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Brindisino F, Mourad F, Maselli F. Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report. Physiother Theory Pract 2021; 38:2257-2267. [PMID: 33910473 DOI: 10.1080/09593985.2021.1920077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Elastofibroma is a benign and rare fibroblast/myofibroblast tumor usually located near the periosteum of the ribs. Patients with elastofibroma can remain asymptomatic or can experience a clicking sensation during shoulder movements, shoulder stiffness, scapular and shoulder pain and dysfunction. Importantly, the symptoms can mimic a musculoskeletal condition being mistaken for orthopedic shoulder joint disease. A 54 years-old amateur swimmer self-referred to physiotherapy for left subscapular and shoulder pain. Concerns from the patient's history that caused suspicion of a medical condition included an insidious onset of nagging deep pain that increased with upper limb exertion and an audible thoracic clunk at arm end range flexion. Deep palpatory examination revealed a mass below the latissimus dorsi and rhomboids further screened by the physiotherapist with Rehabilitative Ultrasound Imaging. The physiotherapist referred the patient to a thoracic surgeon who removed the mass. After an exercise-based physiotherapy management program, the patient returned to previous activities including swimming after 5 months. The challenge for clinicians is to screen patients in whom shoulder pain may be related to non-musculoskeletal conditions. Prompt referral of patients presenting with the suspicion of elastofibroma to an appropriate physician may lead to a timely diagnosis and could avoid expensive and unnecessary rehabilitation procedures.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Roma "Tor Vergata", Roma, Italy
| | - Firas Mourad
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Roma "Tor Vergata", Roma, Italy.,Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova-Campus of Savona, Savona, Italy
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De Weerdt G, Verhoeven V, Vrints I, Thiessen F, Tondu T. Elastofibroma dorsi: a case report of bilateral occurrence and review of literature. Acta Chir Belg 2021; 121:122-126. [PMID: 31311421 DOI: 10.1080/00015458.2019.1642595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Elastofibroma dorsi (ED) is a benign slow growing soft tissue tumor that is most frequently located subscapular. The prevalence is estimated to be 2% on imaging studies in individuals over 60 years old and might occur bilaterally. The etiology, however, remains unclear. CASE PRESENTATION This report presents the case of a man with bilateral ED. He first presented at the age of 49 with a subscapular ED on the right side and again at the age of 53 with a subscapular ED on the left side. At both times, diagnosis of ED was histopathologically confirmed after surgical resection. And, again at both times, the postoperative course was characterized by seroma development. DISCUSSION This report shows a brief review of literature on ED. It contains a summary of the current data on prevalence, etiology, clinical presentation, diagnosis, histopathological findings, surgical treatment and postoperative management. It also includes a flowchart for diagnostic and therapeutic approach. CONCLUSIONS ED might present bilaterally, though not necessarily affecting both sides simultaneously. In order to diagnose ED MRI is ought to be sufficient. Invasive procedures, i.e. complete surgical excision, are mandatory to treat symptomatic ED, although such surgical procedures are often complicated by seroma formation.
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Affiliation(s)
- Glenn De Weerdt
- Abdominal, Pediatric and Reconstructive Surgery, University Hospital Antwerp, Edegem, Belgium
| | | | - Ina Vrints
- Abdominal, Pediatric and Reconstructive Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Filip Thiessen
- Abdominal, Pediatric and Reconstructive Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Thierry Tondu
- Abdominal, Pediatric and Reconstructive Surgery, University Hospital Antwerp, Edegem, Belgium
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Scamporlino A, Ruggiero C, Aramini B, Morandi U, Stefani A. Surgery for elastofibroma dorsi: optimizing the management of a benign tumor-an analysis of 70 cases. J Thorac Dis 2020; 12:1884-1894. [PMID: 32642092 PMCID: PMC7330361 DOI: 10.21037/jtd-20-649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements. The present literature relies only on few small case series. The aim of this study was to analyze the surgical management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique, post-operative outcome and follow-up. Methods We conducted a single-center retrospective cohort analysis of patients operated for ED between 2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a muscle-sparing approach was performed. An open-door follow-up policy was adopted. All clinical, radiological, perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis was performed to investigate risk factors for postoperative complications. Correlations analysis between radiological and pathological measurements of elastofibroma was conducted. Results Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the highest correlation with pathological size (r=0.819), US the lowest (r=0.421). Conclusions Marginal resection through a muscle-sparing approach is safe and effective for the treatment of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the absence of recurrence after complete resection, an open-door follow-up may be appropriate.
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Affiliation(s)
| | - Ciro Ruggiero
- Thoracic Surgery Unit, University Hospital of Modena, Modena, Italy
| | - Beatrice Aramini
- Thoracic Surgery Unit, University Hospital of Modena, Modena, Italy
| | - Uliano Morandi
- Thoracic Surgery Unit, University Hospital of Modena, Modena, Italy
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Tepe M, Polat MA, Calisir C, Inan U, Bayav M. Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:195-198. [PMID: 31031128 PMCID: PMC6599413 DOI: 10.1016/j.aott.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/19/2018] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED. Methods We retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed. Results Of the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35–91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481–2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25–7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report. Conclusion Here, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups. Level of Evidence Level IV, Diagnostic Study.
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Affiliation(s)
- Murat Tepe
- Midyat State Hospital, Department of Radiology, Mardin, Turkey.
| | - Muhammet Ali Polat
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Radiology, Eskisehir, Turkey.
| | - Cuneyt Calisir
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Radiology, Eskisehir, Turkey.
| | - Ulukan Inan
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Orthopedic Surgery, Eskisehir, Turkey.
| | - Murat Bayav
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Radiology, Eskisehir, Turkey.
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Tsubakimoto M, Yamashiro T, Tsuchiya N, Okada M, Maehara H, Kitsukawa K, Murayama S. MRI findings and demographics of elastofibroma dorsi: assessment of diffusion-weighted imaging and contrast enhancement patterns. Acta Radiol 2018; 59:709-715. [PMID: 28920444 DOI: 10.1177/0284185117732099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Elastofibroma dorsi is a rare pseudotumoral lesion. Thus, there is no report of magnetic resonance imaging (MRI) findings that investigates multiple patients particularly with respect to diffusion-weighted imaging (DWI) findings and contrast enhancement patterns. Purpose To describe the imaging findings of elastofibroma on MRI, particularly DWI findings and contrast enhancement patterns, and to further investigate patient demographics. Material and Methods Forty-four patients with elastofibroma that underwent MRI were enrolled in this retrospective study. All images were evaluated by two radiologists to visually assess the signal intensity for each sequence. Enhanced elastofibromas were classified into four categories to assess the enhancement pattern. Differences in gender and laterality were also assessed statistically. Results An equal number of men and women were included (n = 22 each). There was no significant difference in laterality ( P = 0.783). All lesions (73 lesions) had low signal intensity on both T1-weighted (T1W) and T2-weighted (T2W) images: heterogeneous in 56, homogeneous in 17. None of the 41 lesions with DWI had true abnormal diffusion restriction. The average ADC value was 1.36 × 10-3 ± 0.29 mm2/s. All 31 lesions that had contrast-enhanced MRI were classified according to enhancement pattern: homogeneous (three lesions, 9.7%); heterogeneous (15 lesions, 48.4%); streak-like (three lesions, 9.7%); and rim-like (ten lesions, 32.2%). Conclusion There were no statistically significant differences in gender or laterality. Elastofibroma showed homogeneous to heterogeneous low signal intensity on T1W and T2W images. No lesion showed abnormal diffusion restriction, and all lesions demonstrated enhancement on MRI.
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Affiliation(s)
- Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Masahiro Okada
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Hiroki Maehara
- Department of Orthopedic Surgery, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Kaoru Kitsukawa
- Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Elastofibroma of the gluteal region with a concomitant contralateral lesion: case report and review of the literature. Skeletal Radiol 2017; 46:393-397. [PMID: 28058477 DOI: 10.1007/s00256-016-2561-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 02/02/2023]
Abstract
A 51-year-old man presented with elastofibroma (EF) of the gluteal region with a concomitant contralateral lesion. The patient presented with a slow growing mass of the proximal third of the right buttock and had swelling, discomfort in sitting, and right-hip pain during walking for 2 months. On MRI, a soft-tissue mass was noted between the gluteus maximus and the gluteus medius muscle. The mass showed similar signal intensity to the surrounding tissue on T1- and T2-weighted images and with linear hyperintense areas in its internal structure. At surgery, a soft, non-encapsulated, irregular, and rubber-like mass was found attached to the gluteus medius muscles. It was pathologically confirmed to be an EF. This unusual manifestation of an EF is discussed.
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Elastofibroma dorsi: Clinical evaluation of 61 cases and review of the literature. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:7-11. [PMID: 27780619 PMCID: PMC6197596 DOI: 10.1016/j.aott.2016.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/01/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Elastofibroma dorsi (ED) is a rare, benign, soft tissue tumor typically located between inferior corner of scapula and posterior chest wall causing mass, scapular snapping, and pain. When classic symptoms and localization are present, it is diagnosed without biopsy and treated with marginal resection. This study retrospectively analyzed patients operated on for ED to evaluate presenting symptoms, tumor size, complications, and clinical results, and to suggest optimal treatments. METHODS This study included 51 patients who underwent surgery for ED in 2 different clinics between 2005 and 2015. Patient age, gender, profession, side affected, symptoms, average duration of symptoms, and tumor size were researched. Radiological examinations of patients were evaluated. Patients with lesions larger than 5 cm in size were operated on. Postoperative complications, recurrence, and functional results were evaluated using Constant score and compared to preoperative values. RESULTS A total of 61 operated lesions of 51 patients clinically and radiologically diagnosed with ED were retrospectively evaluated. Average length of time patient experienced symptoms was 11.21 months. Lesions in 19 (37.2%) patients were bilateral, 10 of which were symptomatic and larger than 5 cm in size, meeting indication for surgery. Average lesion diameter was 8.7 cm. Average follow-up was 26.89 months. Average of preoperative Constant score of 67.28 subsequently increased to 92.88 (p < 0.05). Seroma and hematoma were observed in 11.5% of patients. CONCLUSION Generally, good clinical results can be obtained with marginal resection without requiring a biopsy, considering classic complaints and radiological appearance of ED. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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8
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Manson DE. Magnetic resonance imaging of the mediastinum, chest wall and pleura in children. Pediatr Radiol 2016; 46:902-15. [PMID: 27229507 DOI: 10.1007/s00247-016-3598-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/10/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
The acceptance of applications for the use of chest MRI in children has been somewhat slow and selective. The use of MRI to image chest wall lesions is likely the most common and widely used indication, aside from the widespread and somewhat sophisticated use of MRI in imaging the cardiovascular structures of the chest. In this respect, fairly standard variations of T1-W, T2-W and contrast-enhanced imaging can be used, similar to the sequences used for musculoskeletal lesions elsewhere in the body. Imaging of the anterior mediastinal masses should be performed in conjunction with a detailed pre-test clinical examination to determine potential cardiovascular compromise. MRI in the setting of middle mediastinal adenopathy, congenital mediastinal cysts or posterior mediastinal masses, however, has been shown to be more effective and more comprehensive than multidetector CT. Although sonographic imaging is the initial modality of choice for pleural abnormalities, MR imaging is extremely effective and clinically useful in the setting of a potentially ambiguous sonographic examination. Faster imaging protocols are likely to increase the acceptance of MRI to replace multidetector CT for many pediatric chest lesions.
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Affiliation(s)
- David E Manson
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Smith HG, Hannay JAF, Thway K, Messiou C, Smith MJF, Strauss DC, Hayes AJ. Elastofibroma dorsi: The clunking tumour that need not cause alarm. Ann R Coll Surg Engl 2016; 98:208-11. [PMID: 26890837 DOI: 10.1308/rcsann.2016.0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Elastofibromas are rare, pseudo-tumours arising at the inferior pole of the scapula that have a characteristic presentation. Due to their tissue of origin and size, they may often be mistaken for soft tissue sarcomas. We present the management of patients diagnosed with elastofibroma at a single institution. METHODS Patients diagnosed with elastofibroma between January 1995 and January 2015 were identified from a prospectively maintained histopathology database. Electronic patient records, imaging and pathology reports were retrieved and reviewed. RESULTS Thirty seven patients were identified, with a median age of 66 years and a male-to-female ratio of 1:1.6. All tumours occurred in the characteristic subscapular location. The median maximum tumour diameter was 8.2 cm. A synchronous contralateral lesion (15.8%) was found in six patients. Cross-sectional imaging was performed in 29 patients, with magnetic resonance imaging the most common modality (59.5%). Diagnosis was confirmed with percutaneous biopsy in all but one patient, who proceeded directly to surgery. Eighteen patients were managed non-operatively; 19 opted for surgical excision due to significant symptoms. Excision was performed in a marginal fashion and, at a median follow-up of 5 months, no functional impairment or local recurrences were observed. CONCLUSIONS Soft tissue masses greater than 5 cm in diameter should prompt the clinician to exclude soft tissue sarcoma. The diagnosis of elastofibroma may be alluded to by its typical presentation and can be confirmed by percutaneous biopsy. After excluding malignancy, these lesions can be safely managed non-operatively, with surgery reserved for symptomatic patients.
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Affiliation(s)
- H G Smith
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
| | - J A F Hannay
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
| | - K Thway
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
| | - C Messiou
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
| | - M J F Smith
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
| | - D C Strauss
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
| | - A J Hayes
- The Sarcoma Unit , The Royal Marsden Hospital NHS Foundation Trust , UK
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Minarro JC, Urbano-Luque MT, López-Jordan A, Roman-Torres M, Carpintero-Benítez P. The comparison of measurement accuracy among three different imaging modalities in evaluating elastofibroma dorsi. An analysis of 52 cases. INTERNATIONAL ORTHOPAEDICS 2015; 39:1145-9. [PMID: 25795250 DOI: 10.1007/s00264-015-2740-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Elastofibroma dorsi (ED) is a rare soft-tissue tumour. Diagnosis is made using imaging, mainly magnetic resonance due to its higher sensitivity and specificity in soft tissues. No agreement exists when deciding which imaging test must be used. Often multiple tests are made in the same patient, increasing time and costs. The aim of this paper is to compare the usual imaging exams and evaluate which one is the most accurate when diagnosing and measuring ED. METHODS A retrospective review was made of those patients who were diagnosed and operated for ED since January 2006 to December 2013. Fifty-two ED were included (19 men, 25 women), and eight of them were bilaterally affected. They were divided into three different groups according to the imaging test used: ultrasound (US) computed tomography (CT) and magnetic resonance (MR). After surgery the pieces were sized and compared with the measurements made by imaging exams. RESULTS Two hundred fourteen measures were analysed (40 US, 33 CT and 34 MR with their pathological equivalent). When CT group and its corresponding AP were analysed, no significant differences between them were founded (p > 0.05). Moreover, we analysed absolute differences between measures. In the US group a mean difference of 2.23 ± 1.87 cm was obtained. In the CT group, the mean difference was 1.22 ± 0.97 cm. Likewise, the difference of the MR group was 1.62 ± 1.15 cm. CONCLUSIONS This study demonstrates that the CT obtains a higher correlation than MR when determining the size of ED.
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Affiliation(s)
- Jose Carlos Minarro
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain,
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Ben Abdelghani K, Slouma M, Chekili S, Laatar A, Zakraoui L. An unusual cause of shoulder pain. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Di Vito A, Scali E, Ferraro G, Mignogna C, Presta I, Camastra C, Donato G, Barni T. Elastofibroma dorsi: a histochemical and immunohistochemical study. Eur J Histochem 2015; 59:2459. [PMID: 25820560 PMCID: PMC4378214 DOI: 10.4081/ejh.2015.2459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- A Di Vito
- Magna Græcia University of Catanzaro.
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Sarici IS, Basbay E, Mustu M, Eskut B, Kala F, Agcaoglu O, Akici M, Ozkurt E. Bilateral elastofibroma dorsi: A case report. Int J Surg Case Rep 2014; 5:1139-41. [PMID: 25437657 PMCID: PMC4275815 DOI: 10.1016/j.ijscr.2014.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/12/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Elastofibroma dorsi(EFD) is slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. As it exhibits benign behavior, it should be surgically removed only in symptomatic patients. Magnetic resonance imaging (MRI) is a useful tool for assessment of EFD and can potentially help avoid the need for unnecessary biopsy and surgery. PRESENTATION OF CASE A 62-year-old woman presented with 2 years complaint of back pain, particularly aggravated with shoulder movements and swelling with bilateral elastofibroma dorsi. Both masses were totally excised with bilateral posterolateral subscapular incision. Symptoms were completely controlled and significant discomfort from the surgical procedure was completely resolved with in a few weeks interval from the operation. DISCUSSION The pathogenesis of the EFD still remains unclear. Elastofibroma dorsi has an unspecific clinical presentation and can be confused with other tumors of the periscapular region Imaging studies are useful for diagnosis. CONCLUSION Elastofibroma dorsi is benign soft tissue tumor mostly observed in the subscapular regions of elderly female patients. The surgery is indicated in symptomatic cases and must be confined to simple excision of the lesion.
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Affiliation(s)
- Inanc Samil Sarici
- Department of General Surgery, Kadirli State Hospital, Osmaniye, Turkey.
| | - Elif Basbay
- Department of Radıology, Kadirli State Hospital, Osmaniye, Turkey
| | - Mehdi Mustu
- Department of Orthopedics, Kadirli State Hospital, Osmaniye, Turkey
| | - Burak Eskut
- Department of Respiratory Diseases, Kadirli State Hospital, Osmaniye, Turkey
| | - Ferhat Kala
- Department of General Surgery, Kadirli State Hospital, Osmaniye, Turkey
| | - Orhan Agcaoglu
- Istanbul Medical Faculty, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Murat Akici
- Istanbul Medical Faculty, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Enver Ozkurt
- Istanbul Medical Faculty, Department of General Surgery, Istanbul University, Istanbul, Turkey
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Triple locations of elastofibroma dorsi: First case report and review. J Orthop 2014; 12:S133-6. [PMID: 26719607 DOI: 10.1016/j.jor.2014.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/29/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Elastofibroma is a rare benign fibroelastic tumor. CASE We report a case of a 44-year-old woman, operated 4 months ago for a left infrascapular desmoid tumor and presented for bilateral mass of the left suprascapular and right infrascapular regions which were surgically resected. The diagnosis of elastofibroma was made and also confirmed for the left infrascapular desmoid tumor. Six months later, she presented an asymptomatic left infrascapular recurrence. Monitoring was continued and the patient is still asymptomatic after 24 months. DISCUSSION We highlight the importance of imaging features understanding in order to avoid misdiagnosis and unnecessary surgical resection.
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Pilge H, Hesper T, Holzapfel BM, Prodinger PM, Straub M, Krauspe R. Elastofibroma: clinical results after resection of a rare tumor entity. Orthop Rev (Pavia) 2014; 6:5329. [PMID: 25002937 PMCID: PMC4083310 DOI: 10.4081/or.2014.5329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/12/2014] [Accepted: 04/18/2014] [Indexed: 11/23/2022] Open
Abstract
Elastofibroma (EF) is a benign proliferation of connective tissue and is typically located at the dorsal thoracic wall. Most patients complain about pain during motion in the shoulder girdle. The aim of our study was to evaluate the outcome after surgical treatment of EF. This study provides an overview of typical clinical findings, diagnostics and pathogenesis of this rare entity. In this retrospective study we analyzed data of 12 patients (6 male, 6 female) with EF treated in our institution between 2004 and 2012. The mean follow-up was 4.7 years (range: 5 months to 7.5 years). All tumors were found to be unilateral and all patients had a negative medical history for EF. Visual analogue scale and range of motion (ROM) was documented pre- and postoperatively. In all patients indication for surgical resection was pain or uneasiness during movement. There was no statistically significant difference in ROM of the shoulder between pre- and postoperatively but all patients reported significantly less pain after surgical resection. Patients benefited from tumor resection by a significant reduction of pain levels and improvement of the motion-dependent discomfort.
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Affiliation(s)
- Hakan Pilge
- Department of Orthopedics, University Clinic Dusseldorf , Germany
| | - Tobias Hesper
- Department of Orthopedics, University Clinic Dusseldorf , Germany
| | - Boris Michael Holzapfel
- Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, Australia
| | | | - Melanie Straub
- Department of Pathology, Technical University of Munich , Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, University Clinic Dusseldorf , Germany
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Karakurt O, Kaplan T, Gunal N, Gulbahar G, Kocer B, Han S, Dural K, Sakinci U. Elastofibroma dorsi management and outcomes: review of 16 cases. Interact Cardiovasc Thorac Surg 2013; 18:197-201. [PMID: 24218496 DOI: 10.1093/icvts/ivt442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Ozgur Karakurt
- Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
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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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