Soft tissue
Fibroblastic / myofibroblastic
Ischemic fasciitis


Topic Completed: 1 June 2013

Minor changes: 29 September 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Ischemic fasciitis


Jerad M. Gardner, M.D.
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Cite this page: Chaudhri, A. Ischemic fasciitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/softtissueischemicfasciitis.html. Accessed November 26th, 2020.
Definition / general
  • Painless pseudosarcomatous fibroblastic proliferation in soft tissue overlying bony prominences subject to intermittent pressure-induced ischemia
  • Also spelled "ischaemic"
  • First described in 1992 as "atypical decubital fibroplasia" (Am J Surg Pathol 1992;16:708)
Epidemiology
Sites
  • Shoulder, chest wall, sacrococcygeal region, greater trochanter
Etiology
  • Similar to decubitus ulcers; pressure-induced ischemia causes mass-producing reactive process, but is insufficient to cause skin ulceration
Case reports
Treatment
  • Local excision is curative, although may recur due to continuation of underlying ischemia and injury
Clinical images

Contributed by Mark R. Wick, M.D.

Decubital

Gross description
  • Usually 1 - 8 cm, poorly circumscribed, often myxoid
  • Usually involves deep subcutis, may involve adjacent skeletal muscle and fascia
  • Ulceration is uncommon (i.e. overlying skin is intact)
Microscopic (histologic) description
  • Zonal pattern of central fibrinoid necrosis with uneven borders staining deep red / violet and prominent myxoid areas surrounded by ectatic, thin walled vessels and proliferating fibroblasts
  • Endothelial cells may be atypical
  • Fibroblasts have degenerative features with abundant, eosinophilic to amphophilic cytoplasm, enlarged nuclei with smudged chromatin and prominent nucleoli (resembling ganglion-like cells in proliferative fasciitis)
  • Variable mitotic activity, but no atypical mitotic figures
  • Fibrin thrombi are common within peripheral vessels, which may show fibrinoid necrosis and recanalization but no true vasculitis
  • May have multivacuolated macrophages in myxoid zones mimicking lipoblasts
Microscopic (histologic) images

AFIP images

Cellular, fibrin rich proliferation centered on subcutaneous fibrous septum and extending into adjacent fat

Hyalinized focus with large ganglion-like cells, suggestive of proliferative fasciitis

Fibrin is adjacent to foci of ganglion-like cells in collagenous stroma



Contributed by Mark R. Wick, M.D.

Decubital



Case #64

Hip mass in 55 year old bedridden man



Images hosted on other servers:

Fibrinoid necrosis with few viable cells

Large nuclei with prominent nucleoli

Various images

Cytology description
Positive stains
Negative stains
Differential diagnosis
  • Epithelioid sarcoma: young adults on distal extremities, more cellular with central tumor cell necrosis, cells have eosinophilic cytoplasm, atypical mitotic figures, keratin+
  • Myxofibrosarcoma: marked atypia, but no smudgy chromatin or fibrin thrombi; lacks zonation and degenerative features
  • Myxoid liposarcoma: prominent plexiform vasculature and lipoblasts, small monotonous cells rather than larger myofibroblasts
  • Proliferative fasciitis: younger patients, lesions not associated with pressure; zonation, myofibroblasts and fibroblasts with tissue culture type growth, also large ganglion cells
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