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Case Reports

Abstract

Ischemic fasciitis is a rare reactive, pseudosarcomatous entity that usually presents in elderly, often in disabled, patients. When encountered in young, healthy patients, it can cause significant diagnostic difficulty. A 28-year-old female presents with a painless mass on her left elbow. She works for a home respiratory service company. Her medical history included a prior excision from the opposite but was otherwise healthy. Histological examination of the excised left elbow mass revealed a vaguely nodular proliferation within the deep dermis and subcutis, characterized by large zones of mixed degenerative and fibrinoid necrosis. Surrounding the necrotic areas was a proliferation of myofibroblasts, some of which had large nucleoli, and a reactive vascular proliferation. Based on the histologic features, a diagnosis of ischemic fasciitis was rendered. Ischemic fasciitis is a subcutaneous pseudo-sarcomatous proliferation characterized by a central zone of fibrinoid necrosis, surrounded by granulation tissue-like vessels, and reactive fibroblasts/myofibroblasts. Myofibroblasts may have a ganglion-cell like appearance. Typically, lesions manifest on bony prominences in elderly patients, often due to immobility or local trauma. Anatomically, the upper extremity and back are more prone. In young healthy patients, lesions appear most commonly on the forearm and elbow. The precise etiology in this patient group is uncertain, but it may be associated with local ischemia from occupations involving long hours of computer/desk work. Dermatopathologists should be aware that this condition can occur in atypical locations, and that involvement of the upper extremity is more frequent in a younger patient subset.