Elastofibroma dorsi

Patient will present with a slow growing, deep-seated, firm mass, often presenting bilaterally. There may be pain or tenderness, but this is rare.

When only present on one side, they are more often present on the right side.{{cite journal |last1=Goyal |first1=P |last2=Gandhi |first2=D |last3=Gupta |first3=S |last4=Li |first4=S |last5=Kumar |first5=Y |last6=Olsavsky |first6=TD |last7=Gupta |first7=N |title=Elastofibroma dorsi. |journal=Proceedings (Baylor University. Medical Center) |date=July 2017 |volume=30 |issue=3 |pages=340-342 |doi=10.1080/08998280.2017.11929641 |pmid=28670080|pmc=5468038 }}

There are several theories about origin:

• There is support for a genetic predisposition, as there are alterations of short arm of chromosome 1;
• Multifocality may suggest systemic enzymatic defect, resulting in abnormal elastogenesis;
• Repeated trauma or friction seems unlikely, but is still a possibility.{{Cite journal | last1 = Mortman | first1 = K. D. | last2 = Hochheiser | first2 = G. M. | last3 = Giblin | first3 = E. M. | last4 = Manon-Matos | first4 = Y. | last5 = Frankel | first5 = K. M. | title = Elastofibroma Dorsi: Clinicopathologic Review of 6 Cases | doi = 10.1016/j.athoracsur.2006.11.050 | journal = The Annals of Thoracic Surgery | volume = 83 | issue = 5 | pages = 1894–1897 | year = 2007 | pmid = 17462431 }}

By computed tomography, there is a poorly circumscribed, heterogeneous soft tissue mass, with a signal intensity similar to skeletal muscle. The fact that the lesion may be bilateral, helps eliminate a sarcoma from further consideration.{{Cite journal | last1 = Ochsner | first1 = J. E. | last2 = Sewall | first2 = S. A. | last3 = Brooks | first3 = G. N. | last4 = Agni | first4 = R. | title = Best Cases from the AFIP: Elastofibroma Dorsi | doi = 10.1148/rg.266055184 | journal = Radiographics | volume = 26 | issue = 6 | pages = 1873–1876 | year = 2006 | pmid = 17102057 | doi-access = }} At US, elastofibromas are depicted deep to the musculature as a multilayered pattern of hypoechoic linear areas of fat deposition intermixed with echogenic fibroelastic tissue.Ochsner JE, Sewall SA, Brooks GN, Agni R. Best cases from the AFIP: Elastofibroma dorsi. Radiographics 2006; 26: 1873-6. The mass often protrudes from the subscapular region upon shoulder abduction, allowing better delineation of the finding.Arend CF. Ultrasound of the Shoulder. Master Medical Books, 2013. Free section on elastofibroma dorsi as a cause of snapping scapula available at [http://www.shoulderus.com/ultrasound-of-the-shoulder/scapulothoracic-joint-ultrasound-snapping-scapula/ ShoulderUS.com]

In general, the tumor is an ill-defined, nonencapsulated, rubbery, and firm, white lesion with interspersed fat. The tumors can be quite large (up to 20 cm), although most are around 5 cm.File:Hematoxylin_and_Eosin_stained_photomicrograph_of_an_elastofibroma_LDRT.tif

By microscopie view, there is an admixture of heavy dense bands of collagenous tissue dissected by fat and abnormal elastic fibers. The elastic fibers are often quite large and are easily identified. The elastic fibers are coarse, thick, and darkly eosinophilic, often fragmented into globules, creating a "string of pearls" or "pipe cleaner" appearance. Because of degeneration, the elastic fibers will appear as globules with a serrated or "prickled" edge.

File:Elastofibroma_stained_with_elastic_stain_LDRT.tif The elastic fibers will be highlighted by a Weigert or von Gieson elastic stains.{{Cite journal | last1 = Nakamura | first1 = Y. | last2 = Ohta | first2 = Y. | last3 = Itoh | first3 = S. | last4 = Haratake | first4 = A. | last5 = Nakano | first5 = Y. | last6 = Umeda | first6 = A. | last7 = Shima | first7 = H. | last8 = Tomoda | first8 = N. | title = Elastofibroma dorsi. Cytologic, histologic, immunohistochemical and ultrastructural studies | journal = Acta Cytologica | volume = 36 | issue = 4 | pages = 559–562 | year = 1992 | pmid = 1636353}}

Given the anatomic site, a spindle cell lipoma, nuchal-type fibroma and fibromatosis colli are all included in the differential diagnosis.{{Cite journal | last1 = Schafmayer | first1 = C. | last2 = Kahlke | first2 = V. | last3 = Leuschner | first3 = I. | last4 = Pai | first4 = M. | last5 = Tepel | first5 = J. | title = Elastofibroma Dorsi as Differential Diagnosis in Tumors of the Thoracic Wall | doi = 10.1016/j.athoracsur.2005.10.049 | journal = The Annals of Thoracic Surgery | volume = 82 | issue = 4 | pages = 1501–1504 | year = 2006 | pmid = 16996964 | doi-access = free }}

Simple excision is the treatment of choice, although given the large size, bleeding into the space can be a potential complication. Isolated recurrences may be seen, but there is no malignant potential.{{Cite journal | last1 = Parratt | first1 = M. T. R. | last2 = Donaldson | first2 = J. R. | last3 = Flanagan | first3 = A. M. | last4 = Saifuddin | first4 = A. | last5 = Pollock | first5 = R. C. | last6 = Skinner | first6 = J. A. | last7 = Cannon | first7 = S. R. | last8 = Briggs | first8 = T. W. R. | doi = 10.1302/0301-620X.92B2.22927 | title = Elastofibroma dorsi: Management, outcome and review of the literature | journal = Journal of Bone and Joint Surgery. British Volume | volume = 92-B | issue = 2 | pages = 262–266 | year = 2010 | pmid = 20130320 | doi-access = free }}

This is a very rare phenomenon (< 0.001% of soft tissue tumors), usually presenting in elderly patients (>50 years of age), and more commonly in women than men (5:1). There is an increased frequency in Okinawa, Japan, but this may be a reporting bias.

The tumor develops very specifically in the subscapular or infrascapular area, deep to the muscle, sometimes even attached to periosteum of ribs. It is usually between the shoulder blade and the lower neck, with rare tumors reported in the chest wall.

• Skin lesion

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{{cite book |author1=Lester D. R. Thompson |author2=Bruce M. Wenig |title=Diagnostic Pathology: Head and Neck: Published by Amirsys |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2011 |pages=8:30–31 |isbn=978-1-931884-61-7 }}

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Category:Dermal and subcutaneous growths