Elastofibroma dorsi: The clunking tumour that need not cause alarm

Abstract

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 8.2cm. 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 5cm 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.

Retrospective analysis of 73 cases of elastofibroma

“…Furthermore, the data from this group showed that the left and right lesions often had different sizes and the right lesions were larger than the left lesions. The maximum diameter of the right lesions ranged between 2cm and 12cm, with a thickness of about 1-6cm; average volume (mean ± standard deviation) was about 143.24 ± 147.80cm 3 . The maximum diameter of the left lesions ranged between 2.5cm and 10cm, with a thickness of about 0.7-6cm; average volume was about 121.59 ± 116.95cm 3 .…”

“…The maximum diameter of the right lesions ranged between 2cm and 12cm, with a thickness of about 1-6cm; average volume (mean ± standard deviation) was about 143.24 ± 147.80cm 3 . The maximum diameter of the left lesions ranged between 2.5cm and 10cm, with a thickness of about 0.7-6cm; average volume was about 121.59 ± 116.95cm 3 . The volumes of the left and right lesions were significantly different (z = 1.000, P < 0.05).…”

“…Literature exclusion criteria included elastofibroma with only a clinical diagnosis without pathological confirmation and cases with incomplete unobtainable clinical data. No more than 600 previously reported cases were obtained (3)(4)(5)(6). Elastofibroma is a rare benign soft-tissue tumour, and in 99% of cases, the tumours were located in the bilateral inferior angles of the scapulae, showing significant site tendency, and elastofibromas were rare in other sites.…”

“…Since then, less than 600 cases have been reported. [3][4][5][6] Approximately 99% of elastofibromas are located in the soft tissue in the inferior angles of the scapulae, deep in the latissimus dorsi, in the serratus anterior and rhomboids, and lateral to the ribs and intercostal muscles. 7 Elastofibromas have been reported to occur in other rare sites, including the hands, 8 feet, 9 mouth, 10 joints, 11 mediastinum, 12 and aorta.…”

Elasto fibroma Dorsi: a case report of bilateral tumours and excision of the symptomatic lesion in a male patient

“…Male patients make up 10% of all cases and bilateral tumours in a male patient is extremely rare [ 1 ]. Magnetic resonance imaging (MRI) is the imaging modality of choice and surgery usually entails a simple excision due to a low risk of recurrence [ 2 ]. A tissue diagnosis is required to exclude a soft tissue sarcoma or if conservative management is being contemplated [ 3 ].…”