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Cranial Fasciitis

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Cranial fasciitis is a rapidly growing benign myofibroblastic proliferation involving soft tissues of the scalp and the underlying cranium. It is considered to be a rare variant of nodular fasciitis. It has been reported in all age groups but is seen most commonly in infants under 1 year of age. Some cases have history of birth trauma caused by forceps delivery or prior craniotomy.

Patients usually present with a 2 to 4-week history of a firm, painless, rapidly growing scalp lesion with a predilection for temporal and parietal regions. It may erode through the outer and inner tables of the cranium to involve the dura and even leptomeninges. In more aggressive cases, the plain radiographs show a lytic defect surrounded by sclerosis.

The histologic features resemble usual nodular fasciitis. There is proliferation of fibroblasts and myofibroblasts arranged in short, intersecting fascicles in a fibromyxoid stroma. The cells lack cytologic atypia and are often organized in a storiform or nodular pattern. Multinucleated giant cells, vascular channels, and a mixed inflammatory infiltrate are present. The image shows a intersecting bundles of fibroblastic cells in a collagenous stroma.

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