Elastofibroma dorsi - Differential diagnosis in chest wall tumours

Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
World Journal of Surgical Oncology (Impact Factor: 1.41). 02/2007; 5(1):15. DOI: 10.1186/1477-7819-5-15
Source: PubMed


Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue.
We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months.
The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated) occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse.
In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

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Available from: Adrien Daigeler, Oct 13, 2015
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    • "The treatment of ED remains controversial. Excision may be offered to symptomatic patients, with curative marginal resection proving to be sufficient and preferred over radical resection; conservative treatment is recommended in elderly, asymptomatic patients because malignant transformation has not been reported [19]. "
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    ABSTRACT: We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department. Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma. The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted. Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.
    Korean Journal of Thoracic and Cardiovascular Surgery 04/2014; 47(2):111-116. DOI:10.5090/kjtcs.2014.47.2.111
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    • "Recurrence is extremely rare and probably the result of incomplete excision [27] [31]. However, no case of malignant transformation has ever been described [2] [34] "
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    ABSTRACT: Elastofibroma dorsi (ED) is an uncommon, slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. Though many patients are asymptomatic, ED can cause local deformity and symptoms such as periscapular pain or discomfort. Herein we report a case of a 65-year-old woman with painful ED. Clinical features, radiodiagnostic, intraoperative, and pathologic findings, and a brief review of the literature are performed.
    01/2013; 2013(7):794247. DOI:10.1155/2013/794247
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    • "On the other hand, the authors of the most recent articles most often consider that imaging studies, particularly MRI, suffice if the lesion is typical [7] [16] [20] [21]. The clinical follow-up of patients who have undergone surgical excision or biopsy vary, depending on the study, between 1 month and 4 years, with a mean follow-up of 9 months with no complications [13] [14] [15]. Local tumor recurrence has been reported after incomplete excision [9] [18]. "
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    ABSTRACT: Elastofibroma is a rare benign soft tissue lesion, typically located deep under the lower pole of the scapula. It is characterized by a fibrous and adipose tissue proliferation and most frequently affects older females. Its characteristic location and its specific aspect in imaging studies most often provides the diagnosis following an incidental discovery. Nevertheless, anatomic and pathologic confirmation is necessary to formally rule out a malignant tumor diagnosis. We report a 66-year-old woman original observation; this lady's occupation involved a number of strenuous manual activities; she consulted for chronic pain related to a left subscapular mass. MRI demonstrated, in fact, two symmetrical tumor masses under each scapula. The only symptomatic lesion was surgically excised.
    Orthopaedics & Traumatology Surgery & Research 08/2009; 95(5):383-7. DOI:10.1016/j.otsr.2009.05.002 · 1.26 Impact Factor
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