MRI findings and demographics of elastofibroma dorsi: assessment of diffusion-weighted imaging and contrast enhancement patterns

Isolated Elastofibroma of the Thigh: A Case Report

A 55-year-old female presented with elastofibroma of the thigh. On presentation, she complained of a palpable, painful mass on the anterolateral right thigh that had been present for one year. She had a history of surgery for a right femur fracture. On MRI, a soft-tissue mass was seen in the vastus intermedius muscle, as a heterogeneous lesion with streaky fatty and fibrous components. The fibrous component was isointense to the muscle, and the fatty component had a high signal on both T1- and T2-weighted images. Histopathological analysis after biopsy established the diagnosis of elastofibroma.

The First-Reported Presentation of Quadruple Locations of Elastofibroma Dorsi: A Case Report and Review of the Literature

Elastofibroma dorsi (EFD) is an uncommon benign tumor of mesenchymal origin that usually occurs in the subscapular region. Bilateral and triple EFD are frequently reported in the literature but cases with more lesions have never been described. Our patient is a 50-year-old female with quadruple locations of bilateral suprascapular and subscapular EFD who presented with left shoulder pain and swelling over the affected area. Clinical presentation, computed tomography (CT) and magnetic resonance imaging (MRI), and biopsy were consistent with EFD. Therapeutic excision was performed and successfully alleviated the patient's discomfort. This report presents the first case of quadruple locations of EFD and highlights the value of MRI in the diagnosis of EFD, especially when there are multiple masses with indistinct margins are deeply located in the chest wall.

[Elastofibroma dorsi: Diagnosis and follow-up in primary care]

OBJECTIVE

To present a series of patients with elastofibroma dorsi (ED) in order to recall the pathology and justify its diagnostic and therapeutic management in the primary care setting.

MATERIALS AND METHODS

Retrospective observational and longitudinal study of 12 patients with 18ED. Epidemiological, clinical and imaging characteristics were analysed. Treatment outcomes were assessed in terms of pain (VAS scale), shoulder function (Constant and Murley scale) and quality of life (EuroQol-5 dimension scale, EQ-5D). The mean follow-up of the cases was 60.5months (5years, range 1-161months).

RESULTS

Six patients were male and six were female, with a mean age at diagnosis of 59years. The diagnosis of suspicion in all cases was based in clinical and imaging findings. Only three required surgery. The results of all were satisfactory.

CONCLUSIONS

Both the diagnosis and the indication for treatment of an ED can be made in the primary care setting. In typical cases, which are the majority, the clinical history and an ultrasound study allow a diagnosis of certainty. The indication for conservative or surgical treatment depends on the informed patient. When there are diagnostic doubts or the patient wishes surgical resection of the tumour, the patient should be referred to a hospital specialist.

Inverted intercostal hernia of elastofibroma dorsi mimicking well-differentiated liposarcoma in the chest wall

Elastofibroma dorsi is a well-known benign chest wall tumor. Herein, we present a case in which an elastofibroma protruded into the thoracic cavity, leading to inverted intercostal hernia. Imaging revealed a soft tissue mass containing fat, typical of elastofibroma dorsi; however, precise diagnosis was difficult owing to the location of this mass that protruded into the thoracic cavity. Liposarcoma had to be ruled out because it was a growing fat-containing mass. Considering that the tumor moved while the patient was undergoing computed tomography-guided biopsy in the prone position, a diagnosis of inverted intercostal hernia of elastofibroma dorsi was made. We report this case with a review of current literature.

Surgery for elastofibroma dorsi: optimizing the management of a benign tumor-an analysis of 70 cases

Background

Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements. The present literature relies only on few small case series. The aim of this study was to analyze the surgical management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique, post-operative outcome and follow-up.

Methods

We conducted a single-center retrospective cohort analysis of patients operated for ED between 2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a muscle-sparing approach was performed. An open-door follow-up policy was adopted. All clinical, radiological, perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis was performed to investigate risk factors for postoperative complications. Correlations analysis between radiological and pathological measurements of elastofibroma was conducted.

Results

Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the highest correlation with pathological size (r=0.819), US the lowest (r=0.421).

Conclusions

Marginal resection through a muscle-sparing approach is safe and effective for the treatment of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the absence of recurrence after complete resection, an open-door follow-up may be appropriate.

Elastofibroma dorsi: What's new?

Elastofibroma dorsi is a rare slowgrowing soft tissues tumor. The lesion usually grows near the shoulder but could also involve other location. Pathogenesis of elastofibroma dorsi is still unknown and in the literature, there are mostly described case report or case series. The aim of our study is to summarize the recent innovation in the histology and immunoistochemical finding about elastofibroma and update the radiological algorithm of diagnosis.

Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity?

Objective

The aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED.

Methods

We retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed.

Results

Of the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35–91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481–2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25–7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report.

Conclusion

Here, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups.

Level of Evidence

Level IV, Diagnostic Study.