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Holiday snaps No.4
Arm
@ZHOUSEH @MattieFarzin @rennmont @DrJPLow @RunjanChetty @ariella8 @JMGardnerMD @01sth02 @TheKarenPinto @MAHoureih @DrBMcGinn @s_prendeville @DrGeeONE @Divya_Madhala @pembeoltulu @Meghna0630 @Mattzaborowski1
#BSTpath #PathTwitter #dermpath #SurgPath
Arm
@ZHOUSEH @MattieFarzin @rennmont @DrJPLow @RunjanChetty @ariella8 @JMGardnerMD @01sth02 @TheKarenPinto @MAHoureih @DrBMcGinn @s_prendeville @DrGeeONE @Divya_Madhala @pembeoltulu @Meghna0630 @Mattzaborowski1
#BSTpath #PathTwitter #dermpath #SurgPath
Diagnosis:
Nodular fasciitis
Nodular fasciitis
1/ Once regarded as a reactive lesion, this pseudosarcomatous is a benign neoplasm that are self-limiting.
2/ They usually present as a rapid growing lesion and only ~50% of patients report a previous associated trauma. https://pubmed.ncbi.nlm.nih.gov/6462780/
2/ They usually present as a rapid growing lesion and only ~50% of patients report a previous associated trauma. https://pubmed.ncbi.nlm.nih.gov/6462780/
3/These lesions are circumscribed & usually less than 3cm.
The rule of thumb
Whole lesion should fit on one slide!
4/More common in upper extremities, but it can occur at almost any anatomical site, including intravascular forms and in any age. https://pubmed.ncbi.nlm.nih.gov/7246849/
The rule of thumb
Whole lesion should fit on one slide!4/More common in upper extremities, but it can occur at almost any anatomical site, including intravascular forms and in any age. https://pubmed.ncbi.nlm.nih.gov/7246849/
5/ They have a characteristic gene fusion MYH9-USP. This can be useful in unusual cases (eg large lesions).
6/ USP6 fusions can also be found in aneurysmal bone cysts and myositis ossificans (MO). https://pubmed.ncbi.nlm.nih.gov/28752842/
6/ USP6 fusions can also be found in aneurysmal bone cysts and myositis ossificans (MO). https://pubmed.ncbi.nlm.nih.gov/28752842/
7/Classic features are:
Myxoid or collagenous matrix
Cellular myo/fibroblastic cells with plump nuclei & occasional nucleoli
Tissue culture-like cells
S/C-shaped fascicles, sometimes storiform
RBC extravasation
Lymphocytes
Hyperchromatic/pleomorphic cells
Myxoid or collagenous matrixCellular myo/fibroblastic cells with plump nuclei & occasional nucleoliTissue culture-like cellsS/C-shaped fascicles, sometimes storiformRBC extravasationLymphocytesHyperchromatic/pleomorphic cells
8/ But also can have:
Numerous mitoses
Scattered giant cells
Focal metaplastic bone formation (relationship to MO)
Centripetally oriented capillaries
Cystic change
Numerous mitoses Scattered giant cells Focal metaplastic bone formation (relationship to MO) Centripetally oriented capillaries Cystic change
