81 | archiv euromedica | 2022 | vol. 12 | num. 2 | A UNIQUE CASE OF NODULAR FASCIITIS IN THE SUBMANDIBULAR GLAND MIMICKING PLEOMORPHIC ADENOMA ABSTRACT — Aim: Nodular fasciitis (NF) is a rare entity responsible for 0.0025% of tumors in the head and neck, to our knowledge; there has been no report in the literature of NF infltrating the submandibular gland. Trough a case of a 29-year-old woman we will discuss the histology and imaging of NF in the submandibular gland and its resemblance to pleomorphic adenoma (PA). Case description: Our patient presented with rapid growth of the right submandibular gland over a 6-month period. Fine Needle Aspiration Cytology suggested PA, nonetheless, mesenchymal origin could not be excluded. MRI strengthened the diagnosis of PA wherein the lesion appeared hyper-intense on T2, hypo-intense on T1 and enhanced with gadolinium. Right submandibulectomy was performed and the histopathological report compatible with NF Conclusion: NF is a self-limited benign process that does not always require surgical removal while PA is a benign tumor treated with surgical resection. Diferentiating between these two pathologies is important since surgery can be avoided with a diagnosis of NF. Currently, there is no non-invasive modality that can provide a defnite diagnosis of NF in salivary glands. It is important to exhaust our diagnostic possibilities and regard scarcer etiologies in order to achieve the most favorable outcome for the patients. KEYWORDS — Nodular Fasciitis, Submandibular gland, Pleomorphic adenoma, Salivary gland. Itay Chen 1 , Attal Pierr 1 , Daria Kozlova 2 , Jean-Yves Sichel 1 1 Department of Otolaryngology, Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, Israel 2 Pathology Institute, Shaare Zedek Medical Center, Jerusalem, Israel chenitay2@gmail.com Acknowledgments Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel ** All authors have no fnancial interests or relationships to disclose ** The authors declare that there is no confict of interest Received 15 January 2022; Received in revised form 25 January 2022; Accepted 27 January 2022 head and neck region with an incidence of 20% (1). Trauma or infection is thought to be the trigger of the fbroblast proliferation although the exact pathogen- esis is still unknown. It Usually presents as a painless rapidly growing mass that spreads along the muscular fascia into the subcutaneous tissue and sometimes into the underlying muscle. Due to its rapid growth, its high mitotic activity and pleomorphic picture NF can be easily mistaken for a malignant tumor. Perioperative fne needle aspiration cytology (FNAC) and imaging such as CT and especially MRI can help in making a presumptive diagnosis (2, 3). CASE REPORT A 29 year-old generally healthy women was admitted to our department with a 6-month history of a rapidly growing mass in the right submandibular area. Te mass was not painful, there was no history of trauma or infection and no history of smoking or alcohol use. Te patient did not report fever, weight loss or pain with swallowing. On physical examination a 2 cm, smooth, frm, non-tender mass was palpated at the posterior aspect of the right submandibular trian- gle with no palpable lymph nodes. Laboratory studies were normal. Neck ultrasonography revealed a 13X20X23 mm solid tumor within the right submandibular gland as well as benign appearing cervical lymph nodes. FNAC was then performed. Te frst attempt was non diagnostic. In the second FNAC specimen (alcohol fxation) blood and small amount of hyalinic mate- rial with a few spindle cells were seen. Tis was read by the cytopathologist as suspicious for pleomorphic adenoma, although a mesenchymal origin could not be ruled out. Prior to surgery an MRI of the neck with contrast was obtained. Tis showed a well- demarcated mass measuring 2.4X2.0X1.1 cm in the right submandibular gland, accompanied by mild enlargement of the gland. Te mass was hyper-intense in T2 weighted image, rela- tive to skeletal muscle (Fig 1A) and was hypo-intense on T1 weighted image (Fig 1B). It showed homogeneous enhancement following gadolinium injection (Fig 1C) and hyper-intensity in apparent difusion coefcient (ADC) map relative to the normal gland. Tis MRI pat- tern was consistent with pleomorphic adenoma. INTRODUCTION Nodular fasciitis (NF) is a rare, self-limiting benign tumor consisting of fbroblasts and myof- broblasts. It can occur anywhere in the body with the highest incidence in the extremities followed by the http://dx.doi.org/10.35630/2199-885X/2022/12/2.20 SURGERY: EXPERIMENTAL RESEARCH