Back issues No.1 - 2013 / Correspondence  

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Intravascular fasciitis of the scalp: A case report
Yi-Hsin Hsiao, Cheng-Sheng Chiu

Case report
A healthy 24-year-old woman presented with an asymptomatic and rapidly growing swelling on the scalp that had been present for 3 months. Clinical examination revealed a 3 cm × 2.5 cm, movable, firm, and deep-seated subcutaneous nodule on her occipital scalp (Figure 1). No irritation or erosion was noted. There was no history of previous trauma, insect bites, or nodule drainage. A schwannoma was suspected clinically and surgical excision performed.
Histopathological examination revealed a well-circumscribed, sausage-shaped, subcutaneous neoplasm that was entirely localized within the lumen of a segmental dilated vein (Figure 2A). The lesion was largely composed of interlacing fascicles of predominantly pleomorphic, plump spindle cells in a loose stroma (Figure 2B). Bland vesicular nuclei, extravasations of erythrocytes, and scattered lymphocyte infiltration were evident under high magnification (Figure 2C). Immunohistochemical staining results showed that most of the spindle cells were positive for smooth muscle actin and negative for CD 31, evidence of myofibroblastic differentiation (Figure 3). Immunohistochemical staining for CD31 demonstrated positively stained vascular endothelial cells outlining the intravascular lesion (Figure 3). A diagnosis of intravascular fasciitis was made based on the clinical and pathological findings. The patient was asymptomatic with no evidence of tumor recurrence after 6-months.

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