NODULAR FASCIITIS OF THE UPPER LIP MIMICKING A SARCOMA

A 39‐year‐old white man in good health noticed a rapidly progressive swelling of his upper lip for which he consulted an otorhinolaryngologist. No pain or other symptoms were mentioned. Physical examination revealed an ill‐defined swelling of the upper lip extending in the region under the nose. This mass was hard and fixed to the underlying tissues. There was no ulceration or discoloration of the overlying skin (Fig. 1). Complete blood count, liver enzymes, renal function, sinus and chest x‐rays were normal. The patient was sub‐mitted to an excisional biopsy of the tumor. Histopathologic evaluation revealed an unencapsulated cellular proliferation of spindle‐shape or stellate cells extending into the dermal, fat, and muscular layers. The cells were pleomorphic without atypia, growing haphazardly or in a storiform pattern. There were very few mitotic figures and no abnormal forms, A few multinucleated cells were also present. The stroma appeared edematous or myxoid in the dermis but more densely collagenized In the hypodermis and muscular layer. The proliferation was accompanied by a well‐developed capillary network (Fig. 2). Clinically, the swelling of the superior lip persisted and another biopsy revealed the same histologic changes. Since the histopathology was oriented towards a benign condition and a complete excision would require extensive mutilating surgery, a wait‐and‐see policy was justified, A periodic follow‐up was arranged and a slowly progressive resolution of the swelling of the upper lip was noted. Six months after the second biopsy, there was only a discrete residual induration.