Elastofibroma dorsi--differential diagnosis in chest wall tumours

Elastofibroma Dorsi: Case Series of a Rare Chest Wall Pseudotumor

BACKGROUND

Elastofibroma dorsi (EFD) is a pseudotumor of the thoracic wall that can be difficult to diagnose due to its rarity. Prompt recognition can limit unnecessary workup and expedite treatment. This study retrospectively analyzed patients with a diagnosis of EFD, discussing clinical presentations and surgical outcomes.

METHODS

This is an IRB-approved single-center retrospective study of all patients with a diagnosis of elastofibroma at our institution between 2000 and 2022.

RESULTS

Ten patients were identified to have a pathologic diagnosis of EFD since 2000, with half presenting in the last 5 years. Our cohort had an average age of 56.8 years and was 50% female. The average age of male subjects was younger than females, 49.6-64.0 years, respectively (p = 0.10). Eighty percent (8/10) of patients had unilateral EFDs and symptoms lasted 27.1 months on average prior to diagnosis. Surgical resection was performed on 66.67% (8/12) of masses, with 87.5% (7/8) of patients who underwent surgery reporting complete resolution of their symptoms and none reporting recurrence.

CONCLUSIONS

Although EFD is a rare pseudotumor, its incidence may be increasing. As such, surgeons should be aware of the typical clinical presentation; specifically, a slow growing, predominantly unilateral, painful, subscapular mass with an inhomogeneous pattern on imaging. Originally thought to predominantly affect elderly women, our study shows that younger men may be at risk as well. If patients present with EFD, complete surgical resection should be performed to achieve favorable outcomes and resolution of symptoms.

Isolated Elastofibroma of the Thigh: A Case Report

A 55-year-old female presented with elastofibroma of the thigh. On presentation, she complained of a palpable, painful mass on the anterolateral right thigh that had been present for one year. She had a history of surgery for a right femur fracture. On MRI, a soft-tissue mass was seen in the vastus intermedius muscle, as a heterogeneous lesion with streaky fatty and fibrous components. The fibrous component was isointense to the muscle, and the fatty component had a high signal on both T1- and T2-weighted images. Histopathological analysis after biopsy established the diagnosis of elastofibroma.

The First-Reported Presentation of Quadruple Locations of Elastofibroma Dorsi: A Case Report and Review of the Literature

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.

Subscapular elastofibrolipoma treated with marginal resection: two case reports

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.

Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System

Bone and soft-tissue tumors display a wide range of metabolic activity on flurodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) imaging due to their varying histopathological features. Several benign tumors show high FDG uptake similar to that seen in malignant lesions and their metabolic characteristics can overlap. Certain benign tumors can potentially undergo malignant transformation and FDG PET/CT can play an important role in detecting malignant change. The intensity of metabolic activity on FDG PET/CT correlates with histological grade of malignant tumors and also acts as a valuable prognostic factor. FDG PET/CT plays an important role in the staging work up of bone and soft-tissue malignancies. It has been found to be superior to conventional imaging techniques primarily for detecting distant metastatic disease. Because of its ability to detect metabolic changes, FDG PET/CT is a very useful in assessing response to treatment. Metabolic response seen on FDG PET is a powerful surrogate marker of histopathological response to chemotherapy. The purpose of this article is to study the variable patterns of FDG uptake in tumors of the musculoskeletal system, describe the clinical utility of FDG PET/CT in predicting malignant change in benign tumors and discuss its role in staging, response assessment, and prognostication of malignant lesions.

Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report

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.

Elastofibroma Dorsi, a Rare Condition, with Challenging Diagnosis. Case Report and Literature Review

Elastofibroma dorsi (ED) is known as a particular clinical and biological entity. We report a case of a bilateral elastofibroma dorsi (ED) in a 65-year-old female who presented to the Department of General and Oncologic Surgery of Emergency Clinical Municipal Hospital Timisoara, Romania. The patient was symptomatic on the right side, presenting pain in the interscapulothoracic region associated with a variable tumoral mass, dependent on the position of the right arm. Imaging studies revealed a well-defined, bilateral tumoral mass with alternation of the muscular and fatty tissue. The initial diagnosis of lipoma was taken into consideration based on the CT scan and clinical findings. Surgical excision of the right subscapular tumor was performed without any postoperative complications. Microscopic examination of hematoxylin and eosin, Masson’s trichrome, and orcein stained slides revealed the diagnosis of ED. Considering the high rate of reported postoperative complications and the asymptomatic presentation of the contralateral subscapular mass, the patient underwent clinical and imagistic monitoring for the contralateral tumor. Due to its rare nature, ED is a difficult preoperative diagnosis that can, however, be suggested by its specific location and may require an accurate histopathological examination for a final diagnosis.

Elastofibroma dorsi: a case report of bilateral occurrence and review of literature

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.

Elastofibroma Dorsi: Case Report with Point of Care Ultrasound Primary Care Applications

Elastofibroma dorsi (ED) is an uncommon, benign, slow-growing soft tissue tumor with an unclear etiology. The growth often presents as a local deformity with mild pain or discomfort in the subscapular region of geriatric populations. The following paper discusses a 73 year old female with mildly painful ED who presented to her primary care physician. We further review current literature on epidemiology, utilization of point of care ultrasound (POCUS) and treatment options.

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.

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.

Retrospective analysis of 73 cases of elastofibroma

OBJECTIVE

Elastofibroma is a rare soft-tissue tumour. This study retrospectively analysed and summarised the clinical, imaging and typical pathological features, together with the short- and long-term surgical outcomes of patients with pathologically confirmed soft-tissue elastofibroma to improve their management.

MATERIALS AND METHODS

We enrolled 73 patients with pathologically confirmed soft-tissue elastofibroma from January 2010 to December 2018. The general, clinical, diagnostic and treatment-related data, operation notes, pathological examination results and follow-up status were obtained by reviewing inpatient medical records. Disease onset age, sex, tumour location and size were statistically analysed using the chi square and rank sum tests.

RESULTS

A total of 90 lesions from 73 patients were examined. Among these, 56 patients had single lesions: 27 were under the right scapula, 26 were under the left scapula, 1 at the umbilicus, 1 on the aortic valve, 1 on the right hip and 17 at the bilateral inferior angles of the scapula. The average age at onset was 56.4 years (range: 6-82 years). The male-to-female incidence ratio was about one to three. Tumour diameter and follow-up duration ranged from 2cm to 12cm and from one month to nine years, respectively; recurrence was not observed. The main postoperative complication was wound effusion, occurring in 24 sites among the 90 lesions, corresponding to an incidence rate of 26.7%.

CONCLUSIONS

A correct diagnosis of elastofibroma can be made prior to surgical resection by examining typical clinical features and characteristic imaging findings. Short- and long-term outcomes of local excision are good, with no further recurrence.

Concomitant bilateral elastofibroma in the infrascapular and gluteal regions: a report of a rare case

BACKGROUND

Elastofibroma is a benign soft tissue tumor characterized by the presence of elastic fibers in a stroma of collagen and mature adipose tissue. It is reported to have a prevalence of 2.73%, as shown by a study through computed tomography (CT) images. However, multiple elastofibromas are uncommon.

CASE PRESENTATION

We report a case of concomitant bilateral elastofibroma in the infrascapular and gluteal regions. A 63-year-old male patient presented with a 6-month history of gradually increasing painless swellings in the upper back. On physical examination, firm, painless bilateral infrascapular masses were identified; these masses were more noticeable on forward arm flexion. Contrast-enhanced computed tomography showed well-defined bilateral infrascapular masses deep to the serratus anterior muscles as well as poorly defined bilateral gluteal masses with attenuation similar to that of the adjacent skeletal muscle. Magnetic resonance imaging revealed heterogenous masses with internal fatty streaks, consistent with elastofibroma. The histopathological diagnosis of elastofibroma was established based on the results of image-guided core-needle biopsy. The patient underwent surgical excision of both infrascapular elastofibromas with no post-operative complications. As the gluteal masses were incidental, surgical management was not warranted.

CONCLUSION

The presence of multiple elastofibromas is unusual. This report describes a rare case of multiple elastofibromas and its typical imaging features, and alerts us that elastofibromas are not exclusive to the periscapular region.

Scapulothoracic pathology: review of anatomy, pathophysiology, imaging findings, and an approach to management

Symptomatic scapulothoracic disorders, including scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders involving the scapulothoracic articulation that have the potential to cause significant patient morbidity. Scapulothoracic crepitus is the presence of a grinding or popping sound with movement of the scapula that may or may not be symptomatic, while scapulothoracic bursitis refers to inflammation of bursa within the scapulothoracic articulation. Both entities may occur either concomitantly or independently. Nonetheless, the constellation of symptoms manifested by both entities has been referred to as the snapping scapula syndrome. Various causes of scapulothoracic crepitus include bursitis, variable scapular morphology, post-surgical or post-traumatic changes, osseous and soft tissue masses, scapular dyskinesis, and postural defects. Imaging is an important adjunct to the physical examination for accurate diagnosis and appropriate treatment management. Non-operative management such as physical therapy and local injection can be effective for symptoms secondary to scapular dyskinesis or benign, non-osseous lesions. Surgical treatment is utilized for osseous lesions, or if non-operative management for bursitis has failed. Open, arthroscopic, or combined methods have been performed with good clinical outcomes.

Elastofibroma dorsi

We present a 60-year-old man with biopsy-proven metastatic squamous cell carcinoma of the right inguinal and external iliac lymph nodes with unknown primary. Hypermetabolic soft tissue masses were identified in bilateral subscapular regions on follow-up positron emission tomography (PET)-computed tomography (CT) after completion of chemoradiation. The right subscapular mass was biopsied under CT guidance, and histopathology showed it to be elastofibroma dorsi. Elastofibroma dorsi is a benign tumor with no malignant potential; due to its ill-defined appearance and tracer uptake on PET-CT, it can be misdiagnosed as soft tissue sarcoma. This report describes the typical location and imaging features of this incidental hypermetabolic mass.

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: case report and review of the literature

Elastofibroma dorsi (ED) is an uncommon benign soft tissue tumor with an uncertain pathogenesis. It mostly occurs in the infrascapular region of elderly people with a female predominance. Typically bilateral, ED can also be unilateral. While many patients remain asymptomatic, ED can be responsible of a periscapular arch source of ache. The diagnosis of ED is set on magnetic resonance imaging, and the pathological study ensures the diagnosis after surgical excision and establishes the differential diagnosis with malignant neoplasic process. The prognosis is excellent with extremely rare recurrence cases. Herein we report a case of a 54-years-old woman with a bilateral painful ED. The diagnosis was based on clinical and MRI findings that revealed bilateral tumors. Surgery was decided due to the symptomatic nature of the tumors. Pathological study confirmed the diagnosis. The post operative course was uncomplicated. We update through a review of the literature aspects of the diagnostic and therapeutic care of Elastofibroma dorsi.

A Unique Case of Pancreatic Mass due to Pancreatic Elastofibromatosis

Elastofibroma is a benign tumor of the musculoskeletal system characterized by the abnormal accumulation of elastinophilic fibers. It has been classically described for subscapular region but has been reported in several musculoskeletal sites over the years and rarely even in the GI tract but never in pancreas. We therefore present the case of a 45-year-old female who presented with intermittent abdominal pain. CT of abdomen revealed 1.4 cm pancreatic neck lesion without peripancreatic lymphadenopathy. Endoscopic ultrasound (EUS) guided FNA was nondiagnostic. Surgical resection was performed with central pancreatectomy. Histopathology revealed well demarcated nodules of hypocellular collagen with abundant elastic fibers, characteristic of pancreatic elastofibroma. Treatment is not needed unless symptomatic and surgical resection is the preferred therapeutic option when indicated. This case adds another entity to the differential diagnosis of pancreatic mass lesions.

Incidental detection of elastofibroma dorsi on PET-CT: initial findings and changes in tumor size and standardized uptake value on serial scans

OBJECTIVE

We describe changes in elastofibroma dorsi (EFD) as observed in serial fluorine-18 fluorodeoxyglucose (F-FDG) PET-computed tomography (CT) imaging studies.

MATERIALS AND METHODS

F-FDG PET-CT studies carried out between January 2006 and January 2015 at a single institution were reviewed by an experienced radiologist and nuclear medicine specialist. When available, previous or subsequent imaging studies were reviewed to evaluate changes in EFD.

RESULTS

Of 28 500 PET-CT studies carried out, EFD was identified in 68 from 20 patients (mean age 67.1±10.2 years; 14 women). Five patients had unilateral lesions and 15 patients had bilateral lesions. Eighteen patients had oncologic diseases. The mean size of EFD at first presentation was 13.95±5.90 mm and the mean homogeneous low-grade F-FDG uptake was maximum standardized uptake value (SUVmax) 2.24±0.95. One or more additional CT scans were performed in 17 patients; the mean interval between the first and last scans was 57.4±39.2 months. EFD was unchanged in size in 7/17 (41%) and showed slow growth in 10/17, reaching a mean size of 19 mm. The mean monthly growth rate was 0.1±0.10 mm. PET imaging in 11 patients showed a mean first SUVmax of 2.08±1.17 and a mean last SUVmax of 2.74±1.05 after a mean of 47.5±31.5 months (P=0.63).

CONCLUSION

Serial PET-CT studies may show a stable or slowly enlarging mass on a CT scan without changes in F-FDG uptake on PET imaging. Familiarity with CT appearances and F-FDG uptake of EFD are important for correct interpretation of F-FDG PET-CT studies.

Elastofibroma: An Uncommon Tumor Revisited

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.

Elastofibroma dorsi: The clunking tumour that need not cause alarm

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.

The comparison of measurement accuracy among three different imaging modalities in evaluating elastofibroma dorsi. An analysis of 52 cases

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.

Bilateral elastofibroma dorsi: A case report

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.

Elastofibroma of scapula: a case report and literature review

Elastofibromas are benign soft tissue tumors. They occur mostly in 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 etiology of this lesion remains uncertain and is a source of ongoing debate. We herein report a 54-year-old female patient, manual worker who presented with bilateral subscapular slow growing tumors for 7 months. Physical examination showed two masses of 4 cm in diameter on the right, and 8 cm on the left, both located inferior to the inferior margin of the scapula. They were more or less firm and mobile on palpation. Computed tomography scan showed large fusiform subscapular soft tissue heterogeneous solid masses with linear areas of low density secondary to fat. The lesions measured 5 cm × 4 cm on the right side and 8 cm × 8 cm on the left. Resection of the largest left tumor was achieved. Macroscopic and histological findings were consistent with elastofibroma.

Elastofibroma dorsi: clinicopathological analysis of 76 cases

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Elastofibroma dorsi: Surgical indications and complications of a rare soft tissue tumor

Elastofibroma dorsi (ED) is a tumor that develops in the space between the lower angle of the scapula and the posterior thoracic wall. Due to the rarity of this type of tumor, the number of reported consecutive series is limited. Surgical excision, usually recommended for symptomatic cases to confirm diagnosis and relieve symptoms, has been associated with a high complication rate. To analyze the clinical characteristics and outcomes of surgical treatment, we retrospectively reviewed 20 consecutive cases of surgically resected ED. Of the 20 patients, 14 (70%) exhibited preoperative symptoms associated with the tumor. The mean diameter of the resected tumors averaged 72 mm (range, 45-110 mm). The surgical outcomes were satisfactory, except for the development of hematoma or seroma in 9 cases (43%), 8 of which achieved a complete resolution with conservative treatment. Age, hypertension, the presence of preoperative tumor-related symptoms and intraoperative bleeding were not found to be significantly associated with the incidence of hematoma. However, tumor diameter and the duration of postoperative drainage were significantly associated with occurrence of hematoma (P=0.02 and P=0.01, respectively). Surgical resection should only be recommended for symptomatic patients, due to the high incidence of postoperative complications. To prevent the development of postoperative hematoma or seroma, careful observation of the wound, with suction drainage for >7 days and additional surgical procedures to facilitate adhesion of the wound margins, are recommended.

Elastofibroma dorsi management and outcomes: review of 16 cases

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.

Painful elastofibroma dorsi: a report of a case and a brief review of the literature

Elastofibroma dorsi (ED) is an uncommon, slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. Though many patients are asymptomatic, ED can cause local deformity and symptoms such as periscapular pain or discomfort. Herein we report a case of a 65-year-old woman with painful ED. Clinical features, radiodiagnostic, intraoperative, and pathologic findings, and a brief review of the literature are performed.

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.

[Dorsi elastofibroma. About 14 cases, and review of the literature]

Elastofibroma dorsi is a benign tumor which usually occurs at the inferior angle of the scapula. We retrospectively reviewed 14 cases of elastofibroma dorsi, in nine patients. The patients were hospitalized in the departments of plastic surgery, orthopedic surgery or visceral surgery. Mean age was 67 years. The location of the lesions (bilateral in five patients) was typical, in the thoracoscapular region. Nine lesions were removed surgically, six shoulders were asymptomatic after surgery. Elastofibroma is a rare, slow-growing lesion. It occurs in connective tissue of the infrascapular region of elderly patients. The pathogenesis of the lesion still remains unclear. MRI and computed tomography are useful for assessment of elastofibroma dorsi, and can potentially help avoid the need for unnecessary biopsy and surgery, especially in the asymptomatic patient. It should be surgically removed only in symptomatic patients.

Elastofibroma dorsi: diagnostic and therapeutic algorithm

BACKGROUND

Elastofibroma typically occurs in the subscapular region of elderly individuals and has a high incidence in Kyushu and the surrounding islands in southern Japan. The treatment of this lesion is somewhat controversial.

PATIENTS AND METHODS

Eleven patients with a diagnosis of elastofibroma dorsi were identified from the unit's database. The clinical presentation, diagnosis, and treatment options were evaluated.

RESULTS

There were 6 men and 5 women, with a mean age of 66.7 years (range, 49-82 years). Bilateral lesions were found in 2 patients. The mean lesion size was 6.6 cm in greatest dimension (range, 5-9 cm). The mean follow-up of both surgically and conservatively managed patients was 16.4 months (range, 2-69 months). All were diagnosed by magnetic resonance imaging, and early in the series, 1 also underwent an open biopsy to confirm the diagnosis. Five patients underwent marginal excision of the lesion. No recurrence was observed at last follow-up.

CONCLUSIONS

Magnetic resonance imaging can be used as a first-line investigation of the lesion, and biopsy is not necessary in most cases. We suggest that a conservative "wait-and-watch" attitude is reasonable and may be considered even when patients are symptomatic.

Bilateral elastofibroma dorsi

Elastofibroma dorsi is a slow-growing, noncapsulated, benign, solid, and soft tissue tumor. It is usually located in the infrascapular region, between the thorax wall and serratus anterior and latissimus dorsi. Although elastofibroma dorsi is usually unilateral, it is also bilateral in 10% of the cases. The pathogenesis of the lesion still remains unclear. Elastofibroma dorsi should be considered in differential diagnosis of soft tissue tumors due to their specific location. As it exhibits benign behavior, it should be surgically removed only in symptomatic patients. A case bilateral elastofibroma dorsi is described and presented.

Elastofibroma dorsi: A soft tissue masquerade

Elastofibroma dorsi (ED) is a soft tissue tumor found in the subscapular region. The pathogenesis of ED is unclear, but may involve a regenerative or reactive hyperproliferation due to mechanical microtrauma. Magnetic resonance imaging (MRI) is preferred to diagnose ED and complete excision is curative. When bilateral, subscapular masses are identified in the elderly patient and MRI characteristics are typical, biopsy and excision can be avoided. Symptomatic EDs should be excised, and recurrence is rare. Three hundred and thirty cases of ED have been reported since 1980. Fourteen case series and 43 isolated case reports involved 263 women and 67 men (F:M ratio = 3.9:1), with a mean age of 62 years (range 6–94 years). Bilateral ED was present in 164 patients and unilateral ED in 157. The reported prevalence in the elderly population ranges from a minimum of 2% to a maximum of 24%.

Elastofibroma dorsi: Review of eight cases

PURPOSE

Elastofibroma dorsi (ED) is a rare, benign soft tissue tumor arising from connective tissue and usually found in the subscapular region. We conducted this retrospective study to contribute to a better understanding of this tumor, the pathogenesis of which is still unclear.

METHODS

We reviewed the medical records of eight patients treated for ED at our institution between 2003 and 2008.

RESULTS

All patients were right-handed and all except one were female. The tumor was located on the right in two patients, on the left in one, and bilaterally in five. All patients underwent complete marginal resections. The resected tumors ranged in size from 5 cm to 12 cm. The only postoperative complication was seroma, observed in two patients. No recurrences have been observed in follow-up ranging from 15 days to 5 years.

CONCLUSIONS

We could not establish a relationship between the side of the dominant hand and the tumor location. If this tumor becomes symptomatic, local excision is the best treatment; however, as malignant transformation has not been reported, follow-up is recommended for asymptomatic lesions.

The snapping scapula: diagnosis and treatment

As a largely under-recognized problem, snapping scapula stems from the disruption of normal mechanics in scapulothoracic articulation. It is especially common in the young, active patient population, and symptoms are frequently seen with overhead and throwing motions. Understanding the anatomy of the scapula and surrounding neurovascular structures is crucial in making a differential diagnosis and providing both nonoperative and surgical treatments. Common causes of snapping scapula include bursitis, muscle abnormality, and bony or soft-tissue abnormalities. Anatomic variations, such as excessive forward curvature of the superomedial border of the scapula, may also be a cause for snapping. Benign tumor conditions of the scapula can also predispose one to snapping scapula syndrome and should be thoroughly investigated during the course of treatment. Patients with snapping scapula syndrome typically present with a history of pain with overhead activities. Snapping scapula is associated with audible and palpable crepitus near the superomedial border of the scapula. Various imaging studies may be used to rule out soft-tissue and bony masses, which may cause impingement at the scapulothoracic articulation. In most cases nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. Corticosteroid injections may also be used for therapeutic and diagnostic purposes. In most cases overuse injuries and repetitive strains respond well to nonoperative treatments. When nonoperative measures fail, surgery is a proven modality, especially if a soft-tissue or bony mass is implicated. Both open and arthroscopic techniques have been described with predictable results.

Bilateral elastofibroma dorsi. A case report and review of the literature

Elastofibroma is a rare benign soft tissue lesion, typically located deep under the lower pole of the scapula. It is characterized by a fibrous and adipose tissue proliferation and most frequently affects older females. Its characteristic location and its specific aspect in imaging studies most often provides the diagnosis following an incidental discovery. Nevertheless, anatomic and pathologic confirmation is necessary to formally rule out a malignant tumor diagnosis. We report a 66-year-old woman original observation; this lady's occupation involved a number of strenuous manual activities; she consulted for chronic pain related to a left subscapular mass. MRI demonstrated, in fact, two symmetrical tumor masses under each scapula. The only symptomatic lesion was surgically excised.