Ischemic fasciitis

BACKGROUND: Ischemic fasciitis, also called atypical decubital fibroplasia, was recently described as a distinctive fibroblastic proliferation occurring predominantly in elderly, bed-ridden individuals. This entity can easily be misdiagnosed as a malignant process. CASE: A 70-year-old, white male presented with an enlarging right hip mass. Fine needle aspiration yielded spindled and ovoid cells with ample cytoplasm and occasional nuclear atypia. The histologic features of a subsequent biopsy and resection specimen included a zonal pattern of fibrinoid necrosis with surrounding reactive fibroblasts, histiocytes and vascular proliferation, which are characteristic of ischemic fasciitis. CONCLUSION: Ischemic fasciitis can be mistaken clinically, cytologically and histologically for sarcoma. The cytologic findings seen in this case, when combined with the clinical history, were sufficient to avoid misdiagnosis of malignancy in a benign, proliferative lesion.