Discussion
Nodular fasciitis is known to be a
rear tumor of the vulva. There is only one published case of a
recurrence of vulvar nodular fasciitis [8]. This case illustrates
the importance of making the distinction between nodular fasciitis and
malignant soft tissue tumors, as their differing risks must be matched
with appropriate clinical intervention, adjuvant treatment, and
follow-up regimen to avoid undertreatment or overtreatment. The
pathologist must recognize the possibility of nodular fasciitis even in
unusual sites and avoid misdiagnosis of malignancy. This case highlights
that recurrence does not always indicate malignancy and can result due
to the incomplete initial surgery. The importance of
immunohistochemistry is also
demonstrated in this case, as histology alone does not exclude other
neoplasms in the differential diagnosis (Table 1).
The pathogenesis of nodular fasciitis is unclear, though some suggest
antecedent trauma may occur. While the precise incidence in the general
population is unknown, it has been described mainly in young and
middle-aged adults in the 4th and 5th decades. Clinically, as in our
patient, it is characterized by rapid growth, pain, and size
<3 cm [3,9].
An important component to optimal health care delivery is the ability to
consult experts in related subspecialties or on rare tumors in real
time. The monthly international tumor board videoconference facilitated
by one gynaecologic oncology professional society, the International
Gynaecologic Cancer Society, allows collaboration and accurate diagnosis
among gynaecologic oncologists, pathologists, and others. This is a
model that may be emulated across the world in various regions and
disciplines to improve diagnosis and patient care.
While more common diseases of the vulva include angiomyofibroblastoma,
cellular angiofibroma, aggressive angiomyxoma, superficial angiomyxoma,
lipoma, and smooth muscle neoplasms (i.e., leiomyoma or leiomyosarcoma)
[10], the clinician should recognize that nodular fasciitis may
occur in the vulva, and the incidence may be more frequent than
previously recognized [8].
Acknowledgements:We would like to acknowledge the
International Gynecologic Cancer Society and its ECHO project, in
collaboration with the MD Anderson Cancer Center; Anna Plotkin MD
(Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, CA); Jubilee Brown MD (Division of Gynecologic
Oncology, Levine Cancer Institute at Atrium Health, Charlotte, NC, USA
Conflict of Interest: The authors report no conflict of
interests to declare.
Ethical approval: We have reported this case in compliance with
the Declaration of Helsinki. Written informed consent was obtained from
the patient.
Data availability statement: The data that support the findings
of this study are available from the corresponding author upon
reasonable request.