Elastofibroma: clinical results after resection of a rare tumor entity

Abstract

Elastofibroma (EF) is a benign proliferation of connective tissue and is typically located at the dorsal thoracic wall. Most patients complain about pain during motion in the shoulder girdle. The aim of our study was to evaluate the outcome after surgical treatment of EF. This study provides an overview of typical clinical findings, diagnostics and pathogenesis of this rare entity. In this retrospective study we analyzed data of 12 patients (6 male, 6 female) with EF treated in our institution between 2004 and 2012. The mean follow-up was 4.7 years (range: 5 months to 7.5 years). All tumors were found to be unilateral and all patients had a negative medical history for EF. Visual analogue scale and range of motion (ROM) was documented pre- and postoperatively. In all patients indication for surgical resection was pain or uneasiness during movement. There was no statistically significant difference in ROM of the shoulder between pre- and postoperatively but all patients reported significantly less pain after surgical resection. Patients benefited from tumor resection by a significant reduction of pain levels and improvement of the motion-dependent discomfort.

Keywords: elastofibroma; orphan disease; surgical outcome; tumor.

Figure 1.

A) Paucicellular tissue composed of mesenchymal cells, fibrous, collagenous strands and elastic fibers, with irregular interdigitation into mature adipose tissue (hematoxylin-eosine-staining). B) Collagen bundles alternate with large, thick eosinophilic elastic cylinders with a dense central core interspersed with mesenchymal cells without atypia (hematoxylin-eosinstaining). C) Elastic stain demonstrates the presence of abundant elastic fibers and associated detached elastin globules (Elasticavan-Gieson).

Figure 2.

Magnetic resonance imaging of a 51 y/o female patient (No. 5) in T1 (coronal plane) and T2 (transverse plane) sequences showing the subscapular location of the elastofibroma. The tumor is located between the M.serratus anterior and M.latissimus dorsi and the thoracic wall.

Figure 3.

Macroscopic aspect after excision: mild yellow colored elastic fibers cover the tumor.

Figure 4.

With a combination of rotation and abduction of the right shoulder, this female patient (No. 4) was able to dislocate the tumour from the scapulo-thoracic space towards the medial edge of the scapula.

Figure 5.

A) Elastofibroma of the hand (Pat No. 12). After resection of the flexor retinaculum the median nerve and its branches are visible (*). B) and C) MRI of the hand (T1 weighted, coronal and sagittal). Elastofibroma is marked with white arrows.