Fasciitis nodularis involves the formation of nodular and fibroblastic growths on the fascia that resemble benign tumors. Speculation is that these are reactive processes after trauma or inflammation of the tissue. Differentiation from malignant disease is particularly difficult for pathologists.
What is fasciitis nodularis?
Fasciae are soft tissue components of connective tissue. Various malignant and benign tumors can originate from them. A benign tumor disease of the fascia is fibromatosis, which, despite being benign, often aggressively infiltrates the surrounding area. The
Fasciitis nodularis is a disease of the fascia associated with fibroblastic growths of the tissue. Synonymously, the terms nodular fasciitis, pseudosarcomatous dermatofibroma, and pseudosarcomatous fibromatosis are used. The pathological phenomenon belongs to fibroproliferative diseases and is one of the most common findings in this field. The exact prevalence is unknown to date. The disease occurs without gender preference and mostly affects people between the ages of 20 and 50. Diagnosis of the disease is complicated because of its histologic similarity to fibromatoses and fibrosarcomas. In the past, the difficulties in differentiation often resulted in incorrect treatment decisions.
Causes
The etiology of fasciitis nodularis has not been conclusively determined. For the apparently related fibromatoses of the connective tissue, the triggering cause is also considered unclear to date. Presumably, the growths of fasciitis nodularis are reactive processes. In most cases, spontaneous remission occurs. Recurrences usually do not occur. Scientists now associate the growths with trauma. It is currently being speculated to what extent previous injuries to the fascia could play a role in the reactive changes. Often, previous violence or nonspecific inflammation is associated with the process. Genetic factors may also be relevant to the condition of fasciitis nodularis. Because many cases of fasciitis nodularis are unrecognized and diagnosed as fibromatoses or related conditions, causation is difficult.
Symptoms, complaints, and signs
Patients with fasciitis nodularis suffer from solitary growths of subcutaneous tissue that are more than two and no more than three centimeters in size. The growths appear coarse and are well demarcated from their surroundings. The fibroblastic nodules grow rapidly and are asymptomatic in most cases. Only rarely are they pressure-sensitive lesions. The growths originate in fascial tissue and usually infiltrate subcutaneous adipose tissue. In some cases, they penetrate into the musculature. The growths are vascular and usually consist of large, spindle-like fibroblasts or myofibroblasts. They may contain innumerable mitoses and usually have prominently protruding endothelia. Multinucleated giant cells may be present in varying densities. The nuclear formations usually appear bizarre. The stroma is loosely myxoid underlain and characterized by fibrous structures. The growths occur preferentially on the upper extremities, so especially in the forearm area. Less commonly, the torso area of patients is affected by the nodular formations.
Diagnosis and course
To diagnose fasciitis nodularis, the physician faces a challenge. The basis of the diagnosis is a biopsy of the affected tissues, which is analyzed histologically. Histologic differential diagnosis, however, proves difficult. The sarcoma-like findings often lead to misdiagnosis and therapeutically incorrect decisions such as radiotherapy. According to studies, of 55 cases of fasciitis nodularis, nearly half were diagnosed as sarcomas. Less than one-fifth of cases were recognized as fasciitis nodularis. The soft tissue lesion is known for the great difficulty it presents to the pathologist in histology. Depending on the individual case, it may be difficult for the physician in charge to distinguish it from other diseases such as the fibromatoses, fibrosarcomas, and fibrous malignant histiocytoma. Patients with fasciitis nodularis have a good prognosis because the tumors usually regress spontaneously and often do not recur.
Complications
Benign tumors usually develop in fasciitis nodularis.However, complications can arise with this disease, as the benign tumors can hardly be distinguished from the malignant cancers. The affected person suffers mainly from strong growths, which can cover the body in different places. Due to the nodules, most patients do not feel attractive and thus suffer from lowered self-esteem. This can also cause lesions that are sensitive to pain. If the growths penetrate into the muscle tissue, it can also lead to restricted movement and severe pain. The patient’s everyday life is relatively severely restricted due to the disease. The treatment itself is primarily carried out to distinguish malignant tumors from benign tumors. If malignant cancers are found, they are surgically removed. As a rule, the course of the disease is positive if the tumor is treated at an early stage. Complications do not occur. However, the patient must undergo some follow-up visits, as fasciitis nodularis may occur one more time if the incomplete tumor tissue was removed.
When should you see a doctor?
Fasciitis nodularis always requires examination and treatment by a physician. As a rule, the symptoms of the disease do not disappear on their own, so treatment is necessary in any case. A doctor should be consulted if the patient suffers from growths in the tissue or on the skin. Often, however, these growths are only detected during check-ups. Even if the nodules are not dangerous, they should still be examined. Especially in case of pressure-sensitive or painful nodes, a visit to the doctor is necessary. The pain can also be transferred to the muscles. As a rule, the general practitioner or dermatologist is consulted first for fasciitis nodularis. Further treatment is then carried out by another specialist and depends to a large extent on the severity of the symptoms. In many cases, patients are dependent on radiation therapy to alleviate the symptoms. However, even after successful treatment, patients are still dependent on regular examinations in order to avoid complications and other complaints. As a rule, the patient’s life expectancy is not reduced by fasciitis nodularis.
Treatment and therapy
Because the cause of nodular fasciitis has not been definitively determined, causal therapy is unthinkable. Only symptomatic therapies can be given. On the other hand, the lesions tend to spontaneously remission and for this reason do not need to be treated immediately in every case. Differentiation from malignant growths of the tissue is the most important step for an appropriate therapeutic decision. Patients suffering from nodular fasciitis should in no case have to undergo radiotherapy or similar harmful therapeutic measures that are used for malignant findings. Surgical excision is usually not necessary in patients with nodular fasciitis. Close monitoring of the patient is recommended during the first few months. Surgical steps are not indicated for the time being. Monitoring corresponds primarily to a size check 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 may be performed. In this procedure, the growths are removed as completely as possible to prevent recurrences. After removal, the patient attends regular check-ups to rule out recurrence. However, since such recurrence is extremely rare in this disease, therapy is usually final and complete with remission or excision of the lesions.
Outlook and prognosis
The prognosis of fasciitis nodularis is favorable. The benign tumors do not usually trigger life-threatening consequences. Because no surgical intervention is performed or mutation is expected, no serious complications occur. The changes in skin appearance can be subject to spontaneous healing at any time. In these cases, the prognosis is particularly favorable. More often, however, without treatment, the growths spread and the symptoms increase.Once adequate medical care is sought, relief of symptoms occurs within a few weeks or months. Since there is no causal method of treatment for fasciitis nodularis, the therapy methods may vary. This can lead to delays in the healing process, or intolerances to the active substances used are conceivable. These are of a temporary nature. Although fasciitis nodularis has a favorable prognosis, it may recur at any time during life. In addition, the changes in the skin appearance must always be distinguished from malignant progressions. Control visits and clarification of the symptoms are therefore necessary in the case of every recurrence. The disease can lead to emotional and mental problems due to the visual conspicuousness. Guilt, shame and a withdrawal behavior are to be expected. In exceptional cases, this can cause mental illness and thus trigger a negative impact on the overall prognosis.
Prevention
To date, it is still unclear what the underlying cause of nodular fasciitis is. For this reason, no preventive steps are available.
Follow-up
In cases of nodular fasciitis, the options for follow-up care are very limited. First and foremost, direct and medical treatment of the symptoms must be given to prevent further complications and inflammation of the tissue. Self-healing is not possible, although early diagnosis and treatment of fasciitis nodularis always have a positive effect on the further course of the disease. Whether this will result in a reduced life expectancy cannot generally be predicted. Fasciitis nodularis should always be examined and monitored by a physician in order to rule out malignancy of the growth. Regular examinations by a physician are necessary. In the case of a malignant growth, it must be removed by surgery. As a rule, the affected person should always rest and take it easy after such an operation. Above all, the affected area should be spared so that fasciitis nodularis does not recur there. Since fasciitis nodularis can also recur, an examination must be performed even after successful treatment. In this disease, contact with other sufferers can also be useful, as this often leads to an exchange of information.
What you can do yourself
Patients with fasciitis nodularis have few options for self-help. In addition, because in most cases the disease is largely asymptomatic, there is little physical impairment. If there is a diagnosis, a strengthening of mental power is often needed. This can be achieved with sufficient rest and adequate sparing. Participation in relaxation techniques is recommended, as this can relieve stress that builds up in everyday life. With techniques such as yoga or meditation, an improvement in well-being is achieved, which basically has a positive influence on health. If growths occur due to fasciitis nodularis, scratching or rubbing the affected areas should be avoided. 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 occur, it is helpful if the patient avoids overexertion and heavy physical strain. Adequate heat intake is helpful to support the muscles. In addition, there should be a healthy diet plan and sufficient fluids should be taken in during the day. One-sided movements or poor posture of the body should be avoided if possible, despite the presence of musculoskeletal complaints.
