Clonal chromosome aberrations secondary to chromosome instability in an elastofibroma

Diagnostic histochemistry of soft tissue lesions

Histochemical methods (HM) were, at one time, extensively used in all facets of anatomic pathology, including analysis of soft tissue lesions. That situation has changed with the advent of other adjunctive procedures, but HM still do contribute meaningfully to the evaluation of several tumefactive conditions in the soft tissue. This brief review considers selected neoplastic, quasineoplastic, and pseudoneoplastic lesions in that category, with emphasis on their histochemical properties.

Elastofibroma dorsi: clinicopathological analysis of 76 cases

BACKGROUND

We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department.

METHODS

Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma.

RESULTS

The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted.

CONCLUSION

Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.

[Bilateral elastofibroma dorsi]

BACKGROUND

Elastofibroma dorsi (EFD) is a rare form of benign soft-tissue tumour that is almost always located at the lower pole of the scapula, deep to the serratus anterior muscle. There are few reports in the dermatological literature since it rarely develops in skin or subcutaneous tissue.

CASE REPORT

We present the case of a 59-year-old man with bilateral elastofibroma dorsi. Physical examination showed two bilateral scapular masses, better visualized in abduction or antepulsion. They were firm, painless, mobile, covered by normal skin, and measured 40/35 mm on the right and 50/55 mm on the left. Ultrasound of soft tissue and a chest CT scan showed two heterogeneous masses (tissue and fat) within the serratus anterior muscle measuring 30/15 mm on the right and 60/19 mm on the left. Histopathological study of a deep biopsy done on the right helped to confirm the diagnosis of EFD. Tumour resection was done on the right.

DISCUSSION

Elastofibroma dorsi is an uncommon, benign, non-encapsulated pseudo-tumour occurring in connective tissue of the infrascapular region of elderly patients. Another mass must be sought in all cases in the corresponding contralateral site since this form of tumour is often bilateral.

CONCLUSION

EFD must be considered in the differential diagnosis of shoulder masses in elderly patients.

Elastofibroma dorsi: diagnostic and therapeutic algorithm

BACKGROUND

Elastofibroma typically occurs in the subscapular region of elderly individuals and has a high incidence in Kyushu and the surrounding islands in southern Japan. The treatment of this lesion is somewhat controversial.

PATIENTS AND METHODS

Eleven patients with a diagnosis of elastofibroma dorsi were identified from the unit's database. The clinical presentation, diagnosis, and treatment options were evaluated.

RESULTS

There were 6 men and 5 women, with a mean age of 66.7 years (range, 49-82 years). Bilateral lesions were found in 2 patients. The mean lesion size was 6.6 cm in greatest dimension (range, 5-9 cm). The mean follow-up of both surgically and conservatively managed patients was 16.4 months (range, 2-69 months). All were diagnosed by magnetic resonance imaging, and early in the series, 1 also underwent an open biopsy to confirm the diagnosis. Five patients underwent marginal excision of the lesion. No recurrence was observed at last follow-up.

CONCLUSIONS

Magnetic resonance imaging can be used as a first-line investigation of the lesion, and biopsy is not necessary in most cases. We suggest that a conservative "wait-and-watch" attitude is reasonable and may be considered even when patients are symptomatic.

Elastofibromatous changes and hyperelastosis of the oral mucosa

Three cases of abnormalities of elastic fibers, two of them on the floor of the mouth and one on the lingual alveolar mucosa, close to the floor of the mouth, in a patient with history of homolateral squamous cell carcinoma of the floor of the mouth, are presented. Comparison with elastofibromatous changes and elastofibromas are made and their possible pathogenesis is discussed. It is suggested that increased awareness may facilitate recognition of such lesions as they can be easily overlooked, especially when they do not present as discrete tumors or they are associated with other "more significant" pathologic processes.

Elastofibromatous Changes in Tissues From Spinal Biopsies. A Degenerative Process Afflicting a Small but Important Subset Of Patients Operated for Spinal Canal Compression: Report of 18 Cases

Elastofibroma is a tumorlike lesion occurring usually in the subscapular region of elderly females. In this study, 18 cases of elastofibromatous tissue retrieved from the spinal canal were analyzed to elucidate its frequency and possible clinical associations. The patients included 8 men and 10 women with a mean age of 63.4 years (range, 40-84 years). The elastic nature of the material was confirmed by Weigert’s elastic stain and immunohistochemically. Elastofibroma was diagnosed in 6 patients, and elastofibroma-like tissue was found in 11 samples. The finding of elastofibromatous tissue was associated with clinical diagnosis of juxtaarticular cysts (3 cases), thickening of ligamentum flavum (4 cases), extradural expansion (2 cases), metastatic involvement of the dorsal spine (3 cases), and a vertebral fracture (1 case). Two cases were located above the transpedicular fixation. Elastofibromatous tissue may be found in approximately 2.6% of all spinal biopsies and it may take part in compression of spinal cord and nerve roots.

Elastofibroma: Diagnosis and Treatment of Six Cases

Elastofibroma is a rare, benign pseudotumor that arises from connective tissue, most commonly found at the right scapular tip. These tumors usually can be distinguished from malignant soft-tissue tumors by their anatomical location and also through imaging techniques. Although elastofibroma is rare, it is important for surgeons to be aware of this diagnosis to prevent unnecessary biopsies and unnecessary operations. We report a series of six patients, four of whom were female, with a median age of 62.5 years, diagnosed with and treated for elastofibroma. Five of the six patients had unilateral lesions, while one patient had bilateral elastofibromas. All unilateral lesions were found on the right side. The elastofibroma in five of six patients was located on the subscapular tip, the remaining patient's elastofibroma was found on the chest wall external to the pleural surface. The pathogenesis of this lesion is discussed, as recent evidence suggests a neoplastic origin to elastofibroma. Additionally, cellular changes occurring in elastofibroma may reflect the pathogenesis of other disorders of elastic fibers.

Elastofibroma: clonal fibrous proliferation with predominant CD34-positive cells

Elastofibroma is a rare fibrous lesion that most commonly occurs in periscapular soft tissues and is characterized by accumulated abnormal elastic fibers. Although the lesion is generally regarded as a reactive process, an unusual fibroblastic pseudotumor, or as a fibroelastic tumor-like lesion, its etiology remains largely unknown. Recent cytogenetic demonstrations of chromosomal instability and some recurrent or clonal chromosomal changes have raised the possibility that the lesion represents a neoplastic process. We analyzed 14 cases of elastofibroma to further explore, morphologically and genetically, the characteristics of its cellular composition. The interspersed spindle or stellate cells showed a fibroblast-like appearance and were almost consistently positive for vimentin and frequently positive for CD34 and lysozyme immunohistochemically. No spindle cells of myofibroblastic phenotype were recognized. To assess the clonality of the lesions in female patients, the X-linked polymorphic human androgen receptor gene assay was performed using formalin-fixed, paraffin-embedded tissues. A nonrandom inactivation of the androgen receptor gene was detected in two informative cases. Thus, these findings suggest that CD34-positive mesenchymal cells are an integral component of elastofibroma, which represents a clonal fibrous proliferation.

Multiple elastofibromas

Elastofibroma is an uncommon fibroelastic tumor or tumorlike process that usually occurs between the scapula and the chest wall of elderly patients. This condition is rarely reported in the dermatologic literature, because it infrequently arises in the skin or within the subcutaneous tissue. We present a 78-year-old man with 15 separate subcutaneous nodules on the buttocks and upper extremities together with bilateral subscapular nodules. All specimens taken from different lesions were histologically confirmed as elastofibromas. As far as we know, this case with 17 distinct elastofibromas demonstrates the largest number ever reported in a single patient. Although the pathomechanism of the occurrence of multiple elastofibromas is unknown, it should be included in the differential diagnosis of multiple subcutaneous nodules.

Translocation (1;4)(p31;q34) in nonossifying fibroma

Nonossifying fibroma is a benign, lytic lesion of fibrous origin most often observed in the metaphyseal region of the long bones in children and adolescents. It is frequently asymptomatic and is often characterized by a history of spontaneous resolution. Herein, we report a clinicohistopathologically typical case of nonossifying fibroma arising in the tibia of an 18-year-old skeletally mature female. Conventional cytogenetic analysis revealed a reciprocal translocation involving bands 1p31 and 4q34 [t(1;4)(p31;q34)]. To the best of our knowledge, this is only the second reported case of a clonally aberrant nonossifying fibroma.