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Background <p>Nodular fasciitis (NF) is tumor-like, non-neoplastic disease.</p> Objective <p>Bone erosion due to nodular fasciitis is extremely rare and may resemble a malignant neoplasm radiologically. The aim of the current work was to present a rare case of nodular fasciitis of the finger associated with bone erosion, emphasizing its radiological and pathological features that may mimic malignancy, and to contribute to the differential diagnosis of similar lesions.</p> Case presentation <p>A 38-year-old man presented with a gradually enlarging, non-tender mass on the dorsal side of the right hand, associated with mild discomfort and restricted movement. Physical exam revealed a 1.5&#xa0;cm mass adjacent to the second metacarpal bone. The ultrasound showed a 20 × 14&#xa0;mm hypoechoic nodular lesion between the second and third metacarpal bones, closely related to the distal second metacarpal. X-ray revealed a well-defined, radiolucent lesion in the distal metaphysis without periosteal reaction. Computed tomography (CT) confirmed a lytic bone lesion with soft tissue involvement, but no aggressive features were observed. Magnetic resonance imaging (MRI) showed a soft tissue mass with internal cystic areas, heterogeneous contrast enhancement, surrounding soft tissue involvement, and bone marrow edema. Excision was performed due to a broad differential diagnosis, including enchondroma protuberance and tenosynovial giant cell tumor. Histological analysis showed a well-circumscribed nodular lesion composed of spindle cells in a myxoid-collagenous matrix, consistent with nodular fasciitis.</p> Conclusions <p>Nodular fasciitis is a rare, benign, and rapidly growing soft tissue lesion that can mimic malignancy both clinically and radiologically, posing a diagnostic challenge. Although it typically arises in subcutaneous tissues of the upper extremities, its occurrence in the hand, particularly with bone involvement, is sporadic. Imaging findings are often nonspecific, with variable ultrasound, CT, and MRI features that may resemble aggressive or malignant lesions. This case highlights an unusual presentation of NF with bone invasion in the hand, emphasizing the importance of including NF in the differential diagnosis of benign-appearing but locally aggressive lesions. Marginal excision remains the treatment of choice, with low recurrence rates when complete resection is achieved.</p>

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Nodular fasciitis of the finger with bone erosion: unusual behavior mimicking malignancy

  • 期刊论文

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  • 发表日期：

    2025年11月18日

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  • Esra Soyer Guldogan,
  • Kursat Duzenli,
  • Tuba Akdag,
  • Omer Ozel,
  • Selim Safali

摘要

Background

Nodular fasciitis (NF) is tumor-like, non-neoplastic disease.

Objective

Bone erosion due to nodular fasciitis is extremely rare and may resemble a malignant neoplasm radiologically. The aim of the current work was to present a rare case of nodular fasciitis of the finger associated with bone erosion, emphasizing its radiological and pathological features that may mimic malignancy, and to contribute to the differential diagnosis of similar lesions.

Case presentation

A 38-year-old man presented with a gradually enlarging, non-tender mass on the dorsal side of the right hand, associated with mild discomfort and restricted movement. Physical exam revealed a 1.5 cm mass adjacent to the second metacarpal bone. The ultrasound showed a 20 × 14 mm hypoechoic nodular lesion between the second and third metacarpal bones, closely related to the distal second metacarpal. X-ray revealed a well-defined, radiolucent lesion in the distal metaphysis without periosteal reaction. Computed tomography (CT) confirmed a lytic bone lesion with soft tissue involvement, but no aggressive features were observed. Magnetic resonance imaging (MRI) showed a soft tissue mass with internal cystic areas, heterogeneous contrast enhancement, surrounding soft tissue involvement, and bone marrow edema. Excision was performed due to a broad differential diagnosis, including enchondroma protuberance and tenosynovial giant cell tumor. Histological analysis showed a well-circumscribed nodular lesion composed of spindle cells in a myxoid-collagenous matrix, consistent with nodular fasciitis.

Conclusions

Nodular fasciitis is a rare, benign, and rapidly growing soft tissue lesion that can mimic malignancy both clinically and radiologically, posing a diagnostic challenge. Although it typically arises in subcutaneous tissues of the upper extremities, its occurrence in the hand, particularly with bone involvement, is sporadic. Imaging findings are often nonspecific, with variable ultrasound, CT, and MRI features that may resemble aggressive or malignant lesions. This case highlights an unusual presentation of NF with bone invasion in the hand, emphasizing the importance of including NF in the differential diagnosis of benign-appearing but locally aggressive lesions. Marginal excision remains the treatment of choice, with low recurrence rates when complete resection is achieved.