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Case Report
Intradermal nodular fasciitis of the ear auricle: A case report and literature review
1 Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
2 Department of Pathology and Molecular Medicine, St. Joseph’s Hospital, 2757 King Street East, Hamilton, Ontario, Canada
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Ahmed Shah
Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario,
Canada
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Article ID: 100038Z11AS2020
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Shah A, Salama S, Alowami S. Intradermal nodular fasciitis of the ear auricle: A case report and literature review. J Case Rep Images Pathol 2020;6:100038Z11AS2020.ABSTRACT
Introduction: Nodular fasciitis (NF) is a benign self-limited neoplasm of fibroblastic and myofibroblastic derivation. It primarily arises within the subcutaneous tissue. It arises less frequently in the skeletal muscle, and very rarely in the skin. Nodular fasciitis of the ear is very rare with only seven publications including one case series of 50 cases, of which only 6 arising from the auricle or pinna are reported in total. Moreover, intradermal NF is itself an extremely rare entity with only 36 reported cases in literature.
Case Report: We report a case of a 53-year-old man who presented with a tender oval-shaped intradermal lesion of the right ear that developed over several weeks, which after histological and immunohistochemical analysis was diagnosed as NF. Our differential diagnoses for NF is atypical fibroxanthoma (AFX) and sarcomas. Other mimics include melanoma, poorly differentiated squamous cell carcinoma, all of which were excluded by the immunohistochemistry analysis. PUBMED database was used to search for available literature on NF of the ear and intradermal NF.
Conclusion: Nodular fasciitis should be distinguished from AFX, sarcomas, melanoma, and squamous cell carcinoma due to significantly different clinical outcomes. The diagnosis is dependent on morphology and distinct immunohistochemistry staining pattern. Complete excision is standard of practice for symptom management and to exclude other differential diagnoses.
Keywords: Atypical fibroxanthoma, Ear, Nodular fasciitis, Sarcoma
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Author Contributions
Ahmed Shah - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Samih Salama - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Salem Alowami - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementThis case does not use any specific patient identifiers, and the pictures are of microscopic histology and immunohistochemistry that cannot be used for patient identification purposes. In the department of pathology, we do not directly interact with patients, but all efforts have been made in great detail to anonymize the case as much as possible.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Ahmed Shah et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
