A case report of nodular fasciitis of the parotid gland: An entity of concern

Abstract

Nodular fasciitis (NF) is a benign, self-limiting, proliferative myofibroblastic lesion typically seen in subcutaneous tissues, muscles, and fascia. NF of the parotid gland is rare, frequently misdiagnosed as a malignant tumour, with the misdiagnosis resulting in inappropriate treatment such as wide surgical resection, radiation therapy, or chemotherapy with sometimes poor aesthetic outcomes.

We present the case of a 44-year-old woman with a 2-cm-diameter, solid, mobile nodular swelling with well-defined edges over the superior margin of the right parotid gland. She has no facial nerve palsy, and the mass was not fixed to the overlying skin. Preoperative ultrasonography, magnetic resonance imaging (MRI), and fine needle aspiration cytology (FNAC) all suggested a pleomorphic adenoma. The postoperative histopathological findings revealed NF.

Cytological diagnosis is crucial for NF diagnosis and management. Preoperative FNAC should be accompanied by immunocytochemical evaluation; if analysis is inadequate and/or suspicious, it should be repeated in a high-volume centre with experience in salivary gland lesions. Comprehensive MRI including diffusion-weighted imaging and perfusion sequences aid differential diagnosis. As NFs are benign and self-limiting, accurate preoperative diagnosis is essential to avoid unnecessary extensive treatment.