Soft tissue

Fibroblastic / myofibroblastic

Ischemic fasciitis



Last author update: 1 June 2013
Last staff update: 26 July 2023

Copyright: 2002-2024, PathologyOutlines.com, Inc.

PubMed Search: Ischemic fasciitis


Jerad M. Gardner, M.D.
Page views in 2023: 3,253
Page views in 2024 to date: 477
Cite this page: Chaudhri, A. Ischemic fasciitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/softtissueischemicfasciitis.html. Accessed February 23rd, 2024.
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

Contributed by Mark R. Wick, M.D., AFIP and Ronald Angeles, M.D. (Case #64)

Cellular, fibrin rich proliferation

Hyalinized focus

Foci of ganglion-like cells

Decubital


Hip mass in 55 year old bedridden man

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
Back to top
Image 01 Image 02