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

Abstract

Abstract. 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: The clunking tumour that need not cause alarm

“…The most common postoperative complications in previous series have been haematomas and seromas, at rates of up to 40% and 86%, respectively. 7,13,19,20 The complication rates in our series were lower (10.5% and 26.3%), although an apparently larger rate in other series may be related to the smaller patient numbers. Elastofibromas should be excised in a marginal fashion, and our institution has no experience of local recurrence following excision.…”

“…The median tumour diameter of 8.2cm and median age at presentation of 66 years in our cohort mirrors that of previous case series. 5,13 The diagnosis of elastofibroma may be suggested by the characteristic symptom of 'clunking' on abduction and adduction of the arm. This was present in less than 60% of our patients, however.…”

“…6 An autopsy series suggested that elastofibromas are twice as common in women than men, and rarely occur in those younger than 55 years of age. 12 Given their size and tendency to present in an elderly population, 5,13 it is not uncommon for an elastofibroma to be mistaken for a soft tissue sarcoma. The diagnosis may be indicated by a typical clinical presentation or the presence of a contralateral lesion, which reassuringly almost certainly excludes a malignant process.…”

Elastofibroma dorsi: clinical experiences of 13 cases and review of the literature

“…However, it was later observed that the condition could develop among people that do not do heavy labor, and in different localizations. The later publications argued that reactive fibromatosis, degeneration due to vascular insufficiency, elastotic degeneration, enzyme defects and systemic involvement could play a role in the pathogenesis [3,8,11]. In addition, Nagamine et al emphasized that there could be a genetic predisposition to etiology, because of the fact that they detected positive family history in 32% of the 170 cases in their study [3].…”

“…However, MRI findings are often sufficient for diagnosis [6]. The disease is frequently treated by the excision of the mass [7,8]. Total excision is necessary to prevent recurrence and to relieve pain [9].…”