DISCUSSION AND CONCLUSIONS
Nodular fasciitis is a rare growing self-limiting benign condition more frequent in the young adults rapidly proliferating and spreading to adjacent tissues thus mimicking a malignancy. It is most commonly misdiagnosed as spindle cell sarcoma, owing to its rapid growth, high cellularity, cellular as well as nuclear polymorphism and mitotic activity. A recent study (8) reported that 18% of cases were misdiagnosed as sarcoma. Moreover, Plaza et al. reported that two-third of their cases had been misdiagnosed as sarcoma which is more frequent in late adult life such as our patient (9).
In this case, the lesion was easily affordable and the patient had a poor compliance due to her age and not fair general condition.
That is why decided to make directly local surgery instead of performing FNAC as it would have been led to either diagnostic delay or misdiagnosis with consequent overtreatment.
In conclusion, although rare, nodular fasciitis has to be considered as an option in the presence of a solitary, rapidly growing mass even in elderly adults. In our case, clinical history would have suggested a malignancy, but resulted as a benign lesion.
To the purpose, we believe that, when feasible, direct surgery should be preferred to FNAC, particularly in the late adult patients thus avoiding misdiagnosis, delays and overtreatment.