A 14-year-old boy presented with left preauricular painless swelling of 10 months' duration. Local examination revealed a 3 × 2-cm, firm, nodular, nonmobile mass in the left preauricular area, just in front of tragus. Fine needle aspiration yielded paucicellular smears comprising singly scattered histiocyte/myofibroblast-like spindle cells and occasional giant cells. It was reported as benign mesenchymal lesion on cytology. Left superficial parotidectomy was performed. Histopathological and immunohistochemical analysis confirmed the diagnosis of nodular fasciitis (NF). It was an ill-circumscribed cellular neoplasm, abutting and focally infiltrating into otherwise normal parotid gland. The tumor comprised spindle cells arranged in short bundles and storiform pattern with interspersed osteoclast-like giant cells, foam cells, extravasated red blood cells (RBCs), and focal areas of keloidal collagenization. The cells were positive for smooth muscle actin and negative for CD34, beta-catenin, S100, and pan-cytokeratin. Final diagnosis of NF was rendered. NF can rarely involve the parotid gland or present as parotid enlargement and pose diagnostic challenge, especially on cytology. However, in appropriate clinical context, subtle cytomorphological clues such as presence of myofibroblasts and fibrocollagenous stromal fragments can help in ruling out the commonly occurring salivary gland neoplasms and offering a definitive cytodiagnosis of NF which will be helpful in deciding the further course of management.

Institution to which the work should be credited: Department of Pathology, Andaman & Nicobar Islands Institute of Medical Sciences, Port Blair.

S.P. contributed to the concept and study design, definition of intellectual content, literature search, grossing and analysis of the histopathological slides, retrieval of clinical details, manuscript preparation, and is the guarantor. C.B.G. contributed to the study design, definition of intellectual content, literature search, analysis of the histopathological slides, manuscript editing and review.

The case was presented as an e-poster at Virtual TAPCON (IAPM-Tamil Nadu and Pondicherry chapter) 2021 conference, held from June 4–6, 2021.

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

None.

Article published online:
20 July 2023

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