Nuchal Fibrocartilaginous Pseudotumor
Cyril Fisher, MD, DSc, FRCPath
Key Facts
Terminology
Metaplastic (pseudoneoplastic) nodule of fibrocartilage originating within nuchal ligament
Etiology/Pathogenesis
Remote or recent history of neck trauma
Clinical Issues
Majority in adults
At posterior aspect of base of neck in midline
At junction of nuchal ligament and deep fascia
Microscopic Pathology
Hypocellular fibrous tissue and cartilage
No calcification
Top Differential Diagnoses
Nuchal fibroma
Soft tissue chondroma
Calcifying aponeurotic fibroma
 Hematoxylin & eosin shows chondroid metaplasia within dense fibrous tissue of nuchal ligament, shown here at its junction with deep fascia. (Courtesy J.X. O’Connell, MD.) |
 Hematoxylin & eosin shows nuchal fibrocartilaginous pseudotumor with area of cartilaginous metaplasia, which displays variable basophilic staining of chondroid stroma. This area is sparsely cellular. |
TERMINOLOGY
Definitions
Metaplastic (pseudoneoplastic) nodule of fibrocartilage originating within nuchal ligament
ETIOLOGY/PATHOGENESIS
Environmental Exposure
Nuchal ligament subject during neck flexion to mechanical trauma from spinous processes
Sesamoid bone formation might result from fibrocartilaginous metaplasia
Most patients have history of whiplash or direct trauma, commonly motor vehicle crash
Rare examples are spontaneous
CLINICAL ISSUES
Epidemiology
Incidence
Very rare
< 20 cases reported
Age
Majority in adults
Occasional cases in childhood
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