Nodular Fasciitis May Mimic Sarcoma - Summary - MDSpire

Nodular Fasciitis May Mimic Sarcoma

Molecular testing may help avoid overtreatment when benign soft-tissue tumors present with atypical clinical or histologic features.

  • By

  • Andrea Surnit

  • May 11, 2026

  • 4 min

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Objective:

To investigate the diagnostic challenges of nodular fasciitis, which can mimic sarcoma or other neoplasms, and to evaluate the utility of molecular testing, particularly in supporting diagnosis in challenging cases.

Key Findings:
  • Nineteen cases presented with nonspecific clinical or radiologic features raising diagnostic concerns, highlighting the need for careful evaluation.
  • Histopathologic findings were compatible with nodular fasciitis in all cases, but variability in cellularity and stromal features contributed to diagnostic uncertainty.
  • FISH for USP6 rearrangement was positive in 15 of 18 nonspecific cases, while NGS identified MYH9::USP6 fusions in four tumors, underscoring the importance of molecular testing.
Interpretation:

Negative or ambiguous FISH results should not exclude nodular fasciitis when histologic findings suggest it; NGS may aid in challenging diagnoses, providing additional diagnostic clarity.

Limitations:
  • Study was retrospective and single-center with a small number of rare-fusion cases, which may limit the applicability of the findings.
  • Results do not establish prognostic differences by fusion subtype or define recurrence risk, necessitating further research.
Conclusion:

Molecular testing, particularly NGS, may be beneficial in diagnosing nodular fasciitis, especially in atypical cases, potentially reducing misdiagnosis and unnecessary treatments.

Original Source(s)

Nodular Fasciitis May Mimic Sarcoma

  • by Andrea Surnit

  • May 11, 2026

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