2014;45:1–11.

    Article  CAS  PubMed  Google Scholar 

  27. Thompson LD, Fanburg-Smith JC, Wenig BM. Nodular fasciitis of the external ear region: a clinicopathologic study of 50 cases. Ann Diagn Pathol. 2001;5:191–8.

    Article  CAS  PubMed  Google Scholar 

  28. Chhieng DC, Cohen JM, Cangiarella JF. Fine-needle aspiration of spindle cell and mesenchymal lesions of the salivary glands. Diagn Cytopathol. 2000;23:253–9.

    Article  CAS  PubMed  Google Scholar 

  29. Layfield LJ, Anders KH, Glasgow BJ, et al. Fine-needle aspiration of primary soft-tissue lesions. Arch Pathol Lab Med. 1986;110:420–4.

    CAS  PubMed  Google Scholar 

  30. Bauer JL, Miklos AZ, Thompson LD. Parotid gland solitary fibrous tumor: a case report and clinicopathologic review of 22 cases from the literature. Head Neck Pathol. 2012;6:21–31.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Coffin CM, Dehner LP. Fibroblastic–myofibroblastic tumors in children and adolescents: a clinicopathologic study of 108 examples in 103 patients. Pediatr Pathol. 1991;11:569–88.

    Article  CAS  PubMed  Google Scholar 

  32. Majmudar B, Winiarski N. Desmoid tumor presenting as a parotid mass. JAMA. 1978;239:337–9.

    Article  CAS  PubMed  Google Scholar 

  33. Carlson JW, Fletcher CD. Immunohistochemistry for beta-catenin in the differential diagnosis of spindle cell lesions: analysis of a series and review of the literature. Histopathology. 2007;51:509–14.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Southern California Permanente Medical Group. The authors thank Ms. Hannah B. Herrera for her conscientious research assistance.

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Authors and Affiliations

  1. Department of Pathology, Woodland Hills Medical Center, Southern California Kaiser Permanente Medical Group, 5601 De Soto Avenue, Woodland Hills, CA, 91365, USA

    Tyler C. Gibson & Lester D. R. Thompson

  2. Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Justin A. Bishop

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  1. Tyler C. Gibson
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  2. Justin A. Bishop
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Correspondence to Lester D. R. Thompson.

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Gibson, T.C., Bishop, J.A. & Thompson, L.D.R. Parotid Gland Nodular Fasciitis: A Clinicopathologic Series of 12 Cases with a Review of 18 Cases from the Literature. Head and Neck Pathol 9, 334–344 (2015). https://doi.org/10.1007/s12105-014-0594-9

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  • DOI: https://doi.org/10.1007/s12105-014-0594-9

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