Ischemic fasciitis

Ischemic fasciitis
Other names	Atypical decubital fibroplasia, decubital ischemic fasciitis
Histopathology of ischemic fasciitis, with typical features
Specialty	Dermatology, Dermatopathology, General Surgery
Causes	Unknown
Treatment	Surgical removal or long-term observation
Prognosis	Completely benign tumor
Frequency	Rare
Deaths	None

Ischemic fasciities (IF), also termed atypical decubital fibroplasia^[1] or decubital ischemic fasciitis,^[2] is a rare pseudosarcomatous (i.e. easily mistaken for a sarcoma) tumor. It was first described by E. A. Montgomery et al. in 1992.^[3] This tumor typically forms in the subcutaneous tissues (i.e. lower most tissue layer of the skin) that overlie bony protuberances such as a hip in individuals who are debilitated and bed-ridden.^[1]

Microscopically, IF lesions consist of proliferating, atypical fibroblasts and/or myofibroblasts. The lesions were initially regarded as non-neoplastic proliferation responses of these cell types to long-term tissue pressure or trauma.^[4] More recently, however, the World Health Organization, 2020, defined IF lesions as neoplasms, i.e. tissue growths which are uncoordinated with that of the normal surrounding tissue and persist in growing even if the original trigger for their development is removed. The Organization formally classified IF lesions as belonging to the category of benign fibroblastic and myofibroblastic tumors.^[5]

The treatment of choice for these often disfiguring, uncomfortable, and/or painful IF tumors is generally conservative, local surgical excision.^[6] It is critically important that these benign tumors be distinguished from other fasciitis tumors as well as certain sarcomas which can be highly invasive and/or malignant and therefor require far more aggressive treatment.^[2]