Nodular Fasciitis of the Periorbital Region: A Pediatric Case Report

Abstract

Introduction: Nodular fasciitis (NF) is a benign, rapidly growing proliferation of fibroblasts and myofibroblasts that can mimic malignant soft-tissue tumors both clinically and histologically. Although commonly found in adults, NF is rare in the pediatric population, especially in the periorbital region. Prompt diagnosis is essential to guide appropriate management. Case Report: We report the case of a 10-month-old infant presenting with a painless, firm, and mobile mass at the medial canthus of the right eye, progressively enlarging over two months. Orbito-ocular computed tomography revealed a well-defined, ovoid soft-tissue lesion with peripheral contrast enhancement. Excisional biopsy showed a spindle-cell proliferation arranged in a storiform pattern, with cells positive for smooth muscle actin and negative for desmin and S100. The Ki-67 proliferation index was 3%, confirming the diagnosis of nodular fasciitis. Postoperative recovery was uneventful, and no recurrence was observed over one-year follow-up. Discussion: Periorbital NF is rare in children and may clinically mimic aggressive malignancies such as rhabdomyosarcoma. Imaging modalities such as CT and MRI help define the lesion, but definitive diagnosis relies on histopathology and immunohistochemistry. Surgical excision is the treatment of choice, with recurrence being uncommon. Rapid excision is particularly important in pediatric patients to prevent functional complications such as amblyopia, strabismus, or mechanical ptosis. Conclusion: This case highlights the diagnostic and therapeutic challenges of periorbital nodular fasciitis in infants. Awareness of this rare entity is essential to differentiate it from malignant tumors and to guide timely and appropriate surgical management, ensuring favorable outcomes.