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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 67, Num. 1, 2005, pp. 47-48

Indian Journal of Surgery, Vol. 67, No. 1, January-February, 2005, pp. 47-48

Case Report

Nodular fasciitis at the base of penis in a four year old boy

Department of Paediatric Surgery, L.T.M. Medical College and General Hospital, Sion, Mumbai - 400 022
Correspondence Address:Dept. of Pediatric Surgery, L.T.M. Medical College and General, Hospital, Sion, Mumbai - 400 022 Email:drparaskothari@rediffmail.com

Code Number: is05009

Abstract

Nodular fasciitis (NF) is a relatively common soft tissue lesion and represents a rapidly growing benign reactive process. Their cause is unknown. Less than 20% occur in children. Lesions in the head and neck region develop more frequently in children than in adults. NF has been reported at various atypical sites. We report a case of nodular fasciitis at the base of the penis in a 4-year-old boy. The nodule was excised with a narrow margin. This is the first reported case of nodular fasciitis at this unusual site.

Keywords: Nodular fasciitis, Paediatric, Penile

INTRODUCTION

Nodular fasciitis (NF) is a benign, discrete, fibroblastic proliferation in soft tissue. The condition is most commonly encountered in middle-aged people in the upper extremities. In children the head and neck region is most commonly involved. It is the most common benign mesenchymal tumour that may mimic malignancy clinically and histologically. It is frequently misdiagnosed as sarcoma due to its rapid[1] growth and deceptive appearance. It is thus important to recognize this condition so as to avoid aggressive treatment.

CASE REPORT

A 4-year-old boy presented with complaints of a rapidly growing subcutaneous nodule at the base of the penis since one month. There was no history of trauma, surgery and urinary complaints. No history of similar lesions on the other parts of the body was present.

The general examination and vitals were essentially normal. Complete blood count and urine routine microscopy were within normal limits.

On local examination, a 2 x 2 cm firm, minimally painful subcutaneous nodule was present on the right side of the base of the penis [Figure - 1].

Excision of the nodule with a narrow margin was done. Histopathology confirmed the swelling as nodular fasciitis.

DISCUSSION

NF is a relatively common soft tissue lesion and represents a benign reactive process.

It is a benign, discrete, fibroblastic proliferation in soft tissue that is frequently misdiagnosed as sarcoma due to its rapid growth and deceptive appearance.[2]

Most of the patients are middle-aged with the upper extremity being the commonest site of involvement. Lesions in the head and neck region develop more frequently in children and infants than in adults.[1]

NF have been reported in the nasal cavity,[2] oral cavity,[3] parotid,[4] vulvar[5] and breast[6] region. Involvement of the penis has not been reported yet. This is the first report of NF at this unusual site- base of the penis.

Clinicians should include NF in the differential diagnosis of rapidly growing subcutaneous tumours and not rush to overly aggressive therapy.

Histologically, these nodules are composed of proliferating immature fibroblasts in short, irregular bundles. These fibroblasts vary from thin, elongated and spindle-shaped with elongated nuclei to plump with one or more large, oval nuclei. Hypercellularity, brisk mitotic rate and the presence of actin cause it to mimic a myogenic sarcoma. Microscopic examination of NF exhibited cohesive clusters of epithelioid to spindle-shaped cells in a background of intact mesenchymal cells, inflammatory cells and myxoid stroma.

It is a benign condition that may mimic malignancy clinically and histologically. It is thus important to recognize this condition so as to avoid aggressive treatment.

References

1.Handa Y, Asai T, Tomita Y. Nodular fasciitis of the forehead in a pediatric patient. Dermatol Surg 2003;29:867-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Harrison HC, Motbey J, Kan AE, de Silva M. Nodular fasciitis of the nose in child. Int J Pediatr Otorhinolaryngol 1995;33:257-64.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Haddad AJ, Avon SL, Clokie CM, Sandor GK. Nodular Fasciitis in the oral cavity. J Can Dent Assoc 2001;67:664-7.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Pereira C, Edwards M. Parotid nodular fasciitis in a mobile phone user. J Laryngol Otol 2000;114:886-7.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.O'Connell JX, Young RH, Nilsen GP, Rosenberg AE, Bainbridge TC, Clement PB. Nodular Fasciitis of the vulva: A study of six cases and literature review. Int J Gynecol pathol 1997;16:117-23.  Back to cited text no. 5    
6.Nodular fasciitis of the breast and knee in the same patient. Polat P, Kantarci M, Alper F, Gursan N, Suma S, Okur A. Am J Roentgenol 2002;178:1426-8.  Back to cited text no. 6    

Copyright 2005 - Indian Journal of Surgery


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