Orbital cranial fasciitis in childhood-a benign masquerader of rhabdomyosarcoma: case report and literature review.

Purpose: Cranial fasciitis (CF) is a rare benign myofibroblastic proliferation predominantly affecting the pediatric skull, often mimicking malignant processes radiologically. While CF is well described pathologically, its imaging characteristics remain underreported, especially in orbital involvement.

Methods: We retrospectively reviewed the literature through PubMed and Scopus using the search terms "cranial fasciitis" and "nodular fasciitis AND orbit." We included only cases localized to the craniofacial region. Demographic, imaging, anatomical origin, and follow-up data were extracted. We categorized CF into five distinct types based on tissue involvement. Additionally, we report a new case of CF with orbital extension in a 32-month-old male, including detailed imaging and histopathologic findings.

Results: A total of 142 CF cases were identified across 73 studies, including our case. Median age at diagnosis was 2 years, with a male predominance (1.5:1). Most cases presented with subcutaneous scalp masses (88.7%), often associated with bone erosion or intracranial extension. Only four cases involved the orbit. The most common imaging type was subcutaneous mass with calvarial destruction (45.1%). MRI findings typically included T2 hyperintensity, T1 hypo- to isointensity, marked contrast enhancement, and facilitated diffusion. Recurrence was rare (7.3%).

Conclusion: This study represents the largest review of CF to date and is the first to systematically describe imaging subtypes. Orbital involvement, while rare, may mimic aggressive lesions and lead to misdiagnosis. Recognizing imaging patterns of CF is essential for accurate diagnosis, avoiding overtreatment, and guiding appropriate surgical management in pediatric patients.