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Superficial Nodular Fasciitis With Atypical Presentations

Report of 3 Cases and Review of Recent Molecular Genetics

Maloney, Nolan MD*; LeBlanc, Robert E. MD*; Sriharan, Aravindhan MD*; Bridge, Julia A. MD†,‡; Linos, Konstantinos MD*

The American Journal of Dermatopathology: December 2019 - Volume 41 - Issue 12 - p 931–936
doi: 10.1097/DAD.0000000000001455
Extraordinary Case Report

Abstract: Nodular fasciitis is a benign proliferation of fibroblasts/myofibroblasts that can be mistaken for an aggressive neoplasm because of its spectrum of appearances and anatomical locations, rapid growth, infiltrative growth pattern, and high mitotic rate. The presence of fusions involving USP6 gene in most cases provides a useful tool for diagnostic confirmation. Nodular fasciitis is often deep, in association with fascia, but less commonly, it arises superficially and can be biopsied by dermatologists. We present herein 3 such cases with confirmed USP6 rearrangement by fluorescence in situ hybridization (FISH) in which the diagnosis of nodular fasciitis was not initially obvious because of atypical morphologic and clinical features. These cases illustrate that in cutaneous myofibroblastic proliferations, nodular fasciitis should be given consideration even when encountered in unusual locations.

*Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH;

Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE; and

Division of Molecular Pathology, Translational Genomics Research Institute (TGen), Phoenix, AZ.

Correspondence: Linos Konstantinos, MD, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 (e-mail:

The authors declare no conflicts of interest.

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