Triple elastofibromas located in the supra- and infrascapular regions—a case report

Abstract

We report a case of triple elastofibromas located in the supra- and infrascapular regions. A 61-year-old female with a history of bilateral elastofibroma in the typical subscapular region (6 years before) was admitted for the evaluation of a left-sided suprascapular mass that she had first noted 3 months before. On physical examination, a firm, painless, mobile mass was palpated in the subcutaneous tissue. The patient had not observed any changes of the two known lesions over the past 6 years. The patient denied a family history of elastofibroma. The signal characteristic on T1- and T2-weighted images as well as contrast enhancement curves on dynamic study was identical in all three masses. Ultrasound-guided biopsy performed before surgical intervention confirmed the diagnosis of elastofibroma. This case report has a teaching value as, to our knowledge, it is the only one in the literature with images of synchronous elastofibromas documented by dynamic contrast-enhanced MRI. In cases of elastofibroma with diagnostic difficulties, particularly in uncommon sites, a dynamic contrast-enhanced MRI may help to establish the proper diagnosis. This case report gives an example of rare multiple elastofibromas, presents current diagnostic imaging methods, and reminds us that elastofibroma is not exclusive to the posterior thoracic region.

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

“…Hassouna et al reported a case of triple elastofibromas with one in the usual infrascapular region and the other two in the unusual suprascapular region [12]. Olchowy et al reported a similar case of triple elastofibromas with MRI documentation [13]. Nishida et al reported a case of elastofibroma that occurred in both thighs and infrascapular regions [14].…”

The Malleable Mesenchyme- Elastofibroma

“…Lesions appear between scapula and vertebrae. The neoplasm is composed of dense fascicles of collagen although elastic fibres are absent [7]. d) Malignant fibrous histiocytoma exhibits nuclear and cellular atypia and pleomorphism, storiform tumour configuration, multinucleated giant cells and an absence of elastic fibres [7].…”

“…Elastic fibres thus denominated can be segregated from amyloid deposits, which exhibits an applegreen birefringence with Congo red staining. Elastic tissue can be eliminated with elastase digestion [7,8]. Typical lesions arising in typical locations can be adequately categorized with imaging techniques.…”

“…Ultrasonography, computerized tomography (CT) and magnetic resonance imaging (MRI) can be suitably employed for probable discernment of elastofibroma (Figure 6). Radiological assessment with computerized tomography (CT) or magnetic resonance imaging (MRI) can categorically delineate bilateral lesions [7,8]. Ultrasonography depicts alternating patterns of hypoechoic and hyperechoic linearity which may be parallel to the chest wall.…”

“…Infiltration of abutting anatomic structures or associated bony lesions is absent [8]. Positron emission computerized tomography (PET CT) frequently enunciates mild to moderate uptake of fluoro-deoxy glucose, contingent to enhanced tumour vascularity, fibroblastic proliferation and inflammation within the tumefaction [7]. Upon magnetic resonance imaging (MRI), unilateral neoplasm appears as a poorly circumscribed, heterogeneous, soft tissue mass.…”