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The pathology of
extracranial scalp and skull masses in young children.
Clin Neuropathol. 2004 Jan-Feb;23(1):34-43.
OBJECTIVE:
Extracranial subcutaneous masses involving the scalp and/or skull in
young children are uncommon lesions that get excised by the
neurosurgeon. Although the most common reported lesion is the dermoid
cyst, our experience suggests that the spectrum of pathology in these
lesions can present diagnostic challenges to the pathologist.
MATERIAL: We reviewed 30 consecutive extracranial masses from 29
patients between July 1998 and June 2003. METHOD: Hematoxylin and
eosin-stained sections were reviewed in all cases, and
immunohistochemistry was performed in select cases. RESULTS:
Twenty-three were within the scalp, 5 involved the scalp and skull and
2 were within the limits of the inner and outer tables of the skull.
There were 8 dermoid cysts, 2 epidermoid cysts, 6 post-traumatic
lesions including 3 calcified cephalhematomas and 3 pseudocysts, 5
vascular lesions including 3 capillary hemangiomas, 1 venous angioma
and 1 lymphangioma, 2 cases of cranial fasciitis and 1 case each of
benign teratoma, deep granuloma annulare, benign fibrous histiocytoma,
congenital melanocytic nevus, hamartoma with ectopic meningothelial
elements, cutaneous hyalinised ectopic meningioma and a meningocele
with a fibrohistiocytic reaction. No lesions have recurred or
exhibited malignant features. CONCLUSIONS: Surgical pathologists and
neuropathologists should be aware that the differential diagnosis of
"lumps and bumps on babie's heads" is quite varied and can be
histologically challenging.
Nodular fasciitis of
the forehead in a pediatric patient. Dermatol
Surg.2003 Aug;29(8):867-8.
BACKGROUND:
Nodular fasciitis is a benign fibroblastic proliferation in soft
tissue that is frequently misdiagnosed as a sarcoma. Most patients are
middle aged, and the upper extremity is the most common localization.
Nodular fasciitis is rarely diagnosed in childhood but appears in the
head and neck region more commonly in children than in adults.
OBJECTIVE: To describe a rare case of nodular fasciitis of the
forehead in a pediatric patient. RESULTS: A 15-year-old female had
been aware of a subcutaneous nodule with subtle tenderness on the
forehead for 4 months. The patient had no history of trauma. The
nodule was totally excised with a narrow margin and was
histopathologically diagnosed as nodular fasciitis. No recurrence was
observed for 22 months. CONCLUSION: When we encounter subcutaneous
nodules of the face and neck region in children, it is important for
dermatologists to keep nodular fasciitis in mind for differential
diagnosis to avoid unnecessary wide resection.
Cranial and extracranial fasciitis of childhood: a
clinicopathologic and immunohistochemical study. Hum
Pathol.1999 Jan;30(1):87-92
Fasciitis of various types constitutes a
distinctive category of soft tissue lesions whose microscopic features
are known for their potential to evoke a pathological diagnosis of one
or another type of sarcoma. Nodular fasciitis is the archetype of this
group of "fibrous tumors." Cranial fasciitis is considered a
nonneoplastic lesion similar to nodular fasciitis, which is seen
almost exclusively in infants and children and has unique
clinicopathologic features. The current study documents our experience
with fibrous-myofibroblastic proliferations in extracranial sites,
mainly in the head and neck region of young children, whose
histological features resemble those of cranial fasciitis. These
lesions were composed of loosely arranged spindle to stellate cells in
a myxoid background. One patient in the study had both cranial and
extracranial involvement. Some histological overlap between nodular
fasciitis and cranial-extracranial fasciitis was noted, but the latter
lesion tended to be more uniform in appearance than nodular fasciitis
with its fascicular, spindle cell features and variability in
histological patterns within the same lesion, unlike the more
consistently uniform myxoid appearance of the cranial and extracranial
lesions. Immunohistochemically, the spindle cells of the extracranial
lesions and the one case of cranial fasciitis co-expressed vimentin
and smooth muscle actin. The extracranial lesions had a predilection
for children in the first year of life with all cases occurring at or
before 2 years of age, unlike nodular fasciitis, which is rarely seen
in the first 4 to 5 years of life. The cranial and extracranial
fasciitides should be differentiated from the fibromatoses that tend
to locally recur, unlike the nonrecurring behavior of these lesions in
common with the other types of fasciitis.
Transcranial eosinophilic granuloma manifested by a
subcutaneous scalp mass. Differential diagnosis in children.J
Dermatol Surg Oncol. 1993 Jul;19(7):631-4.
BACKGROUND. The
differential diagnosis of nodular scalp lesions in a child is
surprisingly extensive. OBJECTIVE. To present a case of eosinophilic
granuloma that was manifested by a scalp mass in a pediatric patient.
METHODS. The case is presented and the relevant literature is
reviewed. CONCLUSIONS. The seriousness of some of these lesions
requires a thorough evaluation, including noninvasive imaging, and
carefully planned surgical intervention so that effective diagnosis
and treatment are ensured. Surgical exposure of unsuspected central
nervous system connections may lead to infection, hemorrhage,
seizures, or other significant morbidity and mortality.
Cranial fasciitis.
Arch Dermatol.1989 May;125(5):674-8.
We present the
clinical, roentgenographic, light-microscopic, immunohistochemical,
and ultrastructural findings in two children with cranial fasciitis. A
7-year-old boy and a 3-year-old girl presented with rapidly expanding
masses on the scalp. Roentgenographic studies showed erosion of the
underlying cranium in one case. Both lesions showed proliferations of
elongated spindle cells in a focally myxoid matrix, together with
areas of hemorrhage, vascular proliferation, and chronic inflammation.
Occasional cells with atypical nuclei were observed, but mitotic
figures were uncommon. Immunoperoxidase studies showed negative or
equivocal staining for desmin, factor VIII-associated antigen, S100
protein, and macrophage antigen. In one lesion there was focal
positivity for alpha 1-antichymotrypsin, and in another lesion, some
cells stained positively for smooth-muscle actin. Electron microscopy
showed cells with dilated endoplasmic reticulum, bundles of
microfilaments, pinocytotic vesicles, and focal external membrane
material, features of myofibroblasts. Both lesions were excised and
there has been no recurrence in 7 years in one case and 1 year in the
other case. Cranial fasciitis is closely related to nodular fasciitis,
but it has a predilection for the scalp of children. Despite its rapid
growth, it has a benign clinical course and is cured by excision with
or without curettage of the underlying bone. Our immunohistochemical
and ultrastructural observations indicate that, like nodular fasciitis,
cranial fasciitis represents a proliferation of fibroblasts and
myofibroblasts.
Scalp and calvarial masses of infants and children.Neurosurgery.
1988 Jun;22(6 Pt 1):1037-42.
Review of 70
children presenting with a solitary nontraumatic lump on the head
revealed that 61% of the lesions were dermoid tumor, 9% were
cephalhematoma deformans, 7% were eosinophilic granuloma, and 4% were
occult meningoceles and encephaloceles. Most of the dermoid cysts
occurred along sutural lines, but some did not. One of the
eosinophilic granulomas was located over the sagittal suture.
Seventeen per cent of the "lumps" had significant intracranial
extension. An additional 20% of the lumps extended intracranially, but
only to the dura mater. Work-up of these lesions should include
initial plain skull roentgenograms to assess multiplicity and
appropriate computed tomographic scans to assess possible intracranial
extension.
Cranial fasciitis of
childhood.Cancer.1980 Jan 15;45(2):401-6.
Nine cases of
fibroblastic lesions occurring in the cranium of young children were
reviewed. The age of the patients at the time of initial treatment
ranged from three weeks to six years (median 18 months), with the
lesions being congenital in two cases. There was 2:1 male
predominance. The size of the lesions averaged 2.5 cm in greatest
dimension with the largest being 9.0 cm. All cases presented as
rapidly growing masses with a preoperative duration of only two
months. The lesions presented as soft-tissue masses deep in the scalp
with involvement of the underlying cranium in all eight of the cases
in which roentgenograms or operative reports were available for
review. Characteristically, there was erosion of only the outer table
of the skull, although in three cases the lesion extended through the
inner table to attach to the underlying dura mater. It was not
possible to detect the exact site or origin, although origin from one
of the deep fascial layers of the scalp or the underlying periosteum
seems most likely. Microscopically, the lesion appeared to be a
proliferation of loosely arranged fibroblasts which most closely
resembled nodular fasciitis. Mitotic figures as well as foci of
osseous metaplasia were present. Treatment consisted of excision of
the mass with local resection or curettage of the affected underlying
bone in some cases. Followup revealed a benign clinical course with no
recurrent or aggressive behavior.
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