Nodular Fasciitis of the Carpus Mimicking Metastasis in a Multi-cancer Survivor

TL;DR

A rare case of wrist nodular fasciitis mimicking cancer recurrence in a cancer survivor is presented, showing successful treatment through surgery.

Contribution

Highlights a rare anatomical presentation of nodular fasciitis mimicking metastasis in a multi-cancer survivor.

Findings

Nodular fasciitis was diagnosed in a rare wrist location, initially suspected as metastasis.

Surgical excision without complex reconstruction led to excellent functional outcomes.

No recurrence was observed at one-year follow-up.

Abstract

Nodular fasciitis is a benign reactive fibroproliferative lesion that is exceedingly rare within the wrist and hand, particularly when involving bone. Its rapid growth and clinical presentation can often mimic sarcomas or metastatic disease, creating a significant diagnostic challenge. We report the case of a 59-year-old male patient with a history of multiple malignancies who presented with a rapidly enlarging dorsal wrist mass. Advanced imaging revealed a large lesion eroding the carpus, raising significant concern for metastasis. However, histopathologic evaluation confirmed nodular fasciitis. The mass was excised en bloc without complex reconstruction. At the one-year follow-up, the patient remained asymptomatic with no clinical or radiographic evidence of recurrence and maintained excellent wrist function. This case highlights a rare anatomic location of nodular fasciitis and illustrates that it can mimic aggressive malignancy, particularly in cancer survivors. It further demonstrates that even with significant bony erosion, surgical excision without complex reconstruction can yield excellent functional outcomes.

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