A Rare Case of Nodular Fasciitis of the Hard Palate with Complete Clinical Resolution.

Abstract

Nodular fasciitis is a rare, benign, and self-limiting proliferation of fibroblasts and myofibroblasts. It is occasionally encountered in the head and neck region, but only a few cases were reported in the palate (1-3). Case: We report the case of a 24-year-old female patient presenting with an exophytically growing, pedunculated palatal mass. According to the patient, the lesion had developed overnight and measured 12 mm in diameter at clinical presentation two weeks later. An initial incisional biopsy was interpreted as a pyogenic granuloma. The lesion then enlarged to 30 × 20 mm within three weeks after initial consultation, accompanied by progressive percussion tenderness and grade II tooth mobility. Laser assisted resection of the mass was therefore performed under the working diagnosis of a recurrent pyogenic granuloma. Histological workup of the excision specimen revealed a bland spindle cell proliferation in a myxoid stroma with a tissue culture-like growth pattern. Molecular analysis confirmed a MYH9::USP6 fusion gene, establishing the diagnosis of nodular fasciitis. After discussion between the treating surgeon and the patient, a watchful-waiting approach was adopted. Eighteen months postoperatively, the patient remained entirely asymptomatic with normalized tooth mobility, and no macroscopic evidence of recurrence. Discussion: The excision was undertaken for progressive local symptoms under the working diagnosis of a pyogenic granuloma, and nodular fasciitis was recognized only on the second specimen. This case nevertheless demonstrates that accurate diagnosis is essential for guiding treatment, particularly in functionally sensitive anatomical regions.