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

Abstract

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.

Case report: Back pseudocyst of unknown origin

“…Moreover, myxomas and melanomas comprise further possible causes of back tumors. Cases of paravertebral clear cell and myxoid sarcomas as well as benign tumors such as elastofibromas have been reported in the literature to be present in the paravertebral area [ [16] , [17] , [18] ]. Although our patient did not have any constitutional symptoms, this does not eliminate the possibility of malignancy as the presence of these symptoms is rare [ 11 ].…”

The Malleable Mesenchyme- Elastofibroma

“…The neoplasm is commonly discerned within the fifth decade, in adults exceeding > 50 years with an age range of 51 years to 79 years and a mean age of tumour discernment at 68.4 years. Tumefaction discerned in children and infants is extremely exceptional [2,3]. A female predilection is observed.…”

“…Majority (90%) of neoplasms are predominantly situated within periscapular, subscapular or infra-scapular region beneath rhomboid major and latissimus dorsi muscle, deep-seated to the serratus anterior. Additionally, sites such as the axilla, oral cavity, ischial tuberosity, greater trochanter, posterior elbow, stomach, rectum, omentum, orbit, hand, foot, deltoid muscle, infra-olecranon, thoracic wall, spinal canal, gluteal and inguinal region, thigh, periosteum, mediastinum or cornea are incriminated [2,3]. The neoplasm is commonly discerned within the fifth decade, in adults exceeding > 50 years with an age range of 51 years to 79 years and a mean age of tumour discernment at 68.4 years.…”

“…Elastofibroma probably represents an exaggerated response to trauma or friction (Figure 1). Racial predilection is denominated with enhanced disease incidence in Japanese individuals [2,3]. Although bilateral, the lesion is frequent discerned upon the right side.…”

“…Bilateral lesions are discerned in roughly 33% of the subjects although neoplasms may be non-synchronous. Besides concomitant infra-scapular and infra-olecranon lesions, multiple lesions of elastofibroma are uncommonly delineated [2,3]. Although considered exceptional, elastofibroma demonstrates a variable disease prevalence of around 2.73%, as discerned with computerized tomography and nearly 24% upon autopsy of the geriatric population.…”