Prior to histopathalogic identification, a presumptive diagnosis
of lipoma was made and excision pursued.
A window of skin was excised above each lesion. A search for the
largest lesion first failed to reveal the lesion in the fat, but it
was palpably deeper. A small knick was made through superficial
muscle and a large firm white mass was extruded (Figure 2). When
cut, mucin was expressed. Although the lesion was movable and
compressible, it clearly had deep attachments. The lesion was cut -
satisfactorily debulking it - and the skin closed (Figure 3).
Follow-up evaluation strategy
It was decided to delay removal of the second lesion until
histopathologic identification of the mass could be performed.
Pathology revealed an elastofibroma. In this case, what seemed to
be an obvious common lipoma was in fact arare elastofibroma, made
all the more unusual by its location off the scapula.
This is a rare reactive tumor-like growth typically seen in the
subscapular region, arising in the connective tissue between the
lower end of the scapula and the chest wall. Usually, these lesions
measure between 5-10 cm and are thought to be a reactive process
from friction. They are harmless but persistent, and if troubling
to the patient, are cured by surgical excision.
Although elastofibroma dorsi is regarded as uncommon, a
prevalence rate of 2% in people over 60 years has been reported in
a CT study,1 and one autopsy study found a prevalence of
24% in women and 11% in men.2
Imaging studies can be useful for diagnosis - ultrasound can
show an alternating pattern of fasciculated type or laminar,
hypo-and hyperechoic lines parallel to the chest wall, and the
Doppler signal is usually negative, demonstrating the absence of
intrinsic vascularity. These data are usually sufficient to make a
Demis DJ: Clinical Dermatology. J.B.Lippincott Company.
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Muramatsu K, Ihara K, Hashimoto T, Seto S, et al.
Elastofibroma dorsi: Diagnosis and treatment. J Shoulder Elbow
Hayes AJ, Alexander N, Clark MA, Thomas JM.. Elastofibroma:
a rare soft tissue tumour with a
pathognomonic anatomical location and clinical symptom. Eur J Surg
Parratt MT, Donaldson JR, Flanagan AM, et al.
Elastofibroma dorsi: management, outcome
and review of the literature. J Bone Joint Surg
- Brandser EA, Goree JC, El-Khoury GY. Elastofibroma dorsi:
prevalence in an elderly patient population as revealed by CT. AJR
Am J Roentgenol. 1998;171:977-80.
- Järvi OH, Länsimies PH. Subclinical elastofibroma in the
scapular region in an autopsy series. Acta Pathol Microbiol Scand
- Cavallasca JA, Sohn DI, Borgia AR, et al. Elastofibroma dorsi:
revisión de 4 casos. Reumatol Clin. 2012; 8(6):358-36.
- Battaglia M, et al. Imaging patterns in elastofibroma dorsi.
Eur J Radiol. 2009;72:16-21.
- Bianchi S, Martinoli C, Abdelwahab IF, et al. Elastofibroma
dorsi: sonographic findings. AJR Am J Roentgenol.