Elastofibroma dorsi - Differential diagnosis in chest wall tumours

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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.
BioMed Central
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World Journal of Surgical Oncology
Open Access
Research
Elastofibroma dorsi – differential diagnosis in chest wall tumours
Adrien Daigeler*
1
, Peter Maria Vogt
2
, Kay Busch
2
, Werner Pennekamp
3
,
Dirk Weyhe
4
, Marcus Lehnhardt
1
, Lars Steinstraesser
1
, Hans-Ulrich Steinau
1
and Cornelius Kuhnen
5
Address:
1
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,
2
Department of Plastic, Hand, and Reconstructive Surgery, Burn Center,
Hannover Medical School, Podbielskistr. 380, 30659 Hannover, Germany,
3
Institute of Diagnostic Radiology, Interventional Radiology and
Nuclear Medicine, BG-Hospital "Bergmannsheil", Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany,
4
Department
of Surgery, St. Josef Hospital – University Medical Center, Ruhr University of Bochum, Gudrunstr. 56, 44791Bochum, Germany and
5
Pathology,
BG-Hospital "Bergmannsheil", Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Carl-Neuberg-Str. 1, 39625 Hannover,
Germany
Email: Adrien Daigeler* - adrien.daigeler@rub.de; Peter Maria Vogt - vogt.peter@mh-hannover.de; Kay Busch - kay.busch@cityweb.de;
Werner Pennekamp - werner.pennekamp@rub.de; Dirk Weyhe - d.weyhe@elis-stiftung.de; Marcus Lehnhardt - marcus.lehnhardt@rub.de;
Lars Steinstraesser - lars.steinstraesser@rub.de; Hans-Ulrich Steinau - hans-ulrich.steinau@bergmannsheil.de;
Cornelius Kuhnen - cornelius.kuhnen@rub.de
* Corresponding author
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Published: 5 February 2007
World Journal of Surgical Oncology 2007, 5:15 doi:10.1186/1477-7819-5-15
Received: 5 December 2006
Accepted: 5 February 2007
This article is available from: http://www.wjso.com/content/5/1/15
© 2007 Daigeler et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
World Journal of Surgical Oncology 2007, 5:15 http://www.wjso.com/content/5/1/15
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Background
Elastofibromas are slowly growing benign tumors of soft
tissue origin. In 99% of the cases, they are located in the
inferior subscapular region between the scapula and the
thoracic wall; they consist of fragmented and enlarged
elastic fibres embedded in collagenous matrix that often
occur bilaterally [1-4]. They are commonly found in active
subjects beyond their 50
th
year [1-4], but may also affect
children [5]. In elderly patients, this tumor was inciden-
tally found in up to 2% by CT imaging [6]. Autopsy stud-
ies reported an even higher incidence of 13% to 17%,
revealing pre-elastofibroma-like morphologic changes
even in 81% of the autopsies [7,8]. In subjects over 55
years of age, prevalence is given with up to 24% [8]. In the
differential diagnosis of soft tissue tumors located at the
thoracic wall, one should be aware of this surprisingly
common lesion. We followed up a series of seven cases
with reference to clinical findings, further clinical course
and functional result after resection, as well as recurrence.
Patients and methods
Data for this case series were acquired retrospectively from
the patients' charts, physical examination and phone calls
to their general practicioners. From 1996 to 2005, seven
patients with diagnosis elastofibroma dorsi were treated
at our institutions (two center study).
All patients underwent MRI imaging preoperatively. Three
patients were core biopsied in advance; for two patients,
the diagnosis was made by instantaneous section. Two
patients were primarily resected completely without pre-
or intraoperative histopathologic verification of the diag-
nosis. In all patients, marginal complete resection was
performed and tissue specimens were sent in for patho-
logical evaluation to an experienced soft tissue patholo-
gist. Defects were closed primarily.
Results
Five patients were female; two were male. The average age
at the time of the treatment was 63.7 years and ranged
from 46 to 79 years. Follow-up data was available for all
patients. Follow-up time ranged from four months to nine
years and averaged 53 months.
The tumors were attached to the thoracic wall, located
between the serratus anterior muscle and the chest wall in
their anterior and between serratus and latissimus dorsi
muscle in their posterior extension (figure 1). In four
cases, the tumor was located at the right side; in two cases,
at the left side; and, in one patient, it was growing bilater-
ally. In only three cases, the lesion was located at the side
of the dominant hand. None of the patients was exten-
sively active during their lifetime. In most of the patients,
the predominant symptoms were swelling and snapping
of the scapula. The tumor sizes ranged from 3 to 13 cm.
On MRI in all patients the margins of the elastofibromas
were well defined. The tumors were located inferior to the
margo inferior of the scapula, adjacent to the thorcic wall.
The central parts contained fibrous masses with low signal
intensity on T1- and T2-weighted images. Hyperintens sig-
nals in T1- and T2- weighted images represented intermin-
gled fatty tissue. On STIR-sequences the fatty tissue also
showed low signal intensity, with a slightly higher inten-
sity of the the fibrous tissue. Focal aereas of high signal
intensity STIR-sequences may also be interpreted as
edema within the lesion. In figure 2 the typical aspect of a
bilateral elastofibroma on MRI is shown (figure 2).
Photographs of the tumour aspect of patients 1 (a) and 1 (b)Figure 1
Photographs of the tumour aspect of patients 1 (a) and 1 (b).
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In one patient, dyspnea and hypertension occurred coin-
cidentally with the elastofibroma and disappeared with
tumor resection. Due to the mild disturbances caused by
the lesions, the patients sought medical advice only late
after the onset of the symptoms (4 months to 4 years). In
all patients but one, postoperative seroma (which had to
be punctuated) occurred; however, at follow-up time, no
patient reported any decrease of function or sensation at
the shoulder or the arm of the operated side. No relapse
of the tumor occurred. One patient could not be followed
up personally as the patient died of cerebral apoplexy 13
months after treatment. At that time, however, the patient
had neither recurrence of the elastofibroma nor any dis-
turbances caused by the tumor resection. A detailed sum-
mary of the patients' data is given in table 1.
Pathology
Macroscopic findings: The soft tissue lesions were typi-
cally characterized by an irregular, poorly defined fibroe-
lastotic mass with a slightly rubbery, elastic consistence.
The cut surface showed strands of white and yellow tissue
caused by the entrapment of fatty remnants, similar to a
"checkerboard" pattern (figure 3). The tumours were not
encapsulated. Microscopic findings: Histologically, all
tumors were composed of fibrous, collagenous strands
and plump, sometimes elongated mostly round-shaped
MRI of bilateral elastofibroma with the tumour being located between the thoracic wall, the anterior serratus, and the latis-simus dorsi muscle (coronal (2a) and axial (2c) T1-weighted images): The small arrows indicate the medial margins of the lesions containing fatty (bright) and fibrous (dark) tissueFigure 2
MRI of bilateral elastofibroma with the tumour being located between the thoracic wall, the anterior serratus, and the latis-
simus dorsi muscle (coronal (2a) and axial (2c) T1-weighted images): The small arrows indicate the medial margins of the
lesions containing fatty (bright) and fibrous (dark) tissue. The tumours are located between the thoracic wall, the anterior ser-
ratus, and the latissimus dorsi muscle. The large arrows points to the margo inferior of the scapula. Figures [2b] and [2d] show
the corresponding STIR -sequences with a slightly inhomogenous signal intensity within the elastofibromas.
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Table 1: Detailed summary of patient data
Patient Age Gender Profession Handedness Location Tumor
extension
in cm
Symptom Comorbidity Duration of
symptoms before
treatment
Operative
procedure
Recurrence Complic
ation
Disturbances
at follow up
1 68 F housewife right right subscapular region
between serratus and latissimus
muscle
6x6x4 swelling hypertension 4 years complete
marginal
resection
no seroma none
2 76 F housewife right right subscapular region
between serratus and latissimus
muscle
12x7x5 pain coronary artery
disease, diabetes
mellitus IIb
9 months complete
marginal
resection
no seroma none, died of
cerebral
apoplexy 13
months after
treatment
3 46 F nurse right left subscapular region between
serratus and latissimus muscle
5.5x5x2 swelling hypertension,
hyperthyreosis
4 months complete
marginal
resection
no seroma none
4 71 F housewife left right subscapular region
between serratus and latissimus
muscle
3x3x3 swelling Leiomyosarcoma both
lower leg,s
gonarthrosis
2 years complete
marginal
resection
no none none
5 47 M engineer right left subscapular region betweeen
latissismus and serratus muscle
5x4x2 pain hypertension 4 years complete
marginal
resection
no hematom
a
none
right subscapular region
between latissimus, serratus, and
rhomboideus maj. muscle
13x11x3 pain 4 years complete
marginal
resection
no seroma none
6 59 M engineer right right subscapular region,
between latissismus and serratus
muscle
9x7x2.5 pain none 1.5 years complete
marginal
resection
no hematom
a, seroma
none
7 79 F housewife right left subscapular region, between
latissismus and serratus muscle
6.5x2.5x5 swelling dyspnea
hypertension
arteriosclerosis 1 year complete
marginal
resection
no seroma none, complete
remission of
dyspnea and
hypertension
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elastic fibres which were densely packed. The elastic struc-
tures typically formed discs or globules and sometimes
appeared in an "asbestos-body-like" fashion. These fibres
were difficult to detect using hematoxylin-eosine-staining,
especially during the frozen section procedure. They were
best highlighted using elastic stain (Elastica-van-Gieson)
which stained the fibres dark brown to black. The lesions
were predominantly hypocellular with fibrocytic and
fibroblastic cells without atypia and mitotic activity (fig-
ure 4a–c).
Discussion
The pathogenesis of elastofibroma dorsi is still unclear,
but repetitive microtrauma caused by friction between the
scapula and the thoracic wall may cause reactive hyper-
proliferation of fibroelastic tissue [9-13]. A systematic
review of the literature gave no further hints to the role of
microtraumatization because most authors did not pro-
vide any information about their patients' activity. There
is a striking predominance of the female gender from 5:4
to 13:1, depending on the study, suggesting that micro-
trauma alone cannot be the major factor in genesis of this
lesion [1-4]. Previous publications referred to other sites
of friction exposure as the tricuspid valve, axilla, foot, and
ischial tuberosity; however, other reports of less common
sites of manifestation with lower mechanical stress like
the mediastinum, the stomach, the greater omentum, the
inguinal region, the orbita, and the intraspinal space sup-
port this theory [3,11,14-18]. With the tumors occurring
at the dominant and nondominant hand site in our
patients, there seemed to be no association to mechanic
stress assuming the dominant side was exposed to a
higher level of repetitive microtrauma during lifetime.
Additionally, only one of our patients had a history of
extensive physical activity in his life (canoeist). Several
authors proposed vascular insufficiency as a possible rea-
son for the degenerative changes [8,12]. A familial predis-
position with an underlying enzymatic defect may exist in
30%, but this has never been finally proved [2,19,20].
Large case series from Japan strongly suggest that heredi-
tary factors may be a predisposition for this lesion [2,21].
The nature of the altered elastic fibres is disputed and con-
troversial. They may be caused by abnormal elastogenesis
or by degenerating as a secondary process, or even by a
combination of both processes [8,13,20,22,23].
The symptoms of elastofibroma dorsi depend on the site
and size of the lesion and may present as shoulder pain or
Macroscopic aspect of elastofibroma dorsi: Poorly defined fibroelastotic tumor with entrapment of fatty remnantsFigure 3
Macroscopic aspect of elastofibroma dorsi: Poorly defined fibroelastotic tumor with entrapment of fatty remnants.
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snapping scapula as in our patients. In 50% of the cases,
the tumor remains asymptomatic or causes mild discom-
fort only, explaining the long periods of up to 67 years
between the onset of the symptoms and treatment [1-
4,24,25]. Large lesions may simulate scapula alata, by ele-
vating the scapula. If palpable, the tumor may mimic sem-
imobility due to its elastic fibres, but intraoperatively it
normally shows adherent to the surrounding tissue. It
occurs predominantly at the right side but, in up to 50%
of the cases, it is found bilaterally [8]. In our collective,
this proportion was 14%. The coincidence of hyperten-
sion and dyspnea with elastofibroma has not yet been
described and may be unrelated, whereas a large tumor
may disturb thoracic elasticity and movements and there-
fore could cause dyspnea by interfering with the breathing
motor function.
Aside from a possible soft tissue signal intensity or ele-
vated scapula, plain radiographs do not show specific
changes. On MRI, probably the most reliable non-inva-
sive technique in diagnosis, the lesions mostly show a sig-
nal intensity, comparable to that of muscle, margins are
well defined and signal intensity is mostly low. Inter-
spersed adipose strands cause a heterogeneous structure
with longitudinal areas of higher signal intensity [4,11,26-
29]. In all of our patients the findings on MRI were con-
sistent with the criteria mentioned above. After applica-
tion of contrast agent, normally faint but also marked
enhancement mimicking malignancy may be observed
[30-32]. CT shows the same changes but is less sensitive
for visualizing the strands of fatty tissue [29]. On PET-CT
radiotracer accumulation of the hypermetabolic tumor
has been described [33]. Differential diagnosis includes
sarcomas, aggressive fibromatosis, lipoma, and fibroma.
Ultrasound patterns of the tumor are characteristic includ-
ing fasciculated structures with hypo- and hyperechogene-
ous striae of different thickness similar to that of muscle
tissue but less organized. Colour Doppler shows vascular-
ization patterns similar to the surrounding muscle. In the
hands of an experienced examiner, ultrasound may repre-
sent a quick and cheap diagnostic tool [34-36]. Due to its
muscle like appearance in all of the imaging procedures
mentioned, the lesion may go undiagnosed or, in case of
abnormal features, misdiagnosed. The advanced age of
the patients, the typical localization, female gender or
bilateral manifestation support the presumptive diagnosis
of elastofibroma. In these cases and with clear imaging
findings, one may refrain from biopsy. In all other cases,
Microscopic findings in elastofibroma dorsi: 4a): Fibrous, collagenous strands intermingled with fat cells (hematoxylin-eosine-staining)Figure 4
Microscopic findings in elastofibroma dorsi: 4a): Fibrous, collagenous strands intermingled with fat cells (hematoxylin-eosine-
staining). 4b): Collagenous material and roundly shaped elastic fibres, mesenchymal cells with bland nuclei (hematoxylin-eosine-
staining). 4c): Elastic fibres and structures forming discs and globules stained dark brown to black using an elastic stain (Elastica-
van-Gieson).
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in contrast to other authors [26,28,37-40], we strongly
recommend that tumor material be obtained to confirm
the presumptive or to establish another diagnosis,
because MRI, CT or ultrasound and clinical findings can-
not give final safety [1,2,32,41-45]. Fine needle aspiration
[46] is not recommended because of the inherent
hypocellularity of the tumor. An open biopsy or at least a
core needle biopsy should be performed to get a repre-
sentative tissue specimen. Histomorphologically, the
diagnosis is based on the presence of the altered elastic
fibres embedded in a collagenous matrix, riddled with
various amounts of fat cells. These elastic fibres are often
fragmented into discs or globules and larger than regular
ones [13,20,47]. Ultrastructurally, the elastinophilic
material frequently contains a central core of mature elas-
tic tissue and appears to be secreted by active fibroblasts;
this further substantiates the thesis that the elastic mate-
rial in elastofibroma is derived from excessive production
by fibroblasts rather than from elastotic degeneration of
collagen. Dense granular bodies within the fibroblast
cytoplasm are described, which are thought to represent
elastin or elastin precursors [48].
In incidental diagnosis of asymptomatic lesions there is
no need for excision as malignant transformation has
never been described. Only in cases of discomfort, snap-
ping or blocking scapula and pain, marginal resection is
widely recommended according to the psychological and
physical strain of the patient [1,2,49], but anecdotal
reports mentioned good results with radiotherapy as well
[16,17]. This may be an option especially for manifesta-
tions in unresectable locations. The high incidence of
seromas in our patients, whereas there is no report about
seromas in the literature, may be a result of insufficient
immobilisation. Taking into account the usually
advanced age of the patients, immobilisation bears the
risk of remaining stiffness in the shoulder girdle, whereas
punctuation of a seroma may only prolong reconvales-
cence and cause mild discomfort. Our patients retrospec-
tively did not experience postoperative seroma as relevant
discomfort. All patients were free of the disease at follow-
up time, concurring with the literature reporting only a
few cases of recurrence [2,32,50].
Conclusion
In differential diagnosis of soft tissue tumors located at
the infrascapular region, elastofibroma should be consid-
ered as likely diagnosis by the surgeon and the surgical
pathologist. We prefer MRI to localize and identify the
lesion. In elderly patients or patients with bilateral mani-
festation and definite findings in imaging, it may be justi-
fied to refrain from biopsy. Otherwise, open biopsy
should be performed to exclude malignancy and to reas-
sure the asymptomatic patient that no surgical treatment
is necessary. Unnecessary wide and radical resections in
the symptomatic patient can be avoided because marginal
resection has proven to be sufficient. We recommend
postoperative wound drainage and compression garment,
as well as shoulder immobilization for one week to reduce
postoperative seroma.
Competing interests
The author(s) declare that they have no competing inter-
ests.
Authors' contributions
AD conceptualised the study, gathered the data and wrote
the manuscript.
PV analysed and interpreted the data.
KB acquired and weighed the data.
WP evaluated the MRI findings and edited the radiology
section.
DW was involved in drafting the manuscript and critically
revising it.
ML interpreted the data and revised the manuscript.
LS reviewed the literature and analysed the data.
HS initiated the study and supervised the process. He gave
final approval for publication.
CK performed the histopathological evaluation and inter-
pretation of the data.
Acknowledgements
We thank Amanda Daigeler for her formal English revision of the manu-
script
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    • "Complete surgical excision in symptomatic patients remains the treatment of choice. [11] These tumors rarely recur and malignant transformation has not been described so far; [2,9] therefore, in asymptomatic lesions there is no need for excision. The role of diagnostic biopsy is to exclude malignancy and to reassure the asymptomatic patient that no radical surgical treatment is necessary. "
    [Show abstract] [Hide abstract] ABSTRACT: Elastofibromas are rare benign, soft-tissue slow-growing tumors seen predominantly in elderly females. The most common location is the infrascapular region. These benign tumors require resection only in symptomatic cases. We present a case of elastofibroma in a 46-year-old female. She presented with gradually increasing soft-tissue swelling of 8 cm × 6 cm in the right inferior subscapular region for the last 2 years. She underwent excisional biopsy and the histopathology was reported as elastofibroma. Microscopically, the mass showed numerous characteristic eosinophilic, beaded elastic fibers. These fibers were highlighted by the Verhoeff's elastic stain. We present this uncommon case to emphasize the important role of histopathology in diagnosis. A definitive diagnosis helps to avoid unnecessary wide and radical resection.
    Full-text · Article · Mar 2016
    • "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]. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2014
    • "We observed no recurrences on the operation site but interestingly 2 patients developed a new ED on the contralateral site of the operation and these 2 patients were manual labourers. Only a few studies45678910111213141516171819 have reported on the outcomes of surgical treatment of ED (Table 2). In a series of 71 patients who underwent complete excision of ED, with similar outcomes, with a tumour size between 3 and 14 cm, complications of 16.7% and no recurrence at follow-up, have been reported [19]. "
    [Show abstract] [Hide abstract] ABSTRACT: Elastofibroma dorsi (ED) is a rare, benign lesion arising from connective tissue, usually found at the inferior pole of the scapula. To date, only a few small series have been reported in the English literature and there are few data about the long-term outcomes after surgery. Our goal is to contribute a better understanding of this tumour and to determine the long-term outcomes after surgery. Sixteen patients with a diagnosis of ED were identified from the unit's database. The clinical presentation, diagnosis, pathological evidences and long-term outcomes were evaluated. There were 11 females and 5 males with a mean age of 61.1 years (range 38-78 years). The tumour was located on the right in 5 (31.2%) patients, on the left in 6 (37.5%) patients and bilaterally in 5 (31.2%). Six patients had painful scapular swelling resulting in restriction of movement of the shoulder whereas 10 reported only painful scapular mass. All 16 patients underwent complete resections. The tumour size ranged from 3 to 15 cm. The mean hospital stay was 3.1 ± 1.4 days with a morbidity of 18.75% (seroma observed in 3 patients). The mean follow-up was 58.4 ± 29.5 months (range 11-92 months). In 2 patients (12.5%) a new occurrence on the contralateral side was observed at the follow-up. Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind.
    Article · Nov 2013
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