Three Cases of Periorbital Nodular Fasciitis

ABSTRACT

PURPOSE: Herein, we report 3 cases of nodular fasciitis presenting with periorbital mass. CASE SUMMARY: An 18-year-old male presented with a mass in his left lateral temple area 3 months in duration. On physical examination, a subcutaneous mass approximately 20 mm in size was palpable with upper eyelid swelling. Orbital magnetic resonance imaging (MRI) showed T1 isointensity and T2 hyper intensity and a well-circumscribed enhancing lesion. A 36-year-old male presented with a 6-month history of a bump under his right upper eyelid. External examination revealed a 15 mm-sized subcutaneous mass in the right central sub-brow area. Orbital computed tomography showed a homogenous, well-circumscribed mass with moderate enhancement. A 3-year-old boy presented with a mass in his right upper eyelid 4 months in duration. A subcutaneous mass approximately 10 mm in size was palpated at the medial superior orbital rim. Orbital MRI revealed an enhanced mass of irregular shape. Surgical excision was performed for all cases. Histopathological examination showed pathognomonic proliferation of spindle cells and immunohistochemical stains showed the spindle cells were positive for smooth muscle actin, negative for S-100 and negative for CD34, consistent with nodular fasciitis. Recurrence of the tumors after excision in the 3 cases was not observed after 4 months, 3 months and 48 months, respectively. CONCLUSIONS: Nodular fasciitis is rare but can occur at the periorbital region. In particular, nodular fasciitis should be considered as a differential diagnosis of a subcutaneous mass short in duration in children or young adults.