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Atalay HÖ, Atasoy D, Atasoy Ç. Superior scapular location: An overlooked albeit frequent finding in elastofibroma dorsi. Clin Imaging 2024; 109:110139. [PMID: 38574606 DOI: 10.1016/j.clinimag.2024.110139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To explore the frequency of superior scapular elastofibroma dorsi in a large patient series with elastofibroma dorsi. METHODS 136 chest CTs from January 2016 to July 2022 reporting elastofibroma dorsi were retrospectively analyzed. Three radiologists assessed the number, size, and location of elastofibroma dorsi. Continuous variables underwent two-tailed t-tests with p < 0.05. Inter-observer agreement was assessed by using Cohen's Kappa values. RESULTS In 136 patients (mean age, 75.9 +/- 9.8 years; 117 female), 330 elastofibroma dorsi were found. Six (4.4 %) patients had single, 87 (64 %) double, 22 (16.2 %) triple and 21 (15.4 %) quadruple lesions. All single and double lesions were in the inferior scapular regions. 43 (31.6 %) patients had superior scapular lesions in addition to inferior scapular elastofibroma dorsi. Inferior scapular elastofibroma dorsi was significantly larger than superior scapular elastofibroma dorsi. The probability of a right superior lesion was significantly higher in patients with a larger right inferior lesion. Inter-observer agreement was very good for experienced radiologist (κ = 94.1) and good for other radiologists (κ = 79.4 and κ = 78). CONCLUSION In contrast to current belief, superior scapular elastofibroma dorsi accompanying the typical inferior scapular lesions is not uncommon and can even manifest bilaterally. To the best of our knowledge, this is the first case series reporting prevalence of quadruple elastofibroma dorsi.
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Affiliation(s)
- Hande Özen Atalay
- Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey.
| | - Duygu Atasoy
- Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey
| | - Çetin Atasoy
- Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey.
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Ngoy A, Tchalukov K, Pollock G, Thomson B, Nguyen C. The First-Reported Presentation of Quadruple Locations of Elastofibroma Dorsi: A Case Report and Review of the Literature. Cureus 2023; 15:e41425. [PMID: 37546062 PMCID: PMC10403338 DOI: 10.7759/cureus.41425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Elastofibroma dorsi (EFD) is an uncommon benign tumor of mesenchymal origin that usually occurs in the subscapular region. Bilateral and triple EFD are frequently reported in the literature but cases with more lesions have never been described. Our patient is a 50-year-old female with quadruple locations of bilateral suprascapular and subscapular EFD who presented with left shoulder pain and swelling over the affected area. Clinical presentation, computed tomography (CT) and magnetic resonance imaging (MRI), and biopsy were consistent with EFD. Therapeutic excision was performed and successfully alleviated the patient's discomfort. This report presents the first case of quadruple locations of EFD and highlights the value of MRI in the diagnosis of EFD, especially when there are multiple masses with indistinct margins are deeply located in the chest wall.
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Affiliation(s)
- April Ngoy
- Department of Radiology, Kaweah Health, Visalia, USA
| | - Konstantin Tchalukov
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Gabriel Pollock
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Bryon Thomson
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Christopher Nguyen
- Department of Radiology, Riverside University Health System Medical Center, Moreno Valley, USA
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Subscapular elastofibrolipoma treated with marginal resection: two case reports. J Med Case Rep 2022; 16:296. [PMID: 35915504 PMCID: PMC9344634 DOI: 10.1186/s13256-022-03522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Elastofibroma dorsi is a rare benign tumor of soft tissue, typically under the lower angle of the scapula. Its specific location and distinctive clinical symptoms can provide enough information for diagnosis. Nevertheless, pathological confirmation by biopsy may be needed to rule out other malignancies. Case presentation Here, we present two cases of 63-year-old and 49-year-old female Asian patients who came to us with the chief complaint of pain and bulging in their shoulders. Both patients had rubbery and mobile masses. Also, shoulder movements were not restricted in the examination; however, the patients expressed pain during movements. Computed tomography scans were compatible with the diagnosis of elastofibroma dorsi. Surgical excision was performed for both cases owing to the symptomatic nature of the masses, and histopathological findings confirmed the diagnosis. Conclusion Elastofibroma dorsi is a benign pseudotumor presenting with an uncomfortable feeling in the shoulder with movement in older females. In typical symptom-free cases of elastofibroma dorsi, observation is sufficient, while in symptomatic patients or if there is suspicion of malignancy, complete resection with marginal resection is the treatment of choice.
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Domanski HA. Elastic fibers in elastofibroma dorsi by fine-needle aspiration. Diagn Cytopathol 2013; 42:609-11. [PMID: 23554149 DOI: 10.1002/dc.22959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 10/08/2012] [Accepted: 12/31/2012] [Indexed: 11/06/2022]
Abstract
Fine-needle aspiration (FNA) features of elastofibroma dorsi (EFD) in a 56-year-old woman were evaluated. The patient presented with 5 cm soft tissue mass located between the inferior part of scapula and the chest wall. FNA smears were hypercellular, characterized by a mixture of uniform spindle cells, mature adipocytes, and collagen tissue fragments in varying proportions. The cytological findings included abundant degenerated elastic fibers presented as linear ("braid-like") and globular bodies with shell-like and stellate appearances with serrate borders, permitting a diagnosis of EFD. Occurrence of degenerated elastic fibers in FNA smears of elastofibroma is a highly diagnostic sign in the typical clinical setting and eliminates the need for preoperative histological examination.
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Affiliation(s)
- Henryk A Domanski
- Department of Pathology & Cytology, Lund University Hospital, S-221 85 Lund, Sweden
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Hocar O, Buffard V, Ortonne N, Bagot M. [Bilateral elastofibroma dorsi]. Ann Dermatol Venereol 2012; 139:41-5. [PMID: 22225741 DOI: 10.1016/j.annder.2011.10.395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 07/24/2011] [Accepted: 10/20/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elastofibroma dorsi (EFD) is a rare form of benign soft-tissue tumour that is almost always located at the lower pole of the scapula, deep to the serratus anterior muscle. There are few reports in the dermatological literature since it rarely develops in skin or subcutaneous tissue. CASE REPORT We present the case of a 59-year-old man with bilateral elastofibroma dorsi. Physical examination showed two bilateral scapular masses, better visualized in abduction or antepulsion. They were firm, painless, mobile, covered by normal skin, and measured 40/35 mm on the right and 50/55 mm on the left. Ultrasound of soft tissue and a chest CT scan showed two heterogeneous masses (tissue and fat) within the serratus anterior muscle measuring 30/15 mm on the right and 60/19 mm on the left. Histopathological study of a deep biopsy done on the right helped to confirm the diagnosis of EFD. Tumour resection was done on the right. DISCUSSION Elastofibroma dorsi is an uncommon, benign, non-encapsulated pseudo-tumour occurring in connective tissue of the infrascapular region of elderly patients. Another mass must be sought in all cases in the corresponding contralateral site since this form of tumour is often bilateral. CONCLUSION EFD must be considered in the differential diagnosis of shoulder masses in elderly patients.
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Affiliation(s)
- O Hocar
- Service de dermatologie, hôpital Henri-Mondor, Créteil, France.
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Vincent J, Maleki Z. Elastofibroma: Cytomorphologic, histologic, and radiologic findings in five cases. Diagn Cytopathol 2011; 40 Suppl 2:E99-E103. [DOI: 10.1002/dc.21732] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 04/06/2011] [Indexed: 11/07/2022]
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Kuroda N, Hamaguchi N, Ohara M, Hirouchi T, Mizuno K, Hayashi Y, Lee GH. Elastofibroma: a histochemical, immunohistochemical, and ultrastructural study of two patients. Med Mol Morphol 2008; 41:179-82. [DOI: 10.1007/s00795-007-0372-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/08/2007] [Indexed: 01/12/2023]
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Huening MA, Reddy S, Dodd LG. Fine-needle aspiration of fibrous dysplasia of bone: A worthwhile endeavor or not? Diagn Cytopathol 2008; 36:325-30. [DOI: 10.1002/dc.20803] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Elastofibromas (EFD) are rare benign soft tissue tumors that are almost always located at the inferior pole of the scapula, deep to the serratus anterior muscle. They are more frequent in elderly women. Their anatomical location and a distinctive clinical symptom distinguish them from malignant soft tissue tumours. They can usually be diagnosed on the basis of their imaging characteristics. Despite their low incidence, these lesions should be kept in mind to differentiate them from malignant tumours and to avoid unnecessary biopsies and wide or radical surgery. We present the case of a 55-year-old woman who complained of chronic pain related to a right infrascapular mass. She was diagnosed by magnetic resonance imaging (MRI) of bilateral subescapular tumor masses both compatible with elastofibroma. She underwent resection of the symptomatic right lesion through an amyotomical approach.
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Belgnaoui F, Bensahraoui M, Hannound S, Ourhrouil MA, Mansouri F, Hassam B. Pseudoxanthome élastique et élastofibrome. Ann Dermatol Venereol 2005; 132:564-6. [PMID: 16145757 DOI: 10.1016/s0151-9638(05)79342-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lewis KG, Bercovitch L, Dill SW, Robinson-Bostom L. Acquired disorders of elastic tissue: part I. Increased elastic tissue and solar elastotic syndromes. J Am Acad Dermatol 2005; 51:1-21; quiz 22-4. [PMID: 15243519 DOI: 10.1016/j.jaad.2004.03.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elastic fibers in the extracellular matrix are an integral component of dermal connective tissue. The resilience and elasticity required for normal structure and function of the skin may be attributed to the network of elastic tissue. Advances in our understanding of elastic tissue physiology provide a foundation for studying the pathogenesis of elastic tissue disorders. Many acquired disorders are nevertheless poorly understood due to the paucity of reported cases. Several acquired disorders in which accumulation or elastotic degeneration of dermal elastic fibers produces prominent clinical and histopathologic features have recently been described. They include elastoderma, linear focal elastosis, and late-onset focal dermal elastosis and must be differentiated from better-known disorders, among them acquired pseudoxanthoma elasticum, elastosis perforans serpiginosa, and Favré-Racouchot syndrome. Learning objective At the conclusion of this learning activity, participants should understand the similarities and differences between acquired disorders of elastic tissue that are characterized by an increase in elastic tissue, as well as the spectrum of solar elastotic dermatoses.
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Affiliation(s)
- Kevan G Lewis
- Department of Dermatology, Brown Medical School-Rhode Island Hospital, Providence, RI 02903, USA
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Cerrolaza N, Alcalá-Santaella R, Ausina S, Bataller J. Elastofibroma dorsi y tumoraciones infraescapulares. Rev Esp Cir Ortop Traumatol (Engl Ed) 2005. [DOI: 10.1016/s1888-4415(05)76312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Domanski HA, Carlén B, Sloth M, Rydholm A. Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: Cytomorphologic study with clinical, radiologic, and electron microscopic correlations. Diagn Cytopathol 2003; 29:327-33. [PMID: 14648789 DOI: 10.1002/dc.10381] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Elastofibroma dorsi (EFD) is a relatively rare soft tissue mass, probably of reactive nature. The lesion is typically located near the inferior margin of the scapula or between the inferior part of scapula and the chest wall in elderly women. Although location of the tumor together with the age/sex of the patients and radiologic findings is often suggestive of the diagnosis, tissue examination has been considered necessary to confirm the diagnosis. Although the histologic features of EFD are well known, there are only four single case reports of the cytologic findings in the English language literature. We describe the cytologic features of EFD in five patients with correlations to clinical, radiologic, histologic, and electron microscopic findings. The current study suggests that the fine-needle aspiration (FNA) features are highly diagnostic, permitting a firm diagnosis of EFD in a typical clinical setting and eliminating the need for preoperative histologic examination.
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Affiliation(s)
- Henryk A Domanski
- Department of Pathology and Cytology, Lund University Hospital, Lund, Sweden.
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Harigopal M, Seshan SV, DeLellis RA, Yankelevitz D, Vazquez M. Aspiration cytology of elastofibroma dorsi: case report with ultrastructural and immunohistochemical findings. Diagn Cytopathol 2002; 26:310-3. [PMID: 11992374 DOI: 10.1002/dc.10106] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Elastofibroma is a well-recognized tumor-like process which typically occurs in the soft tissue of the shoulder. Although fine-needle aspiration (FNA) represents a quick and simple method for definitive diagnosis, the possibility of a false-negative diagnosis is high due to the hypocellularity of the smears. However, a high index of suspicion based on the clinical presentation of a firm mass in a typical location in an elderly person, usually female, aids in the diagnosis. We describe the FNA findings of elastofibroma dorsi in an 89-yr-old woman which, although hypocellular, contained diagnostic aggregates of petaloid globules within a collagenous matrix. The cytologic material showed a green-yellow autofluorescence of the altered elastic fibers with ultraviolet light. Transmission electron microscopy revealed an elongated beaded appearance with small electron densities and obliteration of the central elastin core. The presence of a hypocellular aspirate with autofluorescent elastic fibers should suggest the possibility of elastofibroma dorsi.
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Affiliation(s)
- Malini Harigopal
- Department of Pathology, Division of Cytopathology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, Starr 1928, 525 East 68th Street, New York, NY 10021, USA.
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Abstract
Elastofibroma dorsi was diagnosed in a 48-year-old woman with bilateral subscapular tumor masses diagnosed asynchronously in an interval of 4 months in spite of presence of another lesion at first admittance. She underwent subsequent resections of the lesions. They were diagnosed as elastofibroma. Reevaluation of the initial computerized tomography of thorax indicated an omitted small lesion with a 2-cm diameter and 25.2-day doubling time. Although the real neoplastic nature of elastofibroma is unknown, bilateral presence of the masses with different sizes and relatively short doubling times of the lesions must be kept in mind.
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Affiliation(s)
- Akif Turna
- Yedikule Hospital for Chest Disease and Thoracic Surgery, Zeytinburnu, Istanbul, Turkey.
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