Nodular Fasciitis

What is nodular fasciitis?

Nodular fasciitis is a rare, fast-growing, noncancerous soft tissue tumor that mostly affects adults but can occur in infants and children. Although the tumor is benign (not cancerous), it can appear similarly to malignant soft tissue tumors called sarcomas. For this reason, the lump is sometimes called pseudosarcomatous fasciitis. “Pseudo” means deceptively similar to.

Nodular fasciitis doesn’t often require treatment, but some people will have surgery to remove the growth.

What does nodular fasciitis mean?

You may better understand this condition when you break down its meaning:

• Nodular refers to the mass of cells (a nodule) that causes a lump to form under your skin. The mass is a type of tumor, but it’s not cancer.
• Fasciitis refers to inflammation in the fascia. This fibrous connective tissue is part of your musculoskeletal system. It holds your muscles, nerves, bones, organs and blood vessels in place.

What are other terms for nodular fasciitis?

Your healthcare provider may also use these terms to refer to nodular fasciitis:

• Proliferative fasciitis.
• Pseudosarcomatous fasciitis.
• Cranial fasciitis.
• Intravascular fasciitis.
• Ischemic fasciitis.
• Ossifying fasciitis.

How common is nodular fasciitis?

Nodular fasciitis is a rare benign soft tissue tumor. It mostly affects adults between the ages of 20 and 40, but infants and children can develop nodular fasciitis too.

What are the types of nodular fasciitis?

Most cases of nodular fasciitis develop in fascia. Other types include:

• Deep fascial: The lump forms in thick fibrous tissue layer (deep fascia).
• Dermal: The mass appears in the middle skin layer called the dermis.
• Intermuscular: The growth occurs in between muscles.
• Intramuscular: The lump forms inside a muscle.
• Intravascular: The tumor forms near blood vessels in your cardiovascular.

What causes nodular fasciitis?

Fasciitis occurs when a genetic rearrangement results in a gene fusion of MYH9 and _USP6 _genes. This genetic mutation only happens in the cells that are part of the nodular fasciitis tumor.

What are the symptoms of nodular fasciitis?

Nodular fasciitis causes a lump that you can feel when you push on your skin. Most people have a single lump in one body area that is typically smaller than 1.5 inches (4 centimeters). The lumps can grow quickly. Some lumps grow as large as 5 inches (12 centimeters).

The lump may be:

• Firm.
• Rubbery.
• Solid.
• Tender or painful to touch.

Where does nodular fasciitis occur?

In 4 out of 10 adults, nodular fasciitis develops in your forearm (the lower part of your arm between your elbow and wrist). In children, the mass most commonly affects your head and neck region.

Nodular fasciitis may also form in your:

• Back.
• Chest.
• Lower limbs.
• Trunk.
• Upper arm.

What are the complications of nodular fasciitis?

In rare instances, the mass may press against nerves in your nervous system. You may experience:

• Loss of sensation (numbness) in the affected body area.
• Temporary paralysis.
• Tingling.

How is nodular fasciitis diagnosed?

You may see an orthopedist who specializes in the musculoskeletal system. Your provider may order an MRI or ultrasound. A core needle biopsy or open/excisional biopsy to remove and examine cells from the tumor can determine whether you have a benign tumor or a malignant soft tissue tumor like a sarcoma.

What other conditions cause symptoms similar to nodular fasciitis?

Seeing a specialist is important as other conditions can resemble nodular fasciitis and may require different treatment. In addition to cancerous sarcomas, these conditions include:

• Desmoid tumors and angiomatoid fibrous histiocytomas (different types of benign soft tissue tumors).
• Dupuytren’s disease.
• Myositis ossificans (a reaction to a bruise inside a muscle).
• Neurofibromatosis type 1 (NF1).
• Schwannomas.

How do you treat nodular fasciitis?

Some cases of nodular fasciitis don’t require treatment. If the mass is small and doesn’t cause problems, your healthcare provider may monitor it for a while. A small lump may go away on its own, typically within three months.

If you have pain or other symptoms, minor outpatient surgery can remove the tumor.

Can you prevent nodular fasciitis?

Because genetic mutation and injury are responsible for the development of nodular fasciitis, it’s impossible to prevent the condition altogether.

What is the outlook for someone with nodular fasciitis?

Nodular fasciitis is completely benign. The tumor may go away over time or after surgery to remove it. It’s extremely unlikely to come back. This mass doesn’t develop into cancer or increase your cancer risk.

When should I call the doctor?

Call your healthcare provider if you develop any type of unexplained lump under your skin, especially one that is painful or grows bigger.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the nodular fasciitis?
• Do I need surgery?
• Without surgery, how soon will the lump go away?
• Should I look for signs of complications?

A note from Cleveland Clinic
You should see your healthcare provider anytime you discover an unusual lump anywhere on your body. While nodular fasciitis isn’t cancerous, it mimics sarcomas (cancerous tumors). You’ll need imaging tests and a biopsy to confirm a diagnosis. Nodular fasciitis rarely causes problems. The lump may go away without treatment or after minor treatment like steroid injections. But you may need surgery to remove it if you have pain or the growth presses against a nerve. Once the lump is gone, it rarely comes back.