Nodular and Intravascular Fasciitis of the Lip
Wael Al Daraji, Esther LB Childers, Julie C Fanburg-Smith. Armed Forces Institute of Pathology, Washington, DC; Howard University, Washington, DC; Sibley Memorial Hospital of Johns Hopkins Medicine, Washington, DC
Background: Nodular or intravascular fasciitis of the lip are exceedingly rare, with few singly reported cases.
Design: All oral nodular fasciitis were culled. The patient slides, anatomic locations, and histories were reviewed.
Results: There were 7 cases in the lip, 2 nodular and 5 intravascular fasciitis, 3 of the upper and 4 lower lip, including 6 females and one male. Patient ages ranged from 43-72 years, median 8 years. All patients were smokers and 5 habitually bit their lips. The lesions, 1-2.1.0 cm (median 1.1 cm) arose rapidly over 3 weeks to 3 months. These nodular masses were circumscribed (n=4) or poorly delineated, three involving lip skeletal muscle. The lesions were composed of loose storiform tissue culture like myofibroblasts with myxoid degeneration and extravasated red blood cells. The five intravascular fasciitis additionally had focal myoid/myopericytic features, associated with vessel wall/lumen. None had osteoclast type giant cells, myofibroma or angiomyoma features. All lesions were recurrent between 1 and 11 months (median 4 months) after original removal, but none had any other disease at 12-22 years (median 16 years) follow-up.
Conclusions: Intravascular fasciitis is a subset of nodular fasciitis with a proclivity for lip, in adult females who smoke and lip-bite. These differ from nodular or intravascular fasciitis in other soft tissue sites by their superficial skeletal muscle involvement and the focal myopericytic features associated with intravascular type. Lip intravascular fasciitis may be recurrent, possibly due to continued habitual lip biting and/or smoking, but is ultimately a benign reactive process, probably secondary to mechanical irritation of vessel wall in the lip.
Category: Head & Neck
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 171, Tuesday Afternoon