Elastofibroma dorsi: The clunking tumour that need not cause alarm

Abstract

Introduction: Elastofibromas are rare, pseudo-tumours arising at the inferior pole of the scapula that have a characteristic presentation. Due to their tissue of origin and size, they may often be mistaken for soft tissue sarcomas. We present the management of patients diagnosed with elastofibroma at a single institution.

Methods: Patients diagnosed with elastofibroma between January 1995 and January 2015 were identified from a prospectively maintained histopathology database. Electronic patient records, imaging and pathology reports were retrieved and reviewed.

Results: Thirty seven patients were identified, with a median age of 66 years and a male-to-female ratio of 1:1.6. All tumours occurred in the characteristic subscapular location. The median maximum tumour diameter was 8.2 cm. A synchronous contralateral lesion (15.8%) was found in six patients. Cross-sectional imaging was performed in 29 patients, with magnetic resonance imaging the most common modality (59.5%). Diagnosis was confirmed with percutaneous biopsy in all but one patient, who proceeded directly to surgery. Eighteen patients were managed non-operatively; 19 opted for surgical excision due to significant symptoms. Excision was performed in a marginal fashion and, at a median follow-up of 5 months, no functional impairment or local recurrences were observed.

Conclusions: Soft tissue masses greater than 5 cm in diameter should prompt the clinician to exclude soft tissue sarcoma. The diagnosis of elastofibroma may be alluded to by its typical presentation and can be confirmed by percutaneous biopsy. After excluding malignancy, these lesions can be safely managed non-operatively, with surgery reserved for symptomatic patients.

Keywords: Elastofibroma dorsi; Scapula; Soft tissue sarcoma.

Figure 1

The typical appearances of elastofibroma as seen on magnetic resonance imaging (MRI). Axial (A) and coronal (B) T1-weighted MRI demonstrate a heterogeneous soft tissue mass deep to the serratus anterior, which is isointense to skeletal muscle and interlaced with strands of fat.

Figure 2

The characteristic histological appearance of elastofibromas. These are sparsely cellular lesions, composed of densely collagenous tissue that contains patternless distributions of bland spindle cells with ovoid nuclei and even chromatin and fibrillary cytoplasm. The lesions are often relatively ill-defined, and typically entrap the surrounding mature adipose tissue (haematoxylin and eosin).