Elastofibroma: a histochemical, immunohistochemical, and ultrastructural study of two patients

Elastofibroma dorsi: What's new?

Elastofibroma dorsi is a rare slowgrowing soft tissues tumor. The lesion usually grows near the shoulder but could also involve other location. Pathogenesis of elastofibroma dorsi is still unknown and in the literature, there are mostly described case report or case series. The aim of our study is to summarize the recent innovation in the histology and immunoistochemical finding about elastofibroma and update the radiological algorithm of diagnosis.

Elastofibroma developing at the subscapular port site after thoracoscopic surgery: first case report

In recent years, the number of cancer patients who undergo endoscopic surgery has been increasing, and port-site recurrence is becoming a more common complication. A 66-year-old woman underwent thoracoscopic left lower lobectomy with lymph node dissection for pT1aN0M0 adenocarcinoma of the lung. Six years after surgery, CT revealed a subscapular tumor measuring 3 cm at the site of the surgical port wound. Although port-site cancer recurrence was suspected, needle biopsy revealed that the tumor was an elastofibroma. During 6 months of follow-up, MRI revealed no further change, and it was concluded that development of the tumor at the subscapular port site had been merely coincidental.

Elastofibroma dorsi: a histochemical and immunohistochemical study

Elastofibroma dorsi (ED) is considered a member of a heterogeneous group of benign fibrous (fibroblastic or myofibroblastic) softtissue tumors, frequently localized in the periscapular region in middle aged or older individuals. However, the pathogenesis of ED is still unclear and many authors believe that ED results from a reactive hyperproliferation of fibroblastic tissue, while others suggest that it may be a consequence of a mechanical friction. In our study, we examined 11 cases of ED using histochemical and immunohistochemical methods, in order to extend the knowledge about extracellular matrix composition and histopathogenesis of ED. From the results it appeared that stroma and interspersed spindle cells of ED were positive for both periostin and tenascin-C. Mast cells tryptase-positive were also abundant throughout the lesion. The perivascular distribution of periostin and tenascin-C, associated with the CD34 positivity, suggest that endothelial-mesenchymal transition events can account for neovascularization and production of fibroelastic tissue characteristic of elastofibroma. Our data obtained in endothelial cells cultures demonstrated that elastin production is higher when the status of confluence of the cells is low. So, we can assume that such a phenomenon is a characteristic of mesenchymal/endothelial cells CD34 positive, in which elastin production results to be inversely proportional to the vascular differentiation of cellular elements. In the light of these considerations, we think that a cancerous nature of ED is unlikely. Overall, our study report, for the first time, a detailed description of extracellular matrix composition in ED, suggesting that a mechanical strain-dependent reactivation of periostin and tenascin-C expression, as well as of elastin deposition, could be responsible for development of ED.

Elastofibromatous changes and hyperelastosis of the oral mucosa

Three cases of abnormalities of elastic fibers, two of them on the floor of the mouth and one on the lingual alveolar mucosa, close to the floor of the mouth, in a patient with history of homolateral squamous cell carcinoma of the floor of the mouth, are presented. Comparison with elastofibromatous changes and elastofibromas are made and their possible pathogenesis is discussed. It is suggested that increased awareness may facilitate recognition of such lesions as they can be easily overlooked, especially when they do not present as discrete tumors or they are associated with other "more significant" pathologic processes.

Elastofibromatous Changes in Tissues From Spinal Biopsies. A Degenerative Process Afflicting a Small but Important Subset Of Patients Operated for Spinal Canal Compression: Report of 18 Cases

Elastofibroma is a tumorlike lesion occurring usually in the subscapular region of elderly females. In this study, 18 cases of elastofibromatous tissue retrieved from the spinal canal were analyzed to elucidate its frequency and possible clinical associations. The patients included 8 men and 10 women with a mean age of 63.4 years (range, 40-84 years). The elastic nature of the material was confirmed by Weigert’s elastic stain and immunohistochemically. Elastofibroma was diagnosed in 6 patients, and elastofibroma-like tissue was found in 11 samples. The finding of elastofibromatous tissue was associated with clinical diagnosis of juxtaarticular cysts (3 cases), thickening of ligamentum flavum (4 cases), extradural expansion (2 cases), metastatic involvement of the dorsal spine (3 cases), and a vertebral fracture (1 case). Two cases were located above the transpedicular fixation. Elastofibromatous tissue may be found in approximately 2.6% of all spinal biopsies and it may take part in compression of spinal cord and nerve roots.