Nodular Fasciitis: An Uncommon Pediatric Parotid Region Mass

Aim: To describe a pediatric patient with an uncommon parotid region mass that was felt on ultrasound and clinical examination to be intraparotid.
Case Presentation: A16-year-old female presented with a viral illness and tender left infra-auricular mass, thought to be a reactive lymph node. There was no history of trauma. The mass gradually increased in size. Physical examination revealed a 2 cm mass thought to be arising from the parotid gland. Ultrasound described a mass suspicious for an intraparotid malignancy with biopsy recommended. MRI revealed the mass to be superficial to the left parotid gland. FNA was not performed prior to surgery. Superficial parotidectomy was performed revealing a benign spindle cell tumor. Immunoperoxidase studies were performed on the specimen. The immunophenotype supports the final diagnosis of nodular fasciitis.
Discussion and Conclusion: The differential diagnosis for pediatric parotid region masses is broad and includes both benign and malignant etiologies, many of which have nonspecific imaging findings. These may include schwannoma, reactive lymph node, lymphoma, pleomorphic adenoma, adenoid cystic, acinic cell and adenocarcinoma and sarcoma. Among benign masses to be considered, nodular fasciitis should be included in the differential diagnosis, especially in the context of a new rapidly growing mass and history of recent trauma. In these particular circumstances, FNA can be considered prior to biopsy or excision, sparing the potential morbidity that may be associated with invasive procedures. If FNA yields a definitive diagnosis, nodular fasciitis typically has a benign self-limited course and may completely resolve over time obviating the need for major intervention.