A thoracic surgeon's perspective on the elastofibroma dorsi: A benign tumor of the deep infrascapular region

Abstract

Background: An elastofibroma is a benign, soft-tissue tumor and is important in the differential diagnosis of thoracic wall masses. Here, patients with elastofibromas who underwent thoracic surgery were retrospectively reviewed to elucidate elastofibroma formation and to facilitate the differential diagnosis. Methods: This is a retrospective and descriptive study of a series of 30 patients with elastofibroma dorsi. The data was obtained by review of the hospital records. Results: There were 27 female and three male patients (mean age, 55.13 Ϯ 8.7 years) with a total of 42 elastofibroma dorsi tumors (12 bilateral cases, 18 unilateral cases) diagnosed between January 2004 and October 2011. Twenty patients (67%) underwent surgery as a result of subscapular swelling and pain. In 10 (33%) asymptomatic patients, elastofibromas were found incidentally during a thoracotomy. Imaging methods in symptomatic patients included computerized tomography (15 cases), magnetic resonance (three), and ultrasonography (two). For five patients, fluorodeoxyglucose uptake values were available and revealed mild metabolic activity in the elastofibromas. Elastofibromas were significantly larger in symptomatic patients (8.15 Ϯ 1.9 vs. 6.2 Ϯ 2.3; P = 0.02). Exposure to long-term repetitive micro-trauma was a precipitating factor in 23 (77%) patients. Seroma formation, the most common surgical complication, was observed in 40% of patients. Conclusion: The differential diagnosis of elastofibroma dorsi is straightforward, and preoperative histology is unnecessary when the clinical, radiological, and metabolic characteristics are known. Repetitive micro-trauma may predispose to hyperproliferation of fibroelastic tissue, and genetics may also play a role. Surgical treatment can be reserved for cases with severe symptoms.

Bilateral elastofibroma dorsi: a case report of an uncommon and under-diagnosed tumor

“…Surgical removal of the tumors is the treatment of choice. A common postoperative complication is the formation of seroma or hematoma [ 13 , 14 ], as also seen in our patient. Recurrence after surgery is reported in just a few cases [ 15 ].…”

“…There are some studies which support this theory. For example, in a study of 30 patients with elastofibroma dorsi 63% did hand knitting [ 13 ]. Also our patient was a manual worker.…”

Elastofibroma dorsi: What’s new?

“… 9 , 10 Findikcioglu et al believe that changes in the subscapular region and repeated microtrauma predispose to elastofibroma formation. 11 In fact ED is common among physical laborers and this could explain also the right sided dominance, 12 even if this might be related to the patient’s dominant handedness. 13 Thus this correlation is still unclear.…”

Elastofibroma Dorsi: Review of Literature with Radiological Approach

“…Numerous hypothesis have been suggested in regards to its pathogenesis. One third of the patients have previous family history, which suggests a genetic predisposition, being associated to chromosomic changes and systemic enzymatic defects that produce an alteration in the development of elastic tissue [14,16]. Also, it has been related to vascular insufficiency due to microangiopathic damage [17].…”

“…Microscopic findings: Lesions composed of hyalinized tissue: eosinofilic collagen, with sinusoidal contours, intertwined with fibroblasts and islets of mature adipose tissue of different sizes [6]. The elastic fibers are degenerated, with an appearance of small linear globules [16], under a Van Gieson stain, the collagen fibers are visualized as bands that range from a brown to black coloring [8].…”