Objective:To summarize the clinical characteristics and management experience of complications in patients with cervical necrotizing fasciitis （CNF） with or without descending necrotizing mediastinitis （DNM）, in order to provide a basis for optimizing diagnosis and treatment strategies. Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with CNF and DNM at Shandong Provincial Hospital Affiliated to Shandong First Medical University between October 2019 and March 2024. A comprehensive evaluation was performed based on the patients' clinical characteristics, metagenomic next-generation sequencing （mNGS） pathogen detection results, imaging assessments, surgical interventions, management approaches for specific complications, and prognostic outcomes. Results:Among the 31 patients, 10 had severe diabetes mellitus. Etiological analysis was summarized as follows: 5 cases were odontogenic, 3 were of tonsillar origin, 3 were due to endogenous esophageal injury, 2 were due to exogenous cervical trauma, 2 originated from a congenital branchial cleft fistula, and 16 cases had an unknown etiology. Among them, 29 patients underwent surgery via an external cervical approach, 1 patient underwent surgery via an intraoral approach, and 1 patient received ultrasound-guided puncture and drainage therapy. Ultimately, 29 patients were cured and discharged （including 1 patient who experienced two instances of major neck vessel rupture and successfully underwent two interventional embolization procedures for hemostasis）; 2 patients died after failed rescue efforts due to concurrent sepsis and multiple organ dysfunction. The treatment success rate was 93%, and the mortality rate was 7%. In this cohort of CNF and DNM cases, only a minority had a clearly identified odontogenic cause; although the etiology was unknown in most cases, imaging consistently showed oropharyngeal lymph node necrosis, suggesting a possible pharyngeal origin of infection in adults. The mNGS pathogen profile was predominantly Gram-positive bacteria, accompanied by anaerobic bacilli and fungi. Conclusion:CNF and DNM are severe and rapidly progressive conditions that can lead to life-threatening complications within hours. Timely recognition can reduce unnecessary examinations and expedite treatment.
Humans ; Retrospective Studies ; Fasciitis, Necrotizing/therapy* ; Mediastinitis/complications* ; Neck/pathology* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Prognosis

Objective: To investigate the clinicopathological features, immunophenotypes and molecular genetics of fibroma of tendon sheath (FTS). Methods: One hundred and thirty-four cases of FTS or tenosynovial fibroma diagnosed in the Department of Pathology, West China Hospital, Sichuan University, Chengdu, China from January 2008 to April 2019 were selected. The clinical and histologic features of these cases were retrospectively reviewed. Immunohistochemistry, fluorescence in situ hybridization (FISH) and reverse transcription-polymerase chain reaction (RT-PCR) were performed on the above cases. Results: There were a total of 134 cases of FTS, including 67 males and 67 females. The patients' median age was 38 years (ranged from 2 to 85 years). The median tumor size was 1.8 cm (ranged from 0.1 to 6.8 cm). The most common site was the upper extremity (76/134, 57%). Follow-up data was available in 28 cases and there was no detectable recurrence. Classic FTS (114 cases) were well-defined and hypocellular. A few spindle-shaped fibroblasts were scattered in the dense collagenous sclerotic stroma. Characteristically elongated slit-like spaces or thin-walled vessels were observed. Most of cellular FTSs (20 cases) were well-defined and the area with increased cellularity of the spindle cells coexisted with classic FTS. There were occasional mitotic figures, but no atypical mitotic figures. Immunohistochemistry was performed in 8 cases of classic FTS and most cases were positive for SMA (5/8). Immunohistochemistry was also performed in 13 cases of cellular FTS and showed 100% positive rate for SMA. FISH was conducted on 20 cases of cellular FTS and 32 cases of classical FTS. USP6 gene rearrangement was found in 11/20 of cellular FTS. Among 12 cases of CFTS with nodular fasciitis (NF)-like morphological feature, 7 cases showed USP6 gene rearrangement. The rearrangement proportion of USP6 gene in cellular FTS without NF-like morphological features was 4/8. By contrast, 3% (1/32) of the classic FTS showed USP6 gene rearrangement. RT-PCR was performed in those cases with detected USP6 gene rearrangement and sufficient tissue samples for RT-PCR. The MYH9-USP6 fusion gene was detected in 1 case (1/8) of the cellular FTSs, while no target fusion partner was detected in the classic FTS. Conclusions: FTS is a relatively rare benign fibroblastic or myofibroblastic tumor. Our study and recent literature find that some of the classic FTS also show USP6 gene rearrangements, suggesting that classical FTS and cellular FTS are likely to be at different stages of the same disease (spectrum). FISH for USP6 gene rearrangement may be used as an important auxiliary diagnostic tool in distinguishing FTS from other tumors.
Male ; Female ; Humans ; Gene Rearrangement ; In Situ Hybridization, Fluorescence ; Retrospective Studies ; Fibroma/pathology* ; Fasciitis/genetics* ; Ubiquitin Thiolesterase ; Tendons/pathology*

Humans ; Fasciitis/pathology* ; Fibroma/pathology* ; Gene Rearrangement ; Proto-Oncogene Proteins/genetics* ; Ubiquitin Thiolesterase

Bone Cysts, Aneurysmal/pathology* ; Fasciitis/pathology* ; Gene Rearrangement ; Humans ; Ubiquitin Thiolesterase

This article analyzed the medical records of two patients with Vibrio vulnificus primary sepsis who were admitted to the First Affiliated Hospital of Naval Medical University and reviewed the latest literature. On November 6, 2019, a 54-year-old male patient was admitted to the hospital. The patient's lower limbs were red, swollen, and painful with ecchymosis and hemorrhagic bullae after he ate freshwater products. The emergency fasciotomy was performed 3 h after admission, and the multiple organ failure occurred after operation. The patient was given up treatment 24 h after admission. On August 12, 2020, a 73-year-old male patient was admitted to the hospital. He was in shock state on admission and had hemorrhagic bullae on his right lower limb after he ate seafood. At 3 h post admission, he underwent emergency surgical exploration and amputation of right thigh. Six days later, he received negative pressure wound treatment on the stump. On the 13^th day post admission, his families forgo the active treatment and he died 15 d after admission. The two cases were both failed to be diagnosed at the first time, and the disease progressed rapidly. Necrotizing fasciitis and multiple organ failure occurred. After the diagnosis was confirmed, timely fasciotomy and high amputation were performed respectively. The microbiological examinations both reported Vibrio vulnificus. Although the 2 cases were not cured successfully, the course of disease and some indexes of patient with early amputation were better than those of patients with fasciotomy. Vibrio vulnificus is widely distributed and frequently detected in fresh water products. The pathogenic pathway is fuzzy and complex, and it is easy to be misdiagnosed. It is necessary to establish the treatment process of Vibrio vulnificus sepsis. Early and aggressive surgical intervention should be carried out as soon as possible, fasciotomy and debridement should be thorough, and the patients with hemorrhagic bullae should be amputated early. Postoperative comprehensive measures are also important for improving the survival rate of patients.
Aged ; Fasciitis, Necrotizing/surgery* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis/diagnosis* ; Vibrio Infections/pathology* ; Vibrio vulnificus

Nodular fasciitis (NF) is a benign tumor-like fibroblastic proliferation, and there have only been few reports about NF involving the parotid gland. Here, we report our experience of three cases of NF in the parotid gland, as well as our evaluation of the diagnostic tools for NF in the parotid gland, such as fine-needle aspiration cytology (FNAC), CT, and clinicopathologic investigations. In the three cases observed, all had growing masses in the parotid gland, and the lesions showed heterogeneous or peripheral rim enhancement on the contrast-enhanced CT, which could have been misdiagnosed as parotid malignancy. On FNAC, the cells had an elongated spindle shape and contained variable amounts of stromal matrix, which could have caused misinterpreted as pleomorphic adenoma. We observed dense cellularity and varying amounts of collagenous stroma, and immunohistochemical staining revealed positive reactivity to CD10, CD34, and smooth muscle actin. NF should be considered in the differential diagnosis of benign and malignant parotid tumors.
Actins ; Adenoma, Pleomorphic ; Biopsy, Fine-Needle ; Collagen ; Diagnosis, Differential ; Fasciitis* ; Fibroblasts ; Muscle, Smooth ; Parotid Gland* ; Parotid Neoplasms ; Pathology ; Spiral Cone-Beam Computed Tomography ; Tomography, X-Ray Computed

OBJECTIVETo discuss the relative association of soft tissue tension and cervical physiological curvature chang in patients with scapula muscle fasciitis.

METHODSFrom February 2012 to December 2012,29 patients with scapula muscle fasciitis were investigated. There were 10 males and 19 females with an average age of 27.77 years old (ranged from 22 to 40 years old). Routine AP and lateral cervical X-rays were done in all patients. Cervical lordosis was measured according to Borden's method and the pain point tension was measured by soft tissue tension meter. Finally,perform statistic analysis to bove data.

RESULTSLateral X-rays showed 9 cases were normal cervical lordosis, 18 cases were cervical lordosis decreased, 2 cases were cervical lordosis increased. The regression equation of cerical lordosis changes D(Y) and soft tissue tension displacement D0.5 kg (X) was Y = -15.069 + 3.673X.

CONCLUSIONThere is linear relationship between soft tissue tension and cervical physiological curvature change. With the soft tissue tension increases, the cervical lordosis trend to decrease.

Adult ; Biomechanical Phenomena ; Cervical Vertebrae ; pathology ; physiopathology ; Fasciitis ; pathology ; physiopathology ; Female ; Humans ; Male ; Mechanical Phenomena ; Scapula ; pathology ; physiopathology ; Young Adult

Aged ; Fasciitis, Necrotizing ; complications ; Female ; Humans ; Mediastinitis ; complications ; Neck ; pathology

Actins ; metabolism ; Adult ; Breast Diseases ; metabolism ; pathology ; surgery ; Breast Neoplasms ; pathology ; Calcium-Binding Proteins ; metabolism ; Carcinoma ; pathology ; Diagnosis, Differential ; Fasciitis ; metabolism ; pathology ; surgery ; Female ; Fibroma ; pathology ; Fibrosarcoma ; pathology ; Follow-Up Studies ; Humans ; Microfilament Proteins ; metabolism ; Vimentin ; metabolism ; Young Adult

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.
Adult ; Biopsy ; Diagnosis, Differential ; Fasciitis/*diagnosis/surgery ; Female ; Finger Phalanges/pathology/*radiography ; Humans ; Magnetic Resonance Imaging ; Sarcoma/*diagnosis ; Soft Tissue Neoplasms/*diagnosis ; Thumb/*pathology/surgery