Extensive elastofibroma dorsi with scapulo-thoracic involvement in a male laborer: A case report

Abstract

Introduction and importance: Elastofibroma dorsi is a rare benign soft tissue lesion primarily located in the subscapular region. This distinctive lesion, with its unique radiological and histological features, poses diagnostic challenges due to its subtle presentation and overlap with other conditions.

Case presentation: A 48-year-old man, manual laborer with an unremarkable medical history presented with a progressively enlarging mass below the right scapula over two years. Physical examination revealed a painless, soft, and mobile swelling near the scapular tip and along the chest wall. MRI demonstrated an elongated mass in the right posterolateral thoracic wall, characterized by smooth borders and a striped appearance on T1 and T2 sequences, consistent with elastofibroma. Surgical excision was performed, resulting in the removal of a 14 cm mass with a rubbery consistency and a gross appearance reminiscent of layered leaves. Histopathological analysis confirmed the diagnosis of elastofibroma.

Clinical discussion: Elastofibroma, though usually asymptomatic, can present as a palpable mass in the scapular region. The characteristic striped appearance on MRI reflects alternating fibrous and fatty tissue. Histopathologically, elastofibroma is defined by abnormal elastic fibers within a fibrocollagenous matrix. Surgical excision is curative, and patients generally have an uneventful recovery with no further intervention required.

Conclusions: This case emphasizes the need to recognize elastofibroma as a differential diagnosis for palpable masses near the scapula. Awareness of its clinical, imaging, and histopathological features is essential for accurate diagnosis and effective management, often involving surgical excision with favorable outcomes.

Keywords: Benign tumor, case report; Elastofibroma; Pathology; Soft tissue mass; Surgery.

Fig. 1

A,B, C: Magnetic resonance imaging depicting an elongated mass (blue asterisk) located in the right posterolateral thoracic wall, adjacent to the lower angle of the scapula. The mass (blue asterisk) displayed well-defined borders and a striated pattern, attributed to alternating linear structures with low signal intensity on T1 and T2 MRI sequences within a fatty background.

Fig. 2

A: Intraoperative photos depict the tumor bed after resection, exposing the ribs and the scapulothoracic space following the separation of the scapula without caudal angulation. B: Macroscopic examination of the mass after complete excision, measuring 14 × 10 × 3 cm.

Fig. 3

The cut surface displayed a gross appearance resembling layered leaves, with whitish fibrous tissue interspersed with streaks of yellow fatty tissue. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

A: Histological examination of elastofibroma dorsi reveals a lesion characterized by the presence of fibrocollagenous tissue. Within this tissue, eosinophilic elastic fibers and scattered fibroblasts are observed. Additionally, a variable amount of mature adipose tissue is dispersed throughout the fibrocollagenous matrix. (Hematoxylin and eosin, magnification × 100). B: Microscopic examination reveals elastic fibers with a coarse texture, exhibiting an eosinophilic (pink-stained) appearance and fragmented morphology (black arrows). These fibers have the propensity to align linearly, forming either globular or serrated disk-like structures that bear a resemblance to beads on a string (black arrows). (Hematoxylin and eosin, magnification × 400). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)