Unilateral carpal tunnel syndrome: an unusual presentation of nodular fasciitis

Abstract

Nodular fasciitis is a benign, self-limiting proliferative disorder of fibroblast of uncertain aetiology, occurs frequently in the forearm. Nodular fasciitis in hand inducing carpal tunnel syndrome is exceptional. There are four cases of non-intraneural nodular fasciitis causing peripheral neuropathy that has been reported previously. We present the case of a 38-year-old man with features of unilateral carpal tunnel syndrome. Decompression of the median nerve performed subsequently along with excision of the lesion in a piecemeal fashion. Histopathological and immunohistochemical findings were consistent with nodular fasciitis. There were complete resolution of symptoms and no sign of recurrence at the end of 1 year after surgery.

Keywords: connective tissue disease; orthopaedic and trauma surgery.

Figure 1

Preoperative magnetic resonance images. (A) T1-weighted coronal section shows an isointense lesion. (B) T2-weighted axial section (arrow). (C) T1-weighted axial section shows a space-occupying lesion (arrow) adjacent to the median nerve.

Figure 2

H&E stained sections show a spindle cell lesion with vague nodular and intersecting fascicular pattern (A, H&E ×100). The cells resemble myofibroblasts with vesicular to hyperchromatic nuclei, and eosinophilic cytoplasm. Mitotic figure is present (arrow). Extravasated RBCs and myxoid background are seen (B, H&E ×400). The cells are immunopositive for smooth muscle actin (C, ×200). MIB1 proliferation index is about 5% (D, ×400).