AJR 2000; 175:244
© American Roentgen Ray Society
Radiologic-Pathologic Conferences of Wake Forest University Baptist Medical Center
Elastofibroma Dorsi of the Chest Wall
Liem T. Bui-Mansfield1,
Felix S. Chew1 and
Constance A. Stanton2
1
Department of Radiology, Wake Forest University School of Medicine, Medical
Center Blvd., Winston-Salem, NC 27157-1088.
2
Department of Pathology, Wake Forest University School of Medicine,
Winston-Salem, NC 27157-1088.
Received February 16, 2000;
accepted after revision February 28, 2000.
The opinions and assertions contained herein are those of the authors and
should not be construed as official or as representing the opinions of the
Department of the Army or the Department of Defense.
Address correspondence to F. S. Chew.
Introduction
A 51-year-old man presented with a slowly enlarging, painless mass in the
right infrascapular space. CT showed a well-defined soft-tissue mass with a
striated appearance situated between the ribs and the serratus anterior
musculature (Fig. 1A). The
muscle was elevated but there were no bony changes. A smaller mass of similar
appearance was present on the opposite side. The lesion was resected. At
microscopy, the lesion was composed of hyalinized collagen with scattered
fibroblasts entrapping islands of mature adipose tissue
(Fig. 1B). The presence of
enlarged, hypereosinophilic, refractile elastic fibrils was confirmed by a
Verhoeff-van Gieson stain (Fig.
1C). The final pathologic diagnosis was elastofibroma dorsi.
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Fig. 1A. —Elastofibroma dorsi of right chest wall in 51-year-old man. CT scan
reveals subscapular soft-tissue mass with striated appearance caused by
alternating bands of soft tissue and fat attenuation.
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Fig. 1B. —Elastofibroma dorsi of right chest wall in 51-year-old man.
Photomicrograph shows hyalinized collagen with scattered fibroblasts and
entrapped islands of mature fat cells. (H and E, x40)
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Elastofibroma is a benign reactive fibrous lesion producing abnormal
elastic fibers. This pseudotumor is believed to result from chronic mechanical
friction between the tip of the scapula and the chest wall. An incidental
prevalence of 2% was found in an elderly patient population examined using
chest CT [1], but an autopsy
series found a frequency of 11.2% in men and 24.4% in women
[2]. The characteristic
location is between the chest wall and the inferior tip of the scapula, but 5%
of elastofibromas are found elsewhere
[3]. Most lesions are
asymptomatic, but patients may present with a mass or pain. Large lesions may
ulcerate or cause brachial plexus impingement. Bilateral lesions are common
but are often asymmetric. Radiologists are not generally aware of this common
lesion.
On microscopy, elastofibroma consists of a mixture of enlarged eosinophilic
collagen and elastic fibers that are associated with occasional fibroblasts,
small amounts of interstitial mucoid material, and variously sized aggregates
of mature fat cells. The elastic fibers have a degenerated beaded appearance
or are fragmented into small flowerlike, serrated disks or globules with a
linear arrangement. Special stains for elastin showed branched and unbranched
fibers with a central dense core and an irregular, "motheaten" or
serrated margin [4].
The radiologic appearance of elastofibroma reflects its histology. On
sonography, elastofibroma appears as arrays of interspersed linear or
curvilinear hypoechoic strands (elastic fibers) against an echogenic
background (entrapped fat). CT shows a mass with soft-tissue attenuation with
striations of fat attenuation. On MR imaging, elastofibroma is a poorly
circumscribed semilunar, heterogeneous soft-tissue mass, with signal intensity
similar to that of skeletal muscle interlaced with strands of fat.
Surgery is curative; recurrences (7%) are probably caused by incomplete
excision [3].
References
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Brandser EA, Goree JC, El-Khoury GY. Elastofibroma dorsi:
prevalence in an elderly patient population as revealed by CT.
AJR
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Jarvi OH, Lansimies PH. Subclinical elastofibromas in the scapular
region in an autopsy series: additional notes on the aetiology and
pathogenesis of elastofibroma pseudoneoplasm. Acta Pathol Microbiol
Scand [A] 1975;83:87
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Kransdorf MJ, Meis JM, Montgomery E. Elastofibroma: MR and CT
appearance with radiologic-pathologic correlation. AJR
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Enzinger FM, Weiss SW. Soft tissue tumors,
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Introduction
References
