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: 1.2). 02/2007; 5:15. DOI: 10.1186/1477-7819-5-15
Source: PubMed

ABSTRACT 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, Jul 30, 2015
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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; 2013:794247. 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 · 1.17 Impact Factor
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    ABSTRACT: We evaluated patients who underwent surgical treatment for elastofibroma dorsi (ED). The study included 13 patients (11 women, 2 men; mean age 54 years; range 43 to 74 years) who were treated surgically for ED that caused persistent symptoms. Involvement was on the right in six patients, on the left in five patients, and bilateral in two patients. All the patients presented with a mass lesion that became apparent at the lower corner of the scapula on shoulder flexion and adduction. The complaints were swelling and pain on the back in nine patients, and a snapping sound on shoulder movements together with pain in four patients. Diagnosis of ED was made by magnetic resonance imaging (n=10) and computed tomography (n=3), with no utilization of preoperative biopsy. Marginal tumor excision was performed in all cases. Evaluation for recurrence was made by ultrasonography. The mean follow-up period was 32 months (range 8 to 90 months). All the masses were located at the inferior corner of the scapula, with adherence to the thorax between the serratus anterior, rhomboid, and latissimus dorsi muscles. The mean size of the surgical specimens was 9 x 6 x 3 cm (range 5 x 3 x 1 to 14 x 8 x 3 cm). Clinical diagnosis was confirmed by histopathologic examination in all cases. All major complaints resolved after surgery. Hematoma occurred in four cases postoperatively, but resolved without the need for surgical intervention. No recurrence was observed. Even though ED is a rare clinic entity, it should be recalled while evaluating shoulder pathologies. Marginal excision is adequate for the treatment of patients with sustaining complaints.
    acta orthopaedica et traumatologica turcica 43(5):431-5. DOI:10.3944/AOTT.2009.431 · 0.55 Impact Factor
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