Article

Caratteristiche RM dell’elastofibroma del dorso in correlazione ai rilievi anatomo-patologici: la nostra esperienza

Radiologia Medica - RADIOL MED 01/2009; 114(8):1283-1291. DOI: 10.1007/s11547-009-0442-2
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    ABSTRACT: Elastofibroma is a rare neoplasm. In this article, we report our study of the pathogenesis of fibrosis in elastofibroma. Three tumors obtained from two patients were selected. One patient was a 57-year-old Japanese woman who had a bilateral tumor, and the other patient was a 83-year-old Japanese man. All tumors occurred in the infrascapular region. Macroscopically, the cut surface of all tumors showed a poorly defined and whitish mass with yellowish foci. Microscopically, the tumor consisted of collagen fiber bundles, abnormal elastic fibers, and spindle cells suggestive of fibroblasts. Elastica-van Gieson and Masson-trichrome stain identified abnormal elastic fibers and abundant collagen fibers, respectively, in elastofibroma. Immunohistochemically, fibroblasts were positive for CD34 but negative for alpha-smooth muscle actin and h-caldesmon. Additionally, the cytoplasm of many fibroblasts was positive for TGF-beta in all tumors. Ultrastructurally, some fibroblasts with abundant organelles in one tumor were observed in the adjacent area to amorphous elastic mass and bundles of collagen fibers. However, no myofibroblasts were ultrastructurally identified in the tumor. Finally, our study supplies further evidence that elastofibroma may show the proliferation of CD34-positive fibroblasts and contain no myofibroblasts, and that fibroblasts may produce both abnormal elastic fibers and collagen fibers through the secretion of TGF-beta.
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    ABSTRACT: Elastofibroma dorsi is a benign soft tissue tumor, not well-known because of its low incidence, located in the chest wall in the subscapular area. In 10 patients with elastofibroma dorsi, the clinical symptoms were snapping scapula or shoulder pain. In three of the patients, the previous diagnosis was shoulder impingement, and the patients were treated without success. The clinical diagnosis was confirmed by magnetic resonance imaging. Surgical treatment resolved the symptoms in all patients. This tumor should be considered in the differential diagnosis of snapping scapula or shoulder impingement.
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    ABSTRACT: Elastofibroma dorsi is a rare, benign, soft tumor located at the inferior pole of the scapula. We report a series of 8 patients (5 women, 3 men), with a mean age of 67 years (range, 44-80 years), and discuss the clinical presentation, diagnosis, and treatment. Six lesions were unilateral, and 2 were bilateral. All patients were referred from other clinics with a large, unknown tumor of the back. Two patients presented with symptoms of pain and clunking of the scapula on shoulder abduction. Five underwent simple excision of the tumor. Preoperative diagnosis by magnetic resonance imaging showed agreement with the histopathologic diagnosis. Three patients had the postoperative complication of hematoma formation. Presumptive diagnosis is possible by careful clinical examination and magnetic resonance imaging. Because postoperative hematoma is unexpectedly frequent and symptomatic, radical resection should be avoided, and only excisional biopsy is necessary for histopathologic diagnosis.
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