CLINICAL DERMATOLOGY AND DERMATITIS

ISSN 2631-6714

Spontaneous Regression of Cutaneous Nodular Fasciitis: A Case Report

Coyne J*1,2, Chatzipantelis P1

1 Consultant Histopathologist,  The Royal Oldham Hospital, Rochdale Road, Oldham, United Kingdom
2 Bon Secours Hospital at Barringtons,, Georges Quay, Limerick, Ireland

CitationCitation COPIED

Coyne J. Spontaneous Regression of Cutaneous Nodular Fasciitis: A Case Report. Clin dermatiol dermatitis. 2018 Aug;1(2):106

Abstract

Spontaneous regression of tumours is a well known but rare phenomenon. Tumour regression has more usually been described in sporadic cases of skin, liver, testicular and renal tumours.This report describes for the first time, the immunophenotype of the dermal cellular infiltrateassociated with a case of regressing nodular fasciitis, suggesting an immunologic mechanism for this often cited occurrence.

Keywords

Cutaneous; Nodular Fasciitis; Regression

Case History and Pathology

A 70-year-old man presented with a 10mm ulcerated lump on his scalp. A 3mm biopsy was taken and microscopic examination showed a bland, spindle cell proliferation with a fascicular pattern. The cells were elongated with tapering nuclei and displayed small nucleoli; frequent normal mitoses were present (Figure 1). The stroma was mildly myxoid and the lesion extended into the subcutaneous tissue. Immunohistochemistry showed strong diffuse positivity for SMA and CD10 and a negative reaction with S100 protein, HMB45, Mel A, p63, CK5/6, CKAE1/3, desmin and caldesmon. A moderate, focal and diffuse lymphocytic infiltrate of CD3 and predominant CD8 positive lymphocytes was also present (Figure 2). Occasional CD1a positive cells as well as a few CD68 positive histiocytes were also a feature. Three weeks later the lesional area, which had clinically shrunk, was excised. The biopsy showed no evidence of residual nodular fasciitis but the dermis was elastotic/ degenerated in appearance and contained a diffuse and follicular lymphocytic infiltrate (Figure 3). Centrally, the follicles contained small numbers of CD21 positive reticulum cells; the majority of the lymphocytes stained positively with CD3 and smaller numbers of CD20 positive cells were centrally present in most of the follicles. The T-cells were both CD4 and CD8 positive in approximately equal numbers.Both CD56 and CD34 were negative.