What are the other Names for this Condition? (Also known as/Synonyms)

• Mammary Nodular Fasciitis

What is Nodular Fasciitis of Breast? (Definition/Background Information)

• Nodular Fasciitis of Breast is a rare and rapidly growing benign mass involving the breast skin and breast tissues, presenting tenderness and pain (in some individuals). This well-defined tumor forms over several weeks and is then observed to shrink in size over many months. 
• Since the growth can be rapid, Nodular Fasciitis of Breast can be stressful for women as it may raise concerns of a malignant condition. A biopsy of the tissue mass can ensure a definitive diagnosis and help alleviate any such suspicion
• A complete surgical removal of Nodular Fasciitis of Breast results in a cure and is the treatment of choice. The prognosis of Nodular Fasciitis of Breast is typically excellent; spontaneous regressions have been noted in many cases. Tumor recurrences may be seen in some rare cases though

In general, nodular fasciitis is a benign and rapidly-growing mass that frequently affects the upper extremities (hands). The tumor reduces in size after a period of rapid growth, during which time it can cause severe stress and anxiety to both the affected individual and the healthcare provider.

Who gets Nodular Fasciitis of Breast? (Age and Sex Distribution)

• A wide age range of women are affected, but most of the cases are noted in the 20-40 years’ age group
• Men are very rarely known to be affected
• Nodular Fasciitis of Breast may occur in individuals of all races and ethnic groups

What are the Risk Factors for Nodular Fasciitis of Breast? (Predisposing Factors)

• Presently, no risk factors for Nodular Fasciitis of Breast have been identified

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Nodular Fasciitis of Breast? (Etiology)

Nodular fasciitis is a benign tumor. It was considered to be a reactive process. However, some researchers believe that the tumor may actually be a neoplastic process.

• The exact cause of development of Nodular Fasciitis of Breast is unknown; a proliferation of fibroblastic/myofibroblastic cells is noted in the tumor
• In over 85% of the cases, translocation involving chromosomes 17 and 22 is noted (designated as t(17;22)(p13;q13))
• Some studies have shown USP6 gene rearrangements that can help confirm the condition
• Fusion of MYH9 promoter and USP6 genes causing overexpression of the USP6 gene is also reported

Since, the tumor occurs as a rapidly-proliferating mass, it can be extremely worrisome and mistaken for a cancerous growth.

What are the Signs and Symptoms of Nodular Fasciitis of Breast?

The signs and symptoms of Nodular Fasciitis of Breast include:

• Presence of a rapidly-growing mass within the breast
• The mass is usually well-defined
• Pain in the affected region; in some cases, the tumor mass causes no pain
• Feeling of tenderness
• It can cause distortion of the nipple and areola
• Retraction of breast skin may be noted
• The tumor is usually less than 5cm in size; the size varies from 6 mm to 6 cm

How is Nodular Fasciitis of Breast Diagnosed?

A diagnosis of Nodular Fasciitis of Breast may involve:

• Complete physical examination with comprehensive medical and family history evaluation
• Breast exam to check for any lumps or unusual signs in the breasts
• Mammogram: A mammogram uses X-rays to provide images of the breast
• Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
• Molecular genetic studies: A presence of USP6 gene rearrangement may help confirm the tumor type
• Breast biopsy:
  • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

• Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue
• Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
• Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

It is informed that a FNA and core biopsy may help the healthcare provider to suspect Nodular Fasciitis of Breast. However, an excisional biopsy is used for a definitive diagnosis of the tumor.

The differential diagnosis to exclude conditions with similar presentations include:

• Fibromatosis of breast
• Metaplastic carcinoma of breast
• Myofibroblastic tumors
• Myxoid sarcoma of breast
• Phyllodes tumor (stromal component)
• Pseudoangiomatous stromal hyperplasia (PASH) of breast
• Reactive post-biopsy spindle cell nodule
• Spindle cell carcinoma of breast

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Nodular Fasciitis of Breast?

The possible complications from Nodular Fasciitis of Breast include:

• Concerns of a malignancy leading to severe emotional stress
• Rarely, the tumor can recur on surgical removal

How is Nodular Fasciitis of Breast Treated?

In many cases of Nodular Fasciitis of Breast, a spontaneous regression is noted.

• However, the treatment of choice for nodular fasciitis is a complete surgical excision, which results in a cure
• Occasionally, recurrences have been observed on removal of the tumor

How can Nodular Fasciitis of Breast be Prevented?

Presently, it is not possible to prevent Nodular Fasciitis of Breast, as the cause of the condition is not well understood.

What is the Prognosis of Nodular Fasciitis of Breast? (Outcomes/Resolutions)

• Nodular Fasciitis of Breast is a transient condition, and the tumor mass almost always regresses in size
• A complete excision of the tumor is curative (normally undertaken due to rapid tumor growth)

Additional and Relevant Useful Information for Nodular Fasciitis of Breast:

The following DoveMed website links are useful resources for additional information:

https://www.dovemed.com/healthy-living/womens-health/

https://www.dovemed.com/diseases-conditions/cancer/