In nodular fasciitis, nodular and fibroblastic growths that correspond to benign tumors form on the fascia. According to speculations, these are reactive processes after trauma or inflammation of the tissue. The differentiation from malignant diseases is particularly difficult for the pathologist.
What is nodular fasciitis?
According to Phonecations, the fasciae are soft tissue components of the connective tissue. Various malignant and benign tumors can originate from them. A benign tumor disease of the fascia is fibromatosis, which, despite its benign nature, often aggressively infiltrates the surrounding area. Fasciitis nodularis is a disease of the fascia with fibroblastic growths of the tissue.
The terms nodular fasciitis, pseudosarcomatous dermatofibroma and pseudosarcomatous fibromatosis are used synonymously. The pathological phenomenon is one of the fibroproliferative diseases and is one of the most common findings in this area. The exact prevalence is not yet known.
The disease occurs without gender preference and mostly affects people between the ages of 20 and 50. Diagnosis of the disease is difficult due to the histological similarity to fibromatoses and fibrosarcomas. In the past, the delimitation difficulties often resulted in wrong therapy decisions.
The etiology of nodular fasciitis has not yet been conclusively clarified. For the apparently related fibromatoses of the connective tissue, the triggering cause is still unclear. Presumably the growths of the nodular fasciitis are reactive processes. In most cases, spontaneous remission occurs. There are usually no recurrences.
Science now associates the growths with trauma. There is currently speculation about the extent to which previous injuries to the fascia could play a role in the reactive changes. Previous acts of violence or unspecific inflammation are often related to the process.
Genetic factors may also be relevant for the disease of nodular fasciitis. Since many cases of nodular fasciitis are not recognized and diagnosed as fibromatoses or related phenomena, research into the cause is difficult.
Symptoms, ailments & signs
Patients with nodular fasciitis suffer from solitary growths of more than two and a maximum of three centimeters in the subcutaneous tissue. The growths appear coarse and can be easily demarcated from their surroundings. The fibroblastic nodules grow rapidly and in most cases are symptom-free. The lesions are seldom sensitive to pressure.
The growths start from the fascia tissue and mostly infiltrate the subcutaneous fat tissue. In some cases they penetrate into the muscles. The growths are vascular and usually consist of large, spindle-like fibroblasts or myofibroblasts. They can contain innumerable mitoses and mostly have prominent protruding endothelia. Multinucleated giant cells can be contained in different densities.
The core formations usually seem bizarre. The stroma is loosely lined with myxoid and characterized by fibrous structures. The growths tend to occur on the upper extremities, especially in the area of the forearms. The trunk area of the patient is less often affected by the nodules.
Diagnosis & course
When diagnosing nodular fasciitis, the doctor faces a challenge. The diagnosis is based on a biopsy of the affected tissue, which is analyzed histologically. However, the histological differential diagnosis turns out to be difficult. The sarcoma-like findings often lead to misdiagnoses and therapeutically incorrect decisions such as radiation therapy.
According to studies, of 55 cases of nodular fasciitis, almost half were diagnosed as sarcomas. Less than a fifth of the cases were recognized as nodular fasciitis. The soft tissue lesion is known for the great difficulty it presents to the pathologist in histology. Depending on the individual case, it can be difficult for the doctor responsible to distinguish it from other diseases such as fibromatosis, fibrosarcoma and fibrous malignant histiocytoma. Patients with nodular fasciitis have a good prognosis, as the tumors usually recede spontaneously and often do not reappear.
As a rule, nodular fasciitis leads to the development of benign tumors. However, this disease can lead to complications, as benign tumors can hardly be distinguished from malignant cancers. The person affected mainly suffers from strong growths that can cover the body in different places.
The knots make most patients unattractive and therefore suffer from decreased self-esteem. This can also result in lesions that are sensitive to pain. If the growths penetrate into the muscle tissue, it can also lead to restricted mobility and severe pain. The patient’s everyday life is severely restricted due to the illness.
The treatment itself is primarily carried out to differentiate the malignant tumors from the benign tumors. If malignant cancers are found, they are surgically removed. As a rule, the disease progresses positively if the tumor is treated early.
There are no complications. However, the patient has to undergo some follow-up checks, since the nodular fasciitis can recur if the incomplete tumor tissue has been removed.
When should you go to the doctor?
Nodular fasciitis must always be examined and treated by a doctor. As a rule, the symptoms of the disease do not go away on their own, so treatment is always necessary. A doctor should then be seen if the patient suffers from growths in the tissues or on the skin.
However, these growths are often only recognized during control examinations. Even if the lumps are not dangerous, they should still be examined. A visit to the doctor is necessary, especially in the case of pressure-sensitive or painful lumps.
The pain can also be transferred to the muscles. As a rule, the general practitioner or dermatologist is consulted first in the case of nodular fasciitis. Further treatment is then given by another specialist and depends heavily on the severity of the symptoms. In many cases, the patients are dependent on radiation therapy to alleviate the symptoms.
Furthermore, even after successful treatment, those affected are dependent on regular examinations in order to avoid complications and other complaints. As a rule, nodular fasciitis does not reduce the patient’s life expectancy.
Treatment & Therapy
Since the cause of the nodular fasciitis has not yet been definitively clarified, a causal therapy is unthinkable. Only symptomatic therapies can be used. On the other hand, the lesions tend to spontaneously remission and therefore do not need to be treated immediately in every case. Differentiation from malignant tissue growths is the most important step in making an appropriate therapy decision.
Patients with nodular fasciitis should under no circumstances have to endure radiation therapy or similar therapeutic measures that are harmful to health, which are used in the event of malignant findings. Surgical excision is also usually not necessary in patients with nodular fasciitis. Close monitoring of the patient is advisable for the first few months.
First of all, surgical steps are not indicated. The monitoring corresponds above all to a control of the size of the growths. Checking for any accompanying inflammation is also relevant during the waiting period. If the growths have not regressed on their own within a few months, surgical excision can be made. In this procedure, the growths are removed as completely as possible so that no recurrences occur.
After removal, the patient has regular check-ups to rule out recurrence. Since such a relapse occurs only extremely rarely in this disease, the therapy with remission or excision of the lesions is usually final and complete.
Outlook & forecast
The prognosis for nodular fasciitis is favorable. The benign tumors usually do not cause any life-threatening consequences. Since no surgery is performed or a mutation is expected, no serious complications arise. Changes in the complexion of the skin can be subject to spontaneous healing at any time. In these cases the prognosis is particularly favorable.
Without treatment, however, it is more common for the growths to spread and thus an increase in symptoms. As soon as adequate medical care is obtained, the symptoms will be alleviated within a few weeks or months.
Since there is no causal treatment method for nodular fasciitis, the therapeutic methods can be oriented differently. This can lead to delays in the healing process or intolerance to the active ingredients used are conceivable. These are temporary in nature.
Although nodular fasciitis has a favorable prognosis, it can recur at any time during life. In addition, changes in the complexion of the skin must always be distinguished from malignant processes. Control visits and clarification of the complaints are therefore necessary for every relapse. Due to the visual anomalies, the disease can lead to emotional and mental problems. Guilt, shame and withdrawal behavior can be expected. In exceptional cases, this can cause mental illness and thus have a negative impact on the overall prognosis.
It is still unclear what the underlying cause of the nodular fasciitis is. Because of this, there are no preventive steps available.
In the case of nodular fasciitis, the options for follow-up care are very limited. First and foremost, the symptoms must be treated directly and medically in order to prevent further complications and inflammation of the tissue. Self-healing cannot occur, with early diagnosis and treatment of nodular fasciitis always having a positive effect on the further course of the disease.
Whether this will lead to a reduced life expectancy cannot generally be predicted. The nodular fasciitis should always be examined and monitored by a doctor in order to rule out any malignancy of the growth. Regular examinations by a doctor are necessary.
In the case of a malignant growth, it must be removed by surgery. As a rule, the person affected should always rest and take it easy after such an operation. Above all, the affected area should be spared so that there is no new nodular fasciitis.
Since nodular fasciitis can recur, an examination must be carried out even after successful treatment. In the case of this disease, contact with other affected persons can also be useful, as this often leads to an exchange of information.
You can do that yourself
Patients with nodular fasciitis have few opportunities to help themselves. Since in most cases the disease is largely symptom-free, there are also few physical impairments.
If there is a diagnosis, strengthening of the mental strength is often required. This can be achieved with enough rest and sufficient rest. Participation in relaxation procedures is recommended, as this can reduce stress that builds up in everyday life. Techniques such as yoga or meditation improve wellbeing, which in principle has a positive influence on health.
If the nodular fasciitis causes growths, it should be avoided to scratch or rub the affected areas. If open wounds develop, pathogens can enter the organism and trigger further diseases. In severe cases there is a risk of blood poisoning, which can be avoided with a little discipline in advance.
If muscle complaints arise, it is helpful if the patient avoids overexertion and excessive physical exertion. A sufficient supply of heat is helpful to support the muscles. In addition, there should be a healthy eating plan and sufficient fluids should be consumed during the day. Unilateral movements or poor posture of the body should be avoided as far as possible despite existing muscular problems.