Breast nodular fasciitis in a postmenopausal woman: A case report and review of recent literature

Abstract

Nodular fasciitis (NF) is a benign soft tissue lesion that can occur anywhere in the body. Its occurrence in the breast is a rare phenomenon, but is clinically important to distinguish from a malignant tumor as they both present as lesions of the breast. In this report, we discuss a case of NF of the breast in an postmenopausal woman who presented with an asymmetry of the breast on an annual screening mammogram followed by diagnostic imaging and a core biopsy. Ultimately, excision of the lesion (1.2 cm) was the definitive treatment for this patient and histological evaluation confirmed the diagnosis of NF. Additionally, we review the most recent literature on this topic discussing the significance to better understand the characteristics and best treatment course for breast NF. Results from a review of 11 breast NF cases demonstrated that the average age at diagnosis is 49, the mean diameter of lesions was 1.33 cm, and lesions were more frequently identified in the right upper breast. The clinical features of breast NF may present similarly to that of a malignant tumor. Accurate diagnosis with immunohistochemistry staining or USP6 FISH analysis is critical to prevent misdiagnosis and overtreatment. Clinician awareness, surgical treatment, and patient education are important for best management of breast NF.

Keywords: Benign breast lesion; Nodular fasciitis; Spindle-cell lesion; Subcutaneous pseudosarcomatous fasciitis.

Fig. 1

Mammogram imaging of upper right breast. (A) Mammogram screening shows a focal asymmetry best seen on MLO view. (B) Diagnostic mammogram imaging with spot compression confirms screening with persisting asymmetry within the superior right breast.

Fig 2

Ultrasonography imaging of the upper right breast. (A) Ultrasound findings show a complex cyst (left) at 12:00/8 cm measuring 0.3 × 0.8 × 0.2 cm. Radial view of complex cyst. (B) Antiradial view of complex cyst.

Fig. 3

Histology images of core biopsy tissue. (A) Low power view showing the fascicular arrangement of the bland spindle cells within the fibroadipose tissue with extravasated red blood cells. (B) High power view showing bland spindle cells within a background of myxoid stroma, extravasated red blood cells and rare lymphocytes.