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Revision as of 05:26, 7 August 2019

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Elastofibroma dorsi Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Synonyms and keywords:elastofibroma dorsi

Overview

Historical Perspective

Elastofibroma was first discovered by Jarvi and Saxen, in 1961.[1]


Classification

There is no established system for the classification of elastofibroma.


Pathophysiology

Elastofibroma dorsi is a rare, slow growing, ill-defined soft tissue mass of the chest wall. It occurs most in the periscapular region.It is commonly located beneath latissimus dorsi and rhomboid major muscles near to the inferior angle of the scapula. It is a benign neoplasm with clinical appearence of a malignant tumor. [2]

The exact pathogenesis of elastofibroma dorsi is not fully understood. It is thought that elastofibroma dorsi is the result of subclinical microtrauma, reactive hyperplasia of elastic fibres and increased production of fibrous tissue. [3]

Elastofibroma often has bilateral location in the thoracic wall.[4]

On gross pathology, characteristic findings of elastofibroma include:[5]

  • A solitary, poorly circumscribed, heterogeneous, soft-tissue mass
  • Cut section are firm with grayish-white areas

On microscopic histopathological analysis, characteristic findings of Elastofibroma include: [6]

  • Eosinophilic, beaded elastic fibers with Verhoeff's elastic stain
  • Many fragmented fibers with appearance of beads on a string


Causes

The cause of elastofibroma dorsi has not been identified. Subclinical microtrauma could be one of the reasons. [3]


Differentiating Elastofibroma dorsi from Other Diseases

Elastofibroma dorsi must be differentiated from desmoid tumours, neurofibroma and liposarcoma. [7]

Epidemiology and Demographics

The prevalence of elastofibroma is approximately 11200 in men and 24400 in women per 100,000 individuals in each gender autopsies. [8]

Elastofibroma commonly affects elderly female. [9]

Elastofibroma commonly affects females ranging from 35-94 years. [10]

Female are more commonly affected by elastofibroma than men. The female to male ratio is approximately 2.1

The majority of elastofibroma cases are reported in Japan. [11]


Risk Factors

There are no established risk factors for elastofibroma.


Screening

There is insufficient evidence to recommend routine screening for elastofibroma.


Natural History, Complications, and Prognosis

Prognosis is generally excellent.

Diagnosis

Diagnostic Study of Choice

There are no established criteria for the diagnosis of elastofibroma.

History and Symptoms

The majority of patients with elastofibroma dorsi are asymptomatic. Elastofibroma may present with:[12]

  • Painless swelling
  • Pain ( less than 10% of patients)
  • Scapular snapping
  • Limitation of motion,
  • Clunking sensation in the shoulder adduction-abduction movement[13]


Physical Examination

Patients with elastofibroma usually appear normal.

Physical examination findings of Elastofibroma can include limited range of motion and swelling [13]

Laboratory Findings

There are no diagnostic laboratory findings associated with elastofibroma.

Electrocardiogram

There are no ECG findings associated with elastofibroma.

X-ray

An x-ray may be helpful in the diagnosis of elastofibroma. Findings on an x-ray suggestive of elastofibroma include soft tissue density in the periscapular region. X-ray may be normal. [14]

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with elastofibroma.

CT scan

CT scan may be helpful in the diagnosis of elastofibroma dorsi. Findings on CT scan suggestive of elastofibroma dorsi include a heterogenous soft tissue mass with poorly defined margins. [15]

MRI

Magnetic resonance imaging is the most useful diagnostic tool for diagnosis of elastofibroma dorsi. [16]

Findings on MRI suggestive of elastofibroma include solitary heterogeneous, poorly circumscribed, soft-tissue mass.[17]

The lesion is isointense to muscle in T1 and T2WI images

Other Imaging Findings

Positron emission tomography/computed tomography (PET/CT) may be helpful in the diagnosis of elastofibroma. Findings on PET/CT suggestive of elastofibroma include low to moderate metabolic activity in these patients. PET/CT shows low-grade diffuse 18F fluorodeoxyglucose uptake. [18]

Other Diagnostic Studies

Needle aspiration biopsy is helpful in the diagnosis of elastofibroma and exclude sarcoma. [14]

Treatment

Surgery

Surgical resection is considered only in symptomatic cases. [19]


Primary Prevention

There are no established measures for the primary prevention of elastofibroma.


Secondary Prevention

There are no established measures for the secondary prevention of elastofibroma.

References

  1. JARVI O, SAXEN E (1961). "Elastofibroma dorse". Acta Pathol Microbiol Scand Suppl. 51(Suppl 144): 83–4. PMID 13789598.
  2. Freixinet J, Rodríguez P, Hussein M, Sanromán B, Herrero J, Gil R (August 2008). "Elastofibroma of the thoracic wall". Interact Cardiovasc Thorac Surg. 7 (4): 626–8. doi:10.1510/icvts.2007.174722. PMID 18407963.
  3. 3.0 3.1 Machens HG, Mechtersheimer R, Göhring U, Schlag PN (October 1992). "Bilateral elastofibroma dorsi". Ann. Thorac. Surg. 54 (4): 774–6. PMID 1417241.
  4. Jena, Amitabh; Patnayak, Rashmi; Settipalli, Sarla; Nagesh, N (2016). "Elastofibroma: An uncommon tumor revisited". Journal of Cutaneous and Aesthetic Surgery. 9 (1): 34. doi:10.4103/0974-2077.178543. ISSN 0974-2077.
  5. Jena, Amitabh; Patnayak, Rashmi; Settipalli, Sarla; Nagesh, N (2016). "Elastofibroma: An uncommon tumor revisited". Journal of Cutaneous and Aesthetic Surgery. 9 (1): 34. doi:10.4103/0974-2077.178543. ISSN 0974-2077.
  6. Jena, Amitabh; Patnayak, Rashmi; Settipalli, Sarla; Nagesh, N (2016). "Elastofibroma: An uncommon tumor revisited". Journal of Cutaneous and Aesthetic Surgery. 9 (1): 34. doi:10.4103/0974-2077.178543. ISSN 0974-2077.
  7. Tetikkurt C, Tetikkurt S, Bayar N (2008). "Diagnosis of elastofibroma". Can. Respir. J. 15 (4): 217–8. doi:10.1155/2008/638624. PMC 2677955. PMID 18551204.
  8. Järvi OH, Länsimies PH (January 1975). "Subclinical elastofibromas in the scapular region in an autopsy series". Acta Pathol Microbiol Scand A. 83 (1): 87–108. PMID 1124654.
  9. Patnayak R, Jena A, Settipalli S, Nagesh N (2016). "Elastofibroma: An Uncommon Tumor Revisited". J Cutan Aesthet Surg. 9 (1): 34–7. doi:10.4103/0974-2077.178543. PMC 4812887. PMID 27081248.
  10. Patnayak R, Jena A, Settipalli S, Nagesh N (2016). "Elastofibroma: An Uncommon Tumor Revisited". J Cutan Aesthet Surg. 9 (1): 34–7. doi:10.4103/0974-2077.178543. PMC 4812887. PMID 27081248.
  11. Nagamine N, Nohara Y, Ito E (November 1982). "Elastofibroma in Okinawa. A clinicopathologic study of 170 cases". Cancer. 50 (9): 1794–805. PMID 7116305.
  12. Greenberg JA, Lockwood RC (March 1989). "Elastofibroma dorsi. A case report and review of the literature". Orthop Rev. 18 (3): 329–33. PMID 2652048.
  13. 13.0 13.1 Sarici IS, Basbay E, Mustu M, Eskut B, Kala F, Agcaoglu O, Akici M, Ozkurt E (2014). "Bilateral elastofibroma dorsi: A case report". Int J Surg Case Rep. 5 (12): 1139–41. doi:10.1016/j.ijscr.2014.10.032. PMC 4275815. PMID 25437657.
  14. 14.0 14.1 Tetikkurt C, Tetikkurt S, Bayar N (2008). "Diagnosis of elastofibroma". Can. Respir. J. 15 (4): 217–8. doi:10.1155/2008/638624. PMC 2677955. PMID 18551204.
  15. Hoffman JK, Klein MH, McInerney VK (April 1996). "Bilateral elastofibroma: a case report and review of the literature". Clin. Orthop. Relat. Res. (325): 245–50. PMID 8998883.
  16. Domanski HA, Carlén B, Sloth M, Rydholm A (December 2003). "Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: cytomorphologic study with clinical, radiologic, and electron microscopic correlations". Diagn. Cytopathol. 29 (6): 327–33. doi:10.1002/dc.10381. PMID 14648789.
  17. Go PH, Meadows MC, Deleon EM, Chamberlain RS (October 2010). "Elastofibroma dorsi: A soft tissue masquerade". Int J Shoulder Surg. 4 (4): 97–101. doi:10.4103/0973-6042.79797. PMC 3100815. PMID 21655005.
  18. Patrikeos A, Breidahl W, Robins P (September 2005). "F-18 FDG uptake associated with Elastofibroma dorsi". Clin Nucl Med. 30 (9): 617–8. PMID 16100483.
  19. Jena, Amitabh; Patnayak, Rashmi; Settipalli, Sarla; Nagesh, N (2016). "Elastofibroma: An uncommon tumor revisited". Journal of Cutaneous and Aesthetic Surgery. 9 (1): 34. doi:10.4103/0974-2077.178543. ISSN 0974-2077.


Template:WikiDoc Sources



WikiDoc Resources for Elastofibroma

Articles

Most recent articles on Elastofibroma

Most cited articles on Elastofibroma

Review articles on Elastofibroma

Articles on Elastofibroma in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Elastofibroma

Images of Elastofibroma

Photos of Elastofibroma

Podcasts & MP3s on Elastofibroma

Videos on Elastofibroma

Evidence Based Medicine

Cochrane Collaboration on Elastofibroma

Bandolier on Elastofibroma

TRIP on Elastofibroma

Clinical Trials

Ongoing Trials on Elastofibroma at Clinical Trials.gov

Trial results on Elastofibroma

Clinical Trials on Elastofibroma at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Elastofibroma

NICE Guidance on Elastofibroma

NHS PRODIGY Guidance

FDA on Elastofibroma

CDC on Elastofibroma

Books

Books on Elastofibroma

News

Elastofibroma in the news

Be alerted to news on Elastofibroma

News trends on Elastofibroma

Commentary

Blogs on Elastofibroma

Definitions

Definitions of Elastofibroma

Patient Resources / Community

Patient resources on Elastofibroma

Discussion groups on Elastofibroma

Patient Handouts on Elastofibroma

Directions to Hospitals Treating Elastofibroma

Risk calculators and risk factors for Elastofibroma

Healthcare Provider Resources

Symptoms of Elastofibroma

Causes & Risk Factors for Elastofibroma

Diagnostic studies for Elastofibroma

Treatment of Elastofibroma

Continuing Medical Education (CME)

CME Programs on Elastofibroma

International

Elastofibroma en Espanol

Elastofibroma en Francais

Business

Elastofibroma in the Marketplace

Patents on Elastofibroma

Experimental / Informatics

List of terms related to Elastofibroma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [4]

Synonyms and keywords: Elastofibroma dorsi

Overview

Elastofibroma is an ill-defined fibroelastic tumor-like condition made up of enlarged and irregular elastic fibers. On gross pathology, ill defined, nonencapsulated, rubbery, and firm, white lesion with interspersed fat are characteristic findings of elastofibroma. On microscopic histopathological analysis, heavy dense bands of collagenous tissue dissected by fat and abnormal elastic fibers are characteristic findings of elastofibroma . The elastic fibers are usually 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. Degeneration will cause the elastic fibers to appear as globules with a serrated or prickled edge. Elastofibroma may be caused by either trauma, genetic mutation, or systemic enzyme defects. Elastofibroma must be differentiated from other diseases that cause soft tissue tumor such as: spindle cell lipoma, nuchal-type fibroma, and fibromatosis colli. Elastofibroma may also be diagnosed using biopsy and histochemistry. Surgery is the mainstay of therapy for elastofibroma.

Pathophysiology

  • Elastofibroma, also called elastofibroma dorsi, is an ill-defined fibroelastic tumor-like condition made up of enlarged and irregular elastic fibers. [1] [2]
  • The tumor develops very specifically in the subscapular or infrascapular area, deep to the muscle, and can be attached to periosteum of ribs. It is usually between the shoulder blade and the lower neck, with rare tumors reported in the chest wall. [1] [3] [2]
  • The genetic mutation in has been associated alterations of short arm of chromosome 1 with the development of elastofibroma.
  • On gross pathology, ill defined, nonencapsulated, rubbery, and firm, white lesion with interspersed fat are characteristic findings of elastofibroma.
  • On microscopic histopathological analysis, heavy dense bands of collagenous tissue dissected by fat and abnormal elastic fibers are characteristic findings of elastofibroma. 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. Degeneration will cause the elastic fibers to appear as globules with a serrated or prickled edge.

Causes

Differentiating Elastofibroma from other Diseases

  • Elastofibroma must be differentiated from other diseases that cause soft tissue tumor such as:
  • Spindle cell lipoma
  • Nuchal fibroma
  • Fibromatosis colli

Epidemiology and Demographics

  • Elastoblastoma is a very rare disease.

Age

  • Elastofibroma is more commonly observed among patients aged more than 50 years old.

Gender

  • Females are more commonly affected with elastofibroma than males.
  • The female to male ratio is approximately 5:1.

Race

  • Elastofibroma usually reported more in individuals of the Japanese race.

Risk Factors

  • Common risk factor in the development of elastofibroma is trauma.

Diagnosis

Symptoms

  • Symptoms of elastofibroma may include the following:
  • Swelling
  • Pain

Physical Examination

  • Patients with elastofibroma usually appear normal.
  • Physical examination may be remarkable for:
  • Slow growing, deep-seated, firm mass, often presenting bilaterally
  • Tenderness

Other Diagnostic Studies

  • Elastofibroma may also be diagnosed using biopsy and histochemistry.

Histochemistry

Treatment

Surgery

  • Surgery is the mainstay of therapy for elastofibroma.

References

  1. 1.0 1.1 Chandrasekar, C. R.; Grimer, R. J.; Carter, S. R.; Tillman, R. M.; Abudu, A.; Davies, A. M.; Sumathi, V. P. (2008). "Elastofibroma Dorsi: An Uncommon Benign Pseudotumour". Sarcoma. 2008: 1. doi:10.1155/2008/756565. PMC 2276598. PMID 18382611.
  2. 2.0 2.1 Briccoli, A.; Casadei, R.; Di Renzo, M.; Favale, L.; Bacchini, P.; Bertoni, F. (2000). "Elastofibroma dorsi". Surgery today. 30 (2): 147–152. doi:10.1007/pl00010063. PMID 10664338.
  3. Mortman, K. D.; Hochheiser, G. M.; Giblin, E. M.; Manon-Matos, Y.; Frankel, K. M. (2007). "Elastofibroma Dorsi: Clinicopathologic Review of 6 Cases". The Annals of Thoracic Surgery. 83 (5): 1894–1897. doi:10.1016/j.athoracsur.2006.11.050. PMID 17462431.
  4. Nakamura, Y.; Ohta, Y.; Itoh, S.; Haratake, A.; Nakano, Y.; Umeda, A.; Shima, H.; Tomoda, N. (1992). "Elastofibroma dorsi. Cytologic, histologic, immunohistochemical and ultrastructural studies". Acta cytologica. 36 (4): 559–562. PMID 1636353.