Given its rarity, varied histological presentation and often pseudosarcomatous appearance, nodular fasciitis is frequently misdiagnosed on pre-operative, intra-operative and final analyses.

Four cases of nodular fasciitis are reviewed.

Physical and radiological findings were consistent with a parapharyngeal tumour, probably neurogenic, a level four neck mass suspicious for lymphoma; a sternoclavicular mass in a patient with a history of breast cancer suspicious for metastasis; and a cheek mass consistent with an accessory parotid tumour. Fine needle aspiration results were consistent with a neurogenic tumour in two patients and an undifferentiated malignancy in two patients. Frozen section examination most commonly included masses with spindle-type cells. The final diagnosis of nodular fasciitis was made only after permanent section and immunohistological analysis.

In a patient with nonspecific results following investigation of a head or neck mass, nodular fasciitis should be considered. Use of appropriate immunohistochemical markers will aid in the final diagnosis.

We report a case of infection against a background of pre-existing cranial fasciitis.

Case report and review of world literature on cranial fasciitis.

Cranial fasciitis of childhood is a benign condition and a rare variant of nodular fasciitis. We present the case of a 10-week-old infant with symptoms and signs consistent with a subperiosteal abscess complicating acute mastoiditis. Subsequent findings showed this to be an infection against a background of pre-existing cranial fasciitis.

To our knowledge, this is the first such reported case in the literature. Knowledge of the distinctive histopathological features, coupled with an awareness of the condition, are crucial to establishing a definitive diagnosis of cranial fasciitis and, in turn, to instituting appropriate management. The aetiopathogenesis of the condition remains unclear.