Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: Cytomorphologic study with clinical, radiologic, and electron microscopic correlations

Elastofibroma Dorsi Detected Incidentally on Chest Computed Tomography: The Prevalence and Reporting Rate in Radiology Reports

Background Elastofibroma dorsi (ED) is an uncommon benign connective-tissue tumor, usually seen in the subscapular region of women after the fifth decade. The study aimed to determine the prevalence, radiological characteristics, and the rates of mention in the initial radiology reports of ED incidentally detected by chest computed tomography (CT) imaging in a large population.  Methodology This study was conducted at Hitit University, Erol Olçok Training and Research Hospital Radiology Department in Çorum, Turkey. A total of 3,299 patients (1,554 females, 1,745 males) who underwent non-contrast chest CT for various reasons were included in this retrospective study. The presence, side, thickness, and density of ED were investigated in these patients. Differences in gender and laterality were assessed statistically. It was also reviewed whether it was stated in the initial radiology report or not. Results ED was detected in 79 (2.4%) of 3,299 patients, in 60 (75.9%) females and 19 (24.1%) males with a median age of 57.5 years (range, 18-99 years). The risk of ED presence was determined to be 3.65-fold in females than in males. In the cases determined with ED, the median age was 75 years (range, 53-96 years), and ED was not determined in any patient aged <50 years. A statistically significant correlation was determined between age and the presence of ED (p < 0.001). No statistically significant correlation was found between age and ED thickness or density (p = 0.602, p = 0.233, respectively). It was noted that none of the patients were diagnosed in the first radiological report. Conclusions ED can be easily overlooked on cross-sectional examinations because of the similar appearance and density to adjacent structures. Knowledge of the characteristic radiological features of these lesions and increased awareness of radiologists will make early diagnosis possible in asymptomatic cases.

Is it necessary to always resect elastofibroma dorsi?

BACKGROUND

Elastofibroma dorsi (ED) is a benign soft tissue tumour of the subscapular region of the chest wall. It is a frequent lesion, especially seen in females and in the elderly. It remains unclear whether the size or symptomatology of the tumour is important to make a resection decision. Our aim in this study is to reveal the results between asymptomatic or symptomatic ED cases, and to reveal which factors are important for making a resection decision.

METHODS

Patients operated between January 2010 and December 2019 were included in the study, and divided into two groups as patients who were asymptomatic or with various symptoms. Patients were evaluated in terms of demographic and operational factors.

RESULTS

The study included 57 patients with the average age of 56.1 ± 11.5 years. Whilst 31 (54.4%) of these patients were asymptomatic, 26 (45.6%) were symptomatic. There was a statistical significance between groups in terms of occupation (P < 0.001), comorbidity (P = 0.042) and the duration of complaints (P = 0.001). A statistically significant difference was analysed between comorbidity versus early and late complications (P = 0.011 and P = 0.002, respectively).

CONCLUSION

ED probably occurs as a result of repeated trauma in the subcapular region in people who use their arms extensively. Regardless of the size of the lesion, surgery should be avoided as much as possible, especially in asymptomatic patients. However, in patients who are symptomatic, a precise surgical procedure can give satisfactory results. In these patients, who are generally elderly, early and late complications can be seen more, if they have comorbidity.

Elastic fibers in elastofibroma dorsi by fine-needle aspiration

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.

Sensitivity and positive predictive value of magnetic resonance imaging in the diagnosis of elastofibroma dorsi: review of fourteen cases

BACKGROUND

Elastofibroma dorsi (ED) is a benign soft tissue tumor that classically presents as an ill-defined mass at the inferior pole of the scapula. Several studies have indicated the benefits of using magnetic resonance imaging (MRI) to identify ED. In this study, we calculate the sensitivity and positive predictive value (PPV) of MRI in the diagnosis of ED using histopathology as the gold standard diagnostic method. Clinical characteristics of ED and radiologic features of MRI as well as treatment options are discussed.

MATERIALS AND METHODS

A systematic retrospective review was performed of all ED patients treated in our center between 1999 and 2009. MRI and histopathology samples were performed in all cases. The MRI sensitivity and PPV in the diagnosis of ED were calculated.

RESULTS

A total of 15 patients who were treated within the study period were reviewed; of these, were 14 (3 men, 11 women) true ED cases. MRI scan results matched the histopathology in 14 of 15 patients; 1 false-positive patient was observed, and no false-negative patients (negative MRI and positive histopathology) were noted. The PPV and sensitivity of MRI scan in the diagnosis of ED were 93.3% (95% confidence interval, 68.0%-100.0%) and 100% (95% confidence interval, 75.2%-100.0%) respectively.

CONCLUSIONS

MRI is a useful tool for assessment of ED and can potentially help avoid the need for unnecessary biopsy and surgery, especially in the asymptomatic patient.

Diagnosis of elastofibroma

Elastofibroma is a relatively rare soft tissue mass. The lesion is probably reactive and occurs most commonly in the periscapular region. It is a degenerative benign neoplasm with the clinical appearence of a malignant tumour. The present report describes the case of a 70-year-old man with bilateral elastofibroma. The diagnosis was established with needle aspiration biopsy and positron emission tomography/computed tomography. The present case suggests that needle aspiration biopsy and positron emission tomography/computed tomography are highly useful in the diagnosis of this rare, benign tumour.

Elastofibroma dorsi--differential diagnosis in chest wall tumours

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.

Bilateral elastofibroma dorsi

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.

Elastofibroma Dorsi as Differential Diagnosis in Tumors of the Thoracic Wall

We report the case of a 73-year-old woman who presented with a soft tissue tumor located between the scapula and the rib cage. Magnetic resonance imaging showed an inhomogeneous tumor on the right dorsolateral thoracic wall that measured 7 x 4 x 7 cm with contrast enhancement. The findings were suggestive of partial infiltration of intercostal muscles and were suspicious of a malignant tumor. After local excision at a district hospital had failed to render definitive diagnosis, the patient underwent complete resection of the tumor at our institution. Histology from the specimen was consistent with elastofibroma dorsi with free resection margins.

F-18 FDG Uptake Associated With Elastofibroma Dorsi

A patient with a history of colon carcinoma and computed tomography (CT) evidence suggestive of a liver metastasis underwent an F-18 FDG PET scan. The PET scan confirmed a metastasis in the left lobe of the liver. The study also demonstrated bilateral symmetric uptake involving the inferior subscapular regions. Correlation with the previous CT showed this to correspond to bilateral elastofibroma dorsi, which had been prospectively reported on the CT. Elastofibroma dorsi is a rare benign mass consisting of fibroelastic tissue and fat. It has been previously described on PET, CT, ultrasound, and magnetic resonance imaging (MRI). On CT, the masses are of soft tissue density, similar to adjacent musculature, and may contain linear areas of low density secondary to fat. On MRI, elastofibroma dorsi has been shown to have variable enhancement, which may reflect increased vascularity of the lesion. In this case, the masses demonstrated low-grade diffuse F-18 FDG uptake.