Elastofibroma Dorsi, a Rare Condition, with Challenging Diagnosis. Case Report and Literature Review

Abstract

Elastofibroma dorsi (ED) is known as a particular clinical and biological entity. We report a case of a bilateral elastofibroma dorsi (ED) in a 65-year-old female who presented to the Department of General and Oncologic Surgery of Emergency Clinical Municipal Hospital Timisoara, Romania. The patient was symptomatic on the right side, presenting pain in the interscapulothoracic region associated with a variable tumoral mass, dependent on the position of the right arm. Imaging studies revealed a well-defined, bilateral tumoral mass with alternation of the muscular and fatty tissue. The initial diagnosis of lipoma was taken into consideration based on the CT scan and clinical findings. Surgical excision of the right subscapular tumor was performed without any postoperative complications. Microscopic examination of hematoxylin and eosin, Masson's trichrome, and orcein stained slides revealed the diagnosis of ED. Considering the high rate of reported postoperative complications and the asymptomatic presentation of the contralateral subscapular mass, the patient underwent clinical and imagistic monitoring for the contralateral tumor. Due to its rare nature, ED is a difficult preoperative diagnosis that can, however, be suggested by its specific location and may require an accurate histopathological examination for a final diagnosis.

Keywords: benign tumor; elastic fibers; elastofibroma; lipoma; orcein.

Figure 1

Axial CT view of the thoracic region at the level of the inferior third of the scapula. The tumoral masses are indicated by white arrows).

Figure 2

Coronal CT view of the thoracic region. The tumoral lesions are indicated by white arrows.

Figure 3

Bilateral sagittal view—elastofibroma dorsi (tumors are indicated by the white arrows).

Figure 4

(a) Admixture of eosinophilic collagen fibers and birefractive thick, coarse, and sometimes globular distributed elastic fibers, H&E stain, original magnification (OM) × 10; (b) Acidophilic green different sized bundles of collagen fibers and a smaller quantity of red elastic fibers, Masson’s trichrome stain, OM × 10; (c) Red-brownish elastic fibers, with different sizes and aspects, orcein staining, OM × 10. (Nikon SMZ25 with Nikon’s Perfect Zoom System).