A Unique Case of Pancreatic Mass due to Pancreatic Elastofibromatosis

Abstract

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.

Abdominal elastotic lesions. A clinicopathologic study of 23 cases

“…Elastofibroma is the least common lesion. Table 3 summarizes the clinicopathological features of the previously described 13 cases of this type of lesion [ 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], as well as the present one. The age of the patients ranged from 45 to 88 years (mean, 68.5 years; SD 11.2 years; median, 70.5 years).…”

“…In other series, some of the patients presented abdominal pain, obstruction, hematochezia, or anemia [ 3 , 4 , 12 ]. Unlike our series, other authors presented a balanced gender ratio, most lesions were found during endoscopic examination in the stomach, colon, or rectum (therefore, polypoid lesions were frequent) [ 6 , 8 ], and most of the cases showed a fibroelastosis pattern [ 8 ].…”

“…They may present as polyps [ 5 ], extensive, ill-defined, non-polyp-forming deposits [ 8 ], or pseudoneoplastic accumulations of elastic fibers [ 9 ]. Exceptionally, fibroelastotic lesions have been described in intra-abdominal solid organs, such as the liver [ 10 ] or pancreas [ 11 , 12 ] with a nodular or pseudotumoral appearance. In the gastrointestinal tract (GIT), the elastotic deposits are usually seen in the mucosa, muscularis mucosae , or submucosa layers [ 3 , 4 , 5 , 6 , 7 ], occasionally in the muscularis propria [ 8 ], and rarely in the subserosal fat [ 13 ].…”