Case for Diagnosis
Subcutaneous Tumor Deep to the Lateral Right Eyebrow
Tumoración subcutánea en la cola de la ceja derecha
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"apellidos" => "Tardío" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración subcutánea en la cola de la ceja derecha" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 480 "Ancho" => 600 "Tamanyo" => 150610 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 12-year-old girl with no relevant past history presented with a lesion on the lateral portion of the right eyebrow that had appeared 2 months earlier. The patient had no history of trauma. She reported occasional pain and an increase in the size of the lesion, followed by stabilization.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed an ill-defined oval-shaped subcutaneous growth measuring 2<span class="elsevierStyleHsp" style=""></span>cm in diameter, with a firm elastic consistency, adherent to the deeper tissues, with no alterations of the underlying skin (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Radiographs of the face, orbit, superior orbital fissure, and skull were normal. Soft-tissue ultrasound revealed a solid, rounded growth with some small vessels in the subcutaneous cellular tissue (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical Course and Treatment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The lesion was completely excised, and after 8 months of follow-up there were no signs of local recurrence and no other lesions had appeared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Histopathology</span><p id="par0025" class="elsevierStylePara elsevierViewall">Histologic examination revealed a localized growth in the subcutaneous cellular tissue formed by a proliferation of multipolar spindle-shaped fibroblasts and myofibroblasts with vesicular nuclei and prominent nucleoli, arranged in a non-specific pattern in a myxoid stroma with extravasated blood cells and fibrous areas with hyalinized collagen (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>, hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Nodular fasciitis (NF).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">NF was first described by Konwaler et al. in 1954 as “subcutaneous pseudosarcomatous fibromatosis (fasciitis).”<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It is a fast-growing proliferative lesion that mainly affects the subcutaneous cellular tissue, fascia, and muscle, although a rare dermal variant also exists.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The etiology and pathogenesis of NF remain uncertain, although it is considered to be a reactive, benign, self-limiting process<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–4</span></a> related, in isolated cases, to infectious processes or trauma.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It usually appears in white men<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> in the third or fourth decades of life<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>; only 10% of cases are found in children anywhere from several months to 18 years of age, with the average age falling between 8 and 14 years, depending on the case series.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3–5</span></a> The most common site of NF lesions is the extremities and trunk, followed by the head and neck, the most frequent site during childhood,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> although reports of NF in children are rare.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,5</span></a> NF usually presents as a single asymptomatic lesion. Clinically, NF is characterized by a firm nodule, either fixed or mobile, that is generally less than 3<span class="elsevierStyleHsp" style=""></span>cm in diameter, skin-colored or erythematous, sometimes painful, and without palpable lymph nodes.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">NF is diagnosed histopathologically. Presurgical imaging studies help to better define the lesion and rule out other possible diagnoses.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologic examination shows a proliferation of fibroblasts and myofibroblasts with an increase in mitotic activity and loose myxoid stroma,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> with increased vascularization, extravasated erythrocytes, chronic inflammatory infiltrate<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> and occasional osteoclastic giant cells. Price et al. were the first to classify NF in 3 histologic subtypes: myxoid or reactive (type <span class="elsevierStyleSmallCaps">i</span>, the most common type), cellular (type <span class="elsevierStyleSmallCaps">ii</span>), and fibrous (type <span class="elsevierStyleSmallCaps">iii</span>). It has been suggested that these subtypes may not be independent but rather that they represent the progression of NF over time.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Immunohistochemical studies are positive for muscle-specific actin, smooth muscle actin, calponin, and vimentin and negative for desmin, cytokeratin, h-caldesmon, smooth muscle myosin, S100 protein, and CD34.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,5,6</span></a> As in other mesenchymal tumors, cytogenetic studies have revealed rearrangements of the USP6 locus related to high mitotic activity.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis includes benign lesions such as dermoid or epidermoid cysts, pilomatricoma, lipoma, and postoperative or posttraumatic nodules, as well as malignant tumors<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–5</span></a> such as fibrosarcoma, malignant peripheral nerve sheath tumor, undifferentiated pleomorphic sarcoma, and dermatofibrosarcoma protuberans.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite its reactive character and the possibility of spontaneous remission, surgical excision appears to be the most reasonable form of management, especially in children.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Recurrences are rare and require that the diagnosis be reconsidered.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–5</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical Course and Treatment" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Histopathology" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Diagnosis" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Montero PP. Tumoración subcutánea en la cola de la ceja derecha. Actas Dermosifiliogr. 2017;108:253–254.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 443 "Ancho" => 600 "Tamanyo" => 60892 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 488 "Ancho" => 600 "Tamanyo" => 64707 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 480 "Ancho" => 600 "Tamanyo" => 150610 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subcutaneous pseudosarcomatous fibromatosis (fasciitis)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.E. Konwaler" 1 => "L. Keasbey" 2 => "L. Kaplan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "1955" "volumen" => "25" "paginaInicial" => "241" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14361319" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fascitis nodular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Mauleón Fernández" 1 => "E. Chavarría Mur" 2 => "R. Suárez Fernández" 3 => "P. Lázaro Ochaita" 4 => "M. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 23 | 8 | 31 |
| 2024 Octubre | 153 | 38 | 191 |
| 2024 Septiembre | 161 | 28 | 189 |
| 2024 Agosto | 202 | 60 | 262 |
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| 2024 Febrero | 164 | 33 | 197 |
| 2024 Enero | 148 | 31 | 179 |
| 2023 Diciembre | 110 | 20 | 130 |
| 2023 Noviembre | 147 | 23 | 170 |
| 2023 Octubre | 102 | 36 | 138 |
| 2023 Septiembre | 106 | 31 | 137 |
| 2023 Agosto | 83 | 19 | 102 |
| 2023 Julio | 160 | 34 | 194 |
| 2023 Junio | 107 | 20 | 127 |
| 2023 Mayo | 118 | 29 | 147 |
| 2023 Abril | 122 | 17 | 139 |
| 2023 Marzo | 122 | 24 | 146 |
| 2023 Febrero | 86 | 18 | 104 |
| 2023 Enero | 68 | 38 | 106 |
| 2022 Diciembre | 74 | 55 | 129 |
| 2022 Noviembre | 47 | 19 | 66 |
| 2022 Octubre | 36 | 23 | 59 |
| 2022 Septiembre | 34 | 22 | 56 |
| 2022 Agosto | 27 | 33 | 60 |
| 2022 Julio | 32 | 30 | 62 |
| 2022 Junio | 38 | 21 | 59 |
| 2022 Mayo | 85 | 39 | 124 |
| 2022 Abril | 106 | 21 | 127 |
| 2022 Marzo | 129 | 60 | 189 |
| 2022 Febrero | 66 | 32 | 98 |
| 2022 Enero | 65 | 36 | 101 |
| 2021 Diciembre | 71 | 44 | 115 |
| 2021 Noviembre | 68 | 51 | 119 |
| 2021 Octubre | 80 | 51 | 131 |
| 2021 Septiembre | 55 | 33 | 88 |
| 2021 Agosto | 60 | 41 | 101 |
| 2021 Julio | 55 | 35 | 90 |
| 2021 Junio | 66 | 22 | 88 |
| 2021 Mayo | 71 | 46 | 117 |
| 2021 Abril | 135 | 46 | 181 |
| 2021 Marzo | 90 | 37 | 127 |
| 2021 Febrero | 73 | 29 | 102 |
| 2021 Enero | 45 | 23 | 68 |
| 2020 Diciembre | 48 | 22 | 70 |
| 2020 Noviembre | 24 | 21 | 45 |
| 2020 Octubre | 24 | 21 | 45 |
| 2020 Septiembre | 34 | 15 | 49 |
| 2020 Agosto | 23 | 26 | 49 |
| 2020 Julio | 31 | 21 | 52 |
| 2020 Junio | 32 | 29 | 61 |
| 2020 Mayo | 10 | 10 | 20 |
| 2020 Abril | 24 | 11 | 35 |
| 2020 Marzo | 26 | 15 | 41 |
| 2020 Febrero | 5 | 0 | 5 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 8 | 0 | 8 |
| 2019 Junio | 5 | 0 | 5 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 4 | 6 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 15 | 4 | 19 |
| 2018 Enero | 24 | 6 | 30 |
| 2017 Diciembre | 36 | 3 | 39 |
| 2017 Noviembre | 18 | 4 | 22 |
| 2017 Octubre | 15 | 8 | 23 |
| 2017 Septiembre | 18 | 7 | 25 |
| 2017 Agosto | 24 | 7 | 31 |
| 2017 Julio | 21 | 3 | 24 |
| 2017 Junio | 37 | 10 | 47 |
| 2017 Mayo | 36 | 5 | 41 |
| 2017 Abril | 70 | 32 | 102 |
| 2017 Marzo | 26 | 24 | 50 |
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